丙型肝炎相关迟发性精神分裂症：一项基于全国人群的队列研究。
Hepatitis C-associated late-onset schizophrenia: a nationwide, population-based cohort study.
作者信息
Cheng Jur-Shan, Hu Jing-Hong, Chang Ming-Yu, Lin Ming-Shyan, Ku Hsin-Ping, Chien Rong-Nan, Chang Ming-Ling
机构信息
From the Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taiwan (Cheng, Ku); the Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan (Cheng); the Department of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Yunlin, Taiwan (Hu); the Division of Pediatric Neurologic Medicine, Chang Gung Children's Hospital, Taoyuan, Taiwan (M.-Y. Chang); the Division of Pediatric General Medicine, Chang Gung Children's Hospital, Taoyuan, Taiwan (M.-Y. Chang); the Department of Cardiology, Heart Failure Center, Chang Gung Memorial Hospital, Taiwan (Lin); the Department of Cardiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan (Lin); the Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan (Chien, M.-L. Chang); and the Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan (Chien, M.-L. Chang).
From the Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taiwan (Cheng, Ku); the Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan (Cheng); the Department of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Yunlin, Taiwan (Hu); the Division of Pediatric Neurologic Medicine, Chang Gung Children's Hospital, Taoyuan, Taiwan (M.-Y. Chang); the Division of Pediatric General Medicine, Chang Gung Children's Hospital, Taoyuan, Taiwan (M.-Y. Chang); the Department of Cardiology, Heart Failure Center, Chang Gung Memorial Hospital, Taiwan (Lin); the Department of Cardiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan (Lin); the Liver Research Center, Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan (Chien, M.-L. Chang); and the Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan (Chien, M.-L. Chang)
出版信息
J Psychiatry Neurosci. 2021 Nov 2;46(6):E583-E591. doi: 10.1503/jpn.200154. Print 2021 Nov-Dec.
BACKGROUND
Whether infection with the hepatitis C virus (HCV) causes schizophrenia - and whether the associated risk reverses after anti-HCV therapy - is unknown; we aimed to investigate these topics.
METHODS
We conducted a nationwide, population-based cohort study using the Taiwan National Health Insurance Research Database (TNHIRD). A diagnosis of schizophrenia was based on criteria from the , 9th revision (295.xx).
RESULTS
From 2003 to 2012, from a total population of 19 298 735, we enrolled 3 propensity-score-matched cohorts (1:2:2): HCV-treated (8931 HCV-infected patients who had received interferon-based therapy for ≥ 6 months); HCV-untreated (17 862); and HCV-uninfected 17 862) from the TNHIRD. Of the total sample (44 655), 82.81% (36 980) were 40 years of age or older. Of the 3 cohorts, the HCV-untreated group had the highest 9-year cumulative incidence of schizophrenia (0.870%, 95% confidence interval [CI] 0.556%-1.311%; < 0.001); the HCV-treated (0.251%, 95% CI 0.091%-0.599%) and HCV-uninfected (0.118%, 95% CI 0.062%-0.213%) cohorts showed similar cumulative incidence of schizophrenia ( = 0.33). Multivariate Cox analyses showed that HCV positivity (hazard ratio [HR] 3.469, 95% CI 2.168-5.551) was independently associated with the development of schizophrenia. The HCV-untreated cohort also had the highest cumulative incidence of overall mortality (20.799%, 95% CI 18.739%-22.936%; < 0.001); the HCV-treated (12.518%, 95% CI 8.707%-17.052%) and HCV uninfected (6.707%, 95% CI 5.533%-8.026%) cohorts showed similar cumulative incidence of mortality ( = 0.12).
LIMITATIONS
We were unable to determine the precise mechanism of the increased risk of schizophrenia in patients with HCV infection.
CONCLUSION
In a population-based cohort (most aged ≥ 40 years), HCV positivity was a potential risk factor for the development of schizophrenia; the HCV-associated risk of schizophrenia might be reversed by interferon-based antiviral therapy.
背景
丙型肝炎病毒（HCV）感染是否会导致精神分裂症，以及抗HCV治疗后相关风险是否会逆转，目前尚不清楚；我们旨在研究这些问题。
方法
我们使用台湾国民健康保险研究数据库（TNHIRD）进行了一项全国性的基于人群的队列研究。精神分裂症的诊断基于《国际疾病分类》第9版（295.xx）的标准。
结果
2003 - 2012年，在总计19298735人的总体人群中，我们从TNHIRD中纳入了3个倾向得分匹配队列（1:2:2比例）：HCV治疗组（8名接受基于干扰素治疗≥6个月的HCV感染患者）；HCV未治疗组（名）；以及HCV未感染组（名）。在总样本（44655人）中，82.81%（36980人）年龄在40岁及以上。在这3个队列中，HCV未治疗组的精神分裂症9年累积发病率最高（0.870%，95%置信区间[CI]0.556% - 1.311%；P < 0.001）；HCV治疗组（0.251%，95% CI 0.091% - 0.599%）和HCV未感染组（0.118%，95% CI 0.062% - 0.213%）的精神分裂症累积发病率相似（P = 0.33）。多变量Cox分析显示，HCV阳性（风险比[HR]3.469，95% CI 2.168 - 5.551）与精神分裂症的发生独立相关。HCV未治疗队列的总死亡率累积发病率也最高（20.799%，95% CI 18.739% - 22.936%；P < 0.001）；HCV治疗组（12.518%，95% CI 8.707% - 17.052%）和HCV未感染组（6.707%，95% CI 5.533% - 8.026%）的死亡率累积发病率相似（P = 0.12）。
局限性
我们无法确定HCV感染患者精神分裂症风险增加的确切机制。
结论
在一个基于人群的队列（大多数年龄≥40岁）中，HCV阳性是精神分裂症发生的一个潜在风险因素；基于干扰素的抗病毒治疗可能会逆转与HCV相关的精神分裂症风险。
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