Wang Tzu-Yuan, Lai Hsueh-Chou, Chen Hsin-Hung, Wang Mei-Lin, Hsieh Ming-Chia, Chang Chwen-Tzuei, Chen Rong-Hsing, Ho Chun-Wei, Hung Yi-Chin, Tseng Juei-Yu, Lin Cheng-Li, Kao Chia-Hung
Intelligent Diabetes Metabolism and Exercise Center, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
School of Medicine, China Medical University, Taichung, Taiwan.
Front Med (Lausanne). 2021 May 12;8:675345. doi: 10.3389/fmed.2021.675345. eCollection 2021.
To date, no comprehensive epidemiological study exists on pyogenic liver abscess (PLA) risk in patients with newly diagnosed type 2 diabetes mellitus (T2DM) worldwide. We conducted a retrospective cohort study by using data from Taiwan National Health Insurance Research Database (NHIRD) to examine the association between newly diagnosed T2DM and PLA. The T2DM cohort included patients newly diagnosed as having T2DM (ICD-9-CM:250) from 2000 to 2009, with follow-up until December 31, 2011. The comparison cohort was then recruited through 1:4 random frequency matching with the T2DM cohort. Finally, the adjusted hazard ratios for PLA were compared between the T2DM and comparison cohorts, which included 44,728 patients with T2DM and 178,912 patients without DM respectively. In T2DM cohort, 166 patients were diagnosed as having PLA (incidence rate = 5.87 per 10,000 person-years) and in comparison cohort, 238 patients were diagnosed as having PLA (incidence rate = 2.06 per 10,000 person-years). The T2DM cohort exhibited higher PLA risk than did the comparison cohort (hazard ratio = 2.83, 95% confidence interval = 2.32-3.46). Furthermore, the adjusted hazard ratio for PLA risk in T2DM cohort was the highest in those who were younger, man and with duration of DM <2 years. In the T2DM cohort, the most common PLA causative agent was Klebsiella pneumonia (KP). In addition, PLA risk was high in T2DM patients with gallstone and cholecystitis. Compared with comparison cohort, patients with T2DM prescribed acarbose has a lower PLA risk, however glyburide significantly increased PLA risk in T2DM cohort. In patients with newly diagnosed T2DM, PLA risk was high and acarbose might reduce PLA risk.
迄今为止，全球范围内尚无关于新诊断的2型糖尿病（T2DM）患者发生化脓性肝脓肿（PLA）风险的全面流行病学研究。我们利用台湾国民健康保险研究数据库（NHIRD）的数据进行了一项回顾性队列研究，以检验新诊断的T2DM与PLA之间的关联。T2DM队列包括2000年至2009年新诊断为患有T2DM（国际疾病分类第九版临床修订本：250）的患者，随访至2011年12月31日。然后通过与T2DM队列1:4随机频率匹配招募对照队列。最后，比较了T2DM队列和对照队列中PLA的调整后风险比，T2DM队列和对照队列分别包括44728例T2DM患者和178912例非糖尿病患者。在T2DM队列中，166例患者被诊断为患有PLA（发病率=每10000人年5.87例），在对照队列中，238例患者被诊断为患有PLA（发病率=每10000人年2.06例）。T2DM队列的PLA风险高于对照队列（风险比=2.83，95%置信区间=2.32-3.46）。此外，T2DM队列中PLA风险的调整后风险比在年龄较小、男性且糖尿病病程<2年的患者中最高。在T2DM队列中，最常见的PLA病原体是肺炎克雷伯菌（KP）。此外，患有胆结石和胆囊炎的T2DM患者发生PLA的风险较高。与对照队列相比，服用阿卡波糖的T2DM患者发生PLA的风险较低，然而格列本脲在T2DM队列中显著增加了PLA风险。在新诊断的T2DM患者中，PLA风险较高，阿卡波糖可能会降低PLA风险。
