基于人群的队列研究，探讨了台湾成年人脾切除与脓胸之间的关联。
Population-based cohort study examining the association between splenectomy and empyema in adults in Taiwan.
机构信息
School of Chinese Medicine, China Medical University, Taichung, Taiwan.
Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
出版信息
BMJ Open. 2017 Sep 24;7(9):e015101. doi: 10.1136/bmjopen-2016-015101.
OBJECTIVE
This study aimed to investigate the association between splenectomy and empyema in Taiwan.
METHODS
A population-based cohort study was conducted using the hospitalisation dataset of the Taiwan National Health Insurance Program. A total of 13 193 subjects aged 20-84 years who were newly diagnosed with splenectomy from 2000 to 2010 were enrolled in the splenectomy group and 52 464 randomly selected subjects without splenectomy were enrolled in the non-splenectomy group. Both groups were matched by sex, age, comorbidities and the index year of undergoing splenectomy. The incidence of empyema at the end of 2011 was calculated. A multivariable Cox proportional hazards regression model was used to estimate the HR with 95% CI of empyema associated with splenectomy and other comorbidities.
RESULTS
The overall incidence rate of empyema was 2.56-fold higher in the splenectomy group than in the non-splenectomy group (8.85 vs 3.46 per 1000 person-years). The Kaplan-Meier analysis revealed a higher cumulative incidence of empyema in the splenectomy group than in the non-splenectomy group (6.99% vs 3.37% at the end of follow-up). After adjusting for confounding variables, the adjusted HR of empyema was 2.89 for the splenectomy group compared with that for the non-splenectomy group. Further analysis revealed that HR of empyema was 4.52 for subjects with splenectomy alone.
CONCLUSION
The incidence rate ratio between the splenectomy and non-splenectomy groups reduced from 2.87 in the first 5 years of follow-up to 1.73 in the period following the 5 years. Future studies are required to confirm whether a longer follow-up period would further reduce this average ratio. For the splenectomy group, the overall HR of developing empyema was 2.89 after adjusting for age, sex and comorbidities, which was identified from previous literature. The risk of empyema following splenectomy remains high despite the absence of these comorbidities.
目的
本研究旨在探讨台湾脾脏切除术与脓胸之间的关联。
方法
采用基于人群的队列研究，利用台湾全民健康保险计划的住院数据集。共纳入 2000 年至 2010 年间 13193 例年龄在 20-84 岁之间新诊断为脾脏切除术的患者作为脾脏切除术组，52464 例随机选择的无脾脏切除术患者作为非脾脏切除术组。两组按性别、年龄、合并症和脾脏切除术的索引年份进行匹配。计算 2011 年底脓胸的发生率。采用多变量 Cox 比例风险回归模型估计与脾脏切除术及其他合并症相关的脓胸的 HR 及其 95%CI。
结果
脾脏切除术组的脓胸总发生率是无脾脏切除术组的 2.56 倍（8.85 比 3.46/1000人年）。Kaplan-Meier 分析显示，脾脏切除术组的脓胸累积发生率高于无脾脏切除术组（随访结束时分别为 6.99%和 3.37%）。调整混杂因素后，脾脏切除术组的调整 HR 为 2.89。进一步分析显示，单纯脾脏切除术组的脓胸 HR 为 4.52。
结论
在随访的前 5 年，脾脏切除术组与非脾脏切除术组的发病率比为 2.87，而在 5 年之后的时期，这一比例降至 1.73。需要进一步研究以确认更长的随访时间是否会进一步降低这一平均比值。对于脾脏切除术组，在调整年龄、性别和合并症后，发生脓胸的总体 HR 为 2.89，这与之前的文献一致。尽管没有这些合并症，脾脏切除术后发生脓胸的风险仍然很高。
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