Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan.
School of Medicine, Tzu Chi University, Hualien City, Taiwan.
Rheumatol Int. 2017 Nov;37(11):1847-1852. doi: 10.1007/s00296-017-3828-9. Epub 2017 Sep 26.
Previous research has shown that diabetes mellitus increases the risk of lower extremity amputation in patients with peripheral arterial occlusive disease. However, to our knowledge, no studies have investigated whether systemic autoimmune disease, in particular systemic vasculitis is associated with a higher risk of lower extremity amputation in these patients. To investigate the association between systemic autoimmune disease and lower extremity amputation in patients with severe peripheral arterial occlusive disease based on a secondary analysis of a nationwide, population-based health claims database. Using the inpatient datafile of the Taiwan's National Health Insurance Research Database (NHIRD), we identified 432 patients with severe peripheral arterial occlusive disease that required hospitalization between 2000 and 2012. We also identified patients who had undergone lower extremity amputation and their comorbidities using the same datafile. The risk of lower extremity amputation was assessed using multiple logistic regression analysis, adjusting for age, sex, insured amount, the urbanization level of residence, and the presence of comorbidities. Among patients with severe peripheral arterial occlusive disease, those with systemic vasculitis exhibited a significant higher risk of lower extremity amputation (adjusted odds ratio [aOR] = 6.82, p < 0.001). Diabetes mellitus (aOR = 4.90, p < 0.001) and chronic obstructive pulmonary disease (aOR = 2.87, p = 0.007) were also significantly associated with a higher risk of lower extremity amputation. Among patients with severe peripheral arterial occlusive disease, a significantly higher risk of lower extremity amputation was observed in those with systemic vasculitis.
先前的研究表明，糖尿病会增加外周动脉阻塞性疾病患者下肢截肢的风险。然而，据我们所知，尚无研究调查系统性自身免疫性疾病，特别是系统性血管炎是否与这些患者下肢截肢的风险增加有关。基于全国性基于人群的健康索赔数据库的二次分析，研究严重外周动脉阻塞性疾病患者中系统性自身免疫性疾病与下肢截肢之间的关联。我们使用了台湾全民健康保险研究数据库（NHIRD）的住院病人资料档案，确定了 2000 年至 2012 年期间需要住院治疗的 432 名严重外周动脉阻塞性疾病患者。我们还使用相同的资料档案确定了接受下肢截肢手术的患者及其合并症。使用多变量逻辑回归分析评估下肢截肢的风险，调整了年龄、性别、保险金额、居住的城市化水平以及合并症的存在。在严重外周动脉阻塞性疾病患者中，患有系统性血管炎的患者下肢截肢的风险显著更高（调整后的优势比[aOR] = 6.82，p < 0.001）。糖尿病（aOR = 4.90，p < 0.001）和慢性阻塞性肺疾病（aOR = 2.87，p = 0.007）也与下肢截肢的风险显著增加相关。在严重外周动脉阻塞性疾病患者中，患有系统性血管炎的患者下肢截肢的风险显著更高。
