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内镜胸交感神经切断术治疗手掌多汗症后长期主要不良心血管事件的风险降低。

Risk reduction of long-term major adverse cardiovascular events after endoscopic thoracic sympathectomy in palmar hyperhidrosis.

机构信息

Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

Graduate Institute of Biomedical Informatics, Taipei Medical University, No. 250, Wu-Hsing Street, 110, Taipei, Taiwan.

出版信息

Clin Auton Res. 2017 Dec;27(6):393-400. doi: 10.1007/s10286-017-0464-0. Epub 2017 Sep 19.

Abstract

PURPOSE

Palmar hyperhidrosis (PH) is excessive sweating of the palms resulting from sympathetic overactivity, and patients who undergo endoscopic thoracic sympathectomy (ETS) show reduced cardiac demand after 1 year and improved cerebral perfusion within 2-4 weeks. However, the long-term risks of major adverse cardiovascular events (MACE) following ETS remain unclear.

METHODS

We searched the Longitudinal National Health Insurance Database in Taiwan and identified PH patients (International Classification of Disease, Ninth Revision, Clinical Modification diagnostic code 708.8) from the outpatient database and patients who underwent ETS (procedure code 05.29) from the inpatient database between 2000 and 2010; furthermore, we excluded patients younger than 18 years of age or older than 65 years of age. We defined MACE as stroke (diagnostic codes 430-437), myocardial infarction (diagnostic code 410), or death. Patients followed until the first cardiac event or December 31, 2010. Risk factors were identified using a multivariable Cox proportional hazards regression.

RESULTS

The incidence of MACE was significantly lower in patients with ETS (0.76%) than without (1.67%). In PH patients, ETS significantly reduced the risk of MACE (adjusted hazard ratio 0.473; 95% confidence interval 0.277-0.808).

CONCLUSION

PH patients who underwent ETS showed a reduced risk of MACE over a long-term follow-up period. This result could provide support for patients with PH who are considering undergoing ETS because of its additional cardiovascular benefits.

摘要

目的

手掌多汗症(PH)是由于交感神经过度活跃导致的手掌过度出汗,接受胸腔镜交感神经切除术(ETS)的患者在 1 年后心脏需求减少,并且在 2-4 周内脑灌注得到改善。然而,ETS 后发生重大不良心血管事件(MACE)的长期风险仍不清楚。

方法

我们在台湾纵向全民健康保险数据库中进行了搜索,从门诊数据库中确定了 PH 患者(国际疾病分类,第九修订版,临床修正诊断代码 708.8),并从住院数据库中确定了接受 ETS(程序代码 05.29)的患者,时间范围为 2000 年至 2010 年;此外,我们排除了年龄小于 18 岁或大于 65 岁的患者。我们将 MACE 定义为中风(诊断代码 430-437)、心肌梗死(诊断代码 410)或死亡。患者随访至首次心脏事件或 2010 年 12 月 31 日。使用多变量 Cox 比例风险回归确定风险因素。

结果

接受 ETS 的患者的 MACE 发生率明显低于未接受 ETS 的患者(0.76% vs. 1.67%)。在 PH 患者中,ETS 显著降低了 MACE 的风险(调整后的危险比 0.473;95%置信区间 0.277-0.808)。

结论

接受 ETS 的 PH 患者在长期随访期间发生 MACE 的风险降低。这一结果可为因心血管获益而考虑接受 ETS 的 PH 患者提供支持。

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