Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
Department of Nephrology, Department of Internal Medicine, Fu Jen Catholic University Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2021 Nov 1;84(11):1060-1069. doi: 10.1097/JCMA.0000000000000591.
Nephrotic syndrome (NS) is characterized by various etiologies that damage the glomerulus. Central serous chorioretinopathy (CSCR) is a retinal disease characterized by neurosensory detachment of the retina. Several case reports have described the relationship between both. Therefore, we try to analyze the epidemiological associations between NS and CSCR using the National Health Insurance Research Database in Taiwan.
Data spanning 14 years were extracted from the National Health Insurance Research Database and sub-grouped. The variables were analyzed using Pearson's chi-squared test and Fisher's exact test. The risk factors for disease development with or without comorbidities were examined using an adjusted hazard ratio (aHR). Kaplan-Meier analysis was performed to evaluate the cumulative incidence of CSCR with or without NS.
A total of 14 794 patients with NS and 14 794 matched controls without NS were enrolled in this cohort study. The incidence rate of CSCR was higher in the study cohort than in the control cohort (aHR = 3.349, p < 0.001). The overall incidence of CSCR was 44.51 per 100 000 person-years in the study cohort and 33.39 per 100 000 person-years in the control cohort. In both groups, CSCR occurred more frequently in males than in females. Patients aged 40-49, 50-59, and ≥60 years in the study cohort had a significantly higher risk of developing CSCR than those in the control cohort (aHR = 3.445, 5.421, and 4.957, all p < 0.001). NS patient with a 4-week history of steroid usage has a higher risk of developing CSCR (aHR = 2.010, p < 0.001).
Our data showed that patients with NS have an increased risk of developing subsequent CSCR. Physician should routinely refer their NS patients to ophthalmologist for ophthalmic evaluation. This is the first nationwide epidemiological study reporting the association between these two diseases. Further studies are needed to clarify this relationship.
肾病综合征（NS）的特征是各种病因导致肾小球损伤。中心性浆液性脉络膜视网膜病变（CSCR）是一种以视网膜神经感觉层脱离为特征的视网膜疾病。有几例病例报告描述了这两种疾病之间的关系。因此，我们试图利用台湾全民健康保险研究数据库分析 NS 和 CSCR 之间的流行病学关联。
从全民健康保险研究数据库中提取了 14 年的数据并进行分组。使用 Pearson 卡方检验和 Fisher 确切检验分析变量。使用调整后的风险比（aHR）检查有无合并症时疾病发展的风险因素。进行 Kaplan-Meier 分析以评估有或无 NS 的 CSCR 的累积发生率。
本队列研究共纳入了 14794 例 NS 患者和 14794 例匹配的无 NS 对照组患者。研究队列中 CSCR 的发病率高于对照组（aHR=3.349，p<0.001）。研究队列中 CSCR 的总体发生率为每 100000 人年 44.51 例，对照组为每 100000 人年 33.39 例。在两组中，CSCR 在男性中的发生率均高于女性。研究队列中年龄在 40-49、50-59 和≥60 岁的患者发生 CSCR 的风险明显高于对照组（aHR=3.445、5.421 和 4.957，均 p<0.001）。NS 患者使用类固醇 4 周后发生 CSCR 的风险更高（aHR=2.010，p<0.001）。
我们的数据表明，NS 患者发生后续 CSCR 的风险增加。医生应常规将 NS 患者转介给眼科医生进行眼科评估。这是第一项报告这两种疾病之间关联的全国性流行病学研究。需要进一步的研究来阐明这种关系。
