Lin Huang Ren, Wang Hsiang Chi, Wang Jen Hung, Lu Hsin Han
Department of Family medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan.
Graduate Institute of Clinical Medical Science, China Medical University, Taichung.
Medicine (Baltimore). 2020 Jan;99(5):e18919. doi: 10.1097/MD.0000000000018919.
Previous studies have suggested that patients with psychotic or mental disorders are relatively pain insensitive, resulting in difficulties in the diagnosis of acute intra-abdominal diseases requiring emergency surgeries. We aimed to evaluate whether central nervous system (CNS) or mental disorders are associated with perforated appendicitis in patients with acute appendicitis.We conducted a population-based case-control study using Taiwan's National Health Insurance Research database. Patients aged >18 years who had been hospitalized with a diagnosis of acute appendicitis between 2000 and 2013 were identified. After 1:1 matching for age and sex, 2792 patients with perforated appendicitis (case group) and 2792 patients with nonperforated appendicitis (control group) were included. CNS disorders, mental disorders, pain control medication, and several comorbidities were analyzed for the odds of appendiceal perforation with 95% confidence interval (CI) using the multivariable logistic regression model.Schizophrenia and dementia were associated with a high risk of appendiceal rupture in patients with acute appendicitis, with an adjusted odds ratio of 2.01 for dementia (95% CI: 1.19-3.39, P = .009) and 4.8 for schizophrenia (95% CI: 1.62-14.19, P = .005). Other factors, such as other CNS disorders, comorbidities, and pain control medication, were not associated with the risk of perforated appendicitis.Dementia and schizophrenia are associated with perforated appendicitis in patients with acute appendicitis. This might be owing to altered pain perception, difficult symptom expression, and delayed hospitalization. Further studies are still needed to determine the underlying mechanism and confirm the causality.
以往研究表明，患有精神病或精神障碍的患者对疼痛相对不敏感，这给需要急诊手术的急性腹部疾病的诊断带来困难。我们旨在评估中枢神经系统（CNS）或精神障碍是否与急性阑尾炎患者的阑尾穿孔有关。我们利用台湾地区国民健康保险研究数据库开展了一项基于人群的病例对照研究。确定了2000年至2013年间因急性阑尾炎住院的18岁以上患者。在按年龄和性别进行1:1匹配后，纳入了2792例阑尾穿孔患者（病例组）和2792例非阑尾穿孔患者（对照组）。使用多变量逻辑回归模型分析了CNS疾病、精神障碍、疼痛控制药物以及几种合并症与阑尾穿孔几率的关系，并给出95%置信区间（CI）。精神分裂症和痴呆与急性阑尾炎患者阑尾破裂的高风险相关，痴呆的调整比值比为2.01（95%CI：1.19 - 3.39，P = 0.009），精神分裂症为4.8（95%CI：1.62 - 14.19，P = 0.005）。其他因素，如其他CNS疾病、合并症和疼痛控制药物，与阑尾穿孔风险无关。痴呆和精神分裂症与急性阑尾炎患者的阑尾穿孔有关。这可能是由于疼痛感知改变、症状表达困难和住院延迟所致。仍需进一步研究以确定潜在机制并证实因果关系。
