Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Front Immunol. 2022 Jun 10;13:890543. doi: 10.3389/fimmu.2022.890543. eCollection 2022.
Uveitis, a sight-threatening ocular inflammatory state, is associated with autoimmune diseases and systemic inflammation. This prolonged systemic inflammation may cause plaque formation in coronary arteries, subsequently resulting in acute coronary syndrome (ACS).
This retrospective, population-based study (15-year period) used the Longitudinal Health Insurance Database based on the National Health Insurance Research Database in Taiwan. Chi-square and Student's t-tests were used to examine differences between the study and comparison cohorts for categorical and continuous variables, respectively. Fine and Gray's competing risk model was used to determine the hazard ratio of the risk of ACS. Furthermore, the cumulative risk of ACS was determined using Kaplan-Meier analysis.
A total of 1,111 patients with AS and uveitis were enrolled in this study cohort, and 4,444 patients with AS without uveitis were enrolled in the comparison cohort. After adjustment for age, sex, and comorbidities, patients with AS and uveitis demonstrated an increased risk of ACS compared to those without uveitis (adjusted hazard ratio: 1.675, p<0.001). In addition, Kaplan-Meier analysis revealed that patients with AS and uveitis had a significantly higher risk of ACS than those without uveitis (p<0.001). Age, diabetes mellitus, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, asthma, and systemic steroids were significant risk factors for ACS. Both anterior uveitis and posterior segment involvement were associated with an increased risk of ACS in patients with AS. All-cause mortality was higher in the uveitis group (9.81%) than in the non-uveitis group (8.10%) (p=0.015).
Our analysis revealed that uveitis could potentially be a predictor of ACS in patients with AS. However, further prospective controlled studies are required to assess the association between uveitis and ACS in patients with AS.
葡萄膜炎是一种威胁视力的眼部炎症性疾病，与自身免疫性疾病和全身炎症有关。这种长期的全身炎症可能导致冠状动脉斑块形成，进而导致急性冠状动脉综合征（ACS）。
本回顾性、基于人群的研究（15 年期间）使用了基于台湾全民健康保险研究数据库的纵向健康保险数据库。使用卡方检验和学生 t 检验分别比较研究队列和对照队列的分类变量和连续变量。Fine 和 Gray 的竞争风险模型用于确定 ACS 风险的风险比。此外，使用 Kaplan-Meier 分析确定 ACS 的累积风险。
本研究队列共纳入 1111 例 AS 和葡萄膜炎患者，对照队列共纳入 4444 例无葡萄膜炎的 AS 患者。调整年龄、性别和合并症后，AS 合并葡萄膜炎患者发生 ACS 的风险高于无葡萄膜炎患者（调整后的风险比：1.675，p<0.001）。此外，Kaplan-Meier 分析显示，AS 合并葡萄膜炎患者发生 ACS 的风险明显高于无葡萄膜炎患者（p<0.001）。年龄、糖尿病、高血压、高血脂、慢性阻塞性肺疾病、哮喘和全身类固醇是 ACS 的显著危险因素。前葡萄膜炎和后节受累均与 AS 患者 ACS 风险增加相关。葡萄膜炎组的全因死亡率（9.81%）高于非葡萄膜炎组（8.10%）（p=0.015）。
我们的分析表明，葡萄膜炎可能是 AS 患者 ACS 的预测因子。然而，需要进一步的前瞻性对照研究来评估 AS 患者中葡萄膜炎与 ACS 之间的关联。
