Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan.
Laryngoscope. 2020 Jun;130(6):1402-1407. doi: 10.1002/lary.28272. Epub 2019 Sep 9.
To investigate the association between rheumatoid arthritis (RA) and deep neck infection (DNI).
Retrospective cohort study.
Patients newly diagnosed with RA between 2000 and 2011 were identified from the National Health Insurance Research Database in Taiwan. Moreover, patients without RA were randomly selected and matched at a 1:4 ratio by age, sex, urbanization level, income, and diabetes mellitus. The patients were followed up until death or the end of the study period (December 31, 2013). The primary outcome was the occurrence of DNI.
In total, 30,207 patients with RA and 120,828 matched patients without RA were enrolled. Patients with RA had a significantly higher cumulative incidence of DNI than those without RA (P < 0.001). The adjusted Cox proportional hazard model demonstrated that RA was significantly associated with a higher incidence of DNI (hazard ratio: 2.80, 95% confidence interval: 2.26-3.46, P < 0.001). Therapeutic methods (surgical or nonsurgical) did not differ significantly between the patients with RA-DNI and with non-RA-DNI. Patients with RA-DNI had higher rates of tracheostomy, mediastinitis, mediastinitis-related mortality, and mortality than patients with non-RA-DNI, although these differences were without statistical significance. RA patients receiving no therapy experienced higher rates of DNI compared with those receiving methotrexate alone, disease-modifying antirheumatic drugs, or biologic therapies.
This study is the first to investigate the association between RA and DNI. We conclude RA is an independent predisposing factor for DNI.
4 Laryngoscope, 130:1402-1407, 2020.
研究类风湿关节炎（RA）与深部颈感染（DNI）之间的关联。
回顾性队列研究。
从台湾全民健康保险研究数据库中确定了 2000 年至 2011 年间新诊断为 RA 的患者。此外，按照年龄、性别、城市化水平、收入和糖尿病进行 1:4 比例的随机匹配，选择无 RA 的患者。患者随访至死亡或研究结束（2013 年 12 月 31 日）。主要结局为 DNI 的发生。
共纳入 30207 例 RA 患者和 120828 例匹配的无 RA 患者。RA 患者的 DNI 累积发生率明显高于无 RA 患者（P < 0.001）。调整后的 Cox 比例风险模型表明，RA 与 DNI 的发生率显著相关（风险比：2.80，95%置信区间：2.26-3.46，P < 0.001）。RA-DNI 患者和非 RA-DNI 患者的治疗方法（手术或非手术）无显著差异。RA-DNI 患者的气管切开术、纵隔炎、纵隔炎相关死亡率和死亡率均高于非 RA-DNI 患者，但差异无统计学意义。与单独接受甲氨蝶呤、改善病情抗风湿药或生物疗法治疗的 RA 患者相比，未接受治疗的 RA 患者发生 DNI 的比率更高。
本研究首次探讨了 RA 与 DNI 之间的关联。我们得出结论，RA 是 DNI 的独立致病因素。
4 级喉镜，130：1402-1407，2020。
