Kuo Pei-Lun, Lin Kun-Chang, Tang Pei-Ling, Cheng Chin-Chang, Huang Wei-Chun, Chiang Cheng-Hung, Lin Hsiao-Chin, Chuang Tzu-Jung, Wann Shue-Ren, Mar Guang-Yuan, Cheng Jin-Shiung, Liu Chun-Peng
From the Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (P-LK, K-C L, P-LT, C-CC, W-CH, C-HC, H-CL, T-JC, S-RW, G-YM, C-PL); School of Medicine, National Yang-Ming University, Taipei, Taiwan (P-LK, C-CC, W-CH, C-HC, C-PL); Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan (C-CC, W-CH, C-HC); and Section of Gastroenterology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (J-SC).
Medicine (Baltimore). 2016 Feb;95(5):e2678. doi: 10.1097/MD.0000000000002678.
Although a possible association between hepatitis B and cardiovascular disease has been identified, the impact of viral hepatitis B on long-term prognosis after an acute myocardial infarction (AMI) is uncertain. Therefore, the aim of our study was to evaluate the specific impact of viral hepatitis B on survival after a first AMI through a retrospective analysis of data from the Taiwan National Health Insurance Research Database.This was a nationwide, propensity score-matched case-control study of patients admitted to hospitals between January 2000 and December 2012 with a primary diagnosis of a first AMI. Among the 7671 prospective patients, 244 patients with a confirmed diagnosis of viral hepatitis B infection were identified. A propensity score, one-to-one matching technique was used to match 244 controls to the AMI group for analysis. Controls were matched on the following variables: sex, age, hypertension, dyslipidemia, diabetes, peripheral vascular disease, heart failure, cerebrovascular accidents, end-stage renal disease, chronic obstructive pulmonary disease, and percutaneous coronary intervention (PCI).Overall, viral hepatitis B infection did not influence the 12-year survival rate (P = 0.98). However, survival was lower in female patients with viral hepatitis B infection compared to those without (P = 0.03; hazard ratio, 1.79; 95% confidence interval, 1.08-2.94). Inclusion of percutaneous coronary management improved survival, independent of sex, age, or hepatitis B status.Hepatitis B infection might increase the mortality risk of female patients after a first AMI. PCI may improve the long-term survival of patients after a first AMI, regardless of sex, age, and hepatitis B status.
虽然已确定乙型肝炎与心血管疾病之间可能存在关联，但乙型病毒性肝炎对急性心肌梗死（AMI）后长期预后的影响尚不确定。因此，我们研究的目的是通过对台湾国民健康保险研究数据库的数据进行回顾性分析，评估乙型病毒性肝炎对首次AMI后生存率的具体影响。
这是一项全国性的倾向评分匹配病例对照研究，研究对象为2000年1月至2012年12月期间因首次AMI入院的患者。在7671名前瞻性患者中，确定了244例确诊为乙型病毒性肝炎感染的患者。采用倾向评分一对一匹配技术，将244名对照与AMI组进行匹配以进行分析。对照在以下变量上进行匹配：性别、年龄、高血压、血脂异常、糖尿病、外周血管疾病、心力衰竭、脑血管意外、终末期肾病、慢性阻塞性肺疾病和经皮冠状动脉介入治疗（PCI）。
总体而言，乙型病毒性肝炎感染不影响12年生存率（P = 0.98）。然而，与未感染乙型病毒性肝炎的女性患者相比，感染乙型病毒性肝炎的女性患者生存率较低（P = 0.03；风险比，1.79；95%置信区间，1.08 - 2.94）。纳入经皮冠状动脉管理可提高生存率，与性别、年龄或乙型肝炎状态无关。
乙型肝炎感染可能会增加首次AMI后女性患者的死亡风险。PCI可能会提高首次AMI后患者的长期生存率，无论性别、年龄和乙型肝炎状态如何。
