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梅尼埃病患者受伤风险增加及治疗效果:基于人群的回顾性队列研究

Increased Risk of Injury in Ménière's Disease and Effects of Treatment: Population-Based Retrospective Cohort Study.

作者信息

Wu Po-Ling, Lin Hung-Che, Chien Wu-Chien, Chung Chi-Hsiang, Chen Jeng-Wen

机构信息

Department of Medical Education and Research, Cardinal Tien Hospital, New Taipei City.

Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei.

出版信息

Otolaryngol Head Neck Surg. 2023 Mar;168(3):443-452. doi: 10.1177/01945998221106628. Epub 2023 Jan 27.

Abstract

OBJECTIVE

To investigate the risk of injury in patients with Ménière's disease (MD) and the effects of treatment.

STUDY DESIGN

Population-based retrospective cohort study.

SETTING

Data were collected from the Longitudinal Health Insurance Database 2005, containing the information of 2 million randomly selected individuals in Taiwan.

METHODS

We enrolled 90,481 patients with newly diagnosed MD between 2000 and 2017 and 361,924 matched individuals without MD. The study outcomes were diagnoses of all-cause injuries. The Kaplan-Meier method was used to determine the cumulative incidence rates of injury in the MD and non-MD cohorts, and a log-rank test was used to analyze the differences between the cohorts. Cox proportional hazards models were used to calculate the 18-year hazard ratios of each cohort.

RESULTS

A total of 80,151 patients were diagnosed with injuries during the follow-up period: 24,031 and 56,120 from the MD and non-MD cohorts, respectively. The adjusted hazard ratio (aHR) was 2.19 (95% CI, 2.16-2.35) after adjusting for demographic characteristics and comorbidities. Subgroup analysis revealed that MD was associated with an increased incidence of unintentional and intentional injuries (aHR, 2.24 [95% CI, 2.21-2.41] and 2.05 [95% CI, 2.01-2.19], respectively). Treatment with diuretics, antivertigo medications, or surgery did not reduce the risk of injury (aHR, 0.98 [95% CI, 0.59-1.54], 0.94 [95% CI, 0.58-1.50], and 0.99 [95% CI, 0.61-1.54]).

CONCLUSION

MD is independently associated with an increased risk of injuries. Medical or surgical treatment for MD does not reduce the risk of injury in patients with MD. Physicians should counsel patients with MD regarding preventive measures for avoiding subsequent injuries.

摘要

目的

探讨梅尼埃病(MD)患者的受伤风险及治疗效果。

研究设计

基于人群的回顾性队列研究。

研究地点

数据收集自2005年纵向健康保险数据库,该数据库包含台湾随机选取的200万个人的信息。

方法

我们纳入了2000年至2017年间新诊断为MD的90481例患者以及361924例匹配的非MD个体。研究结局为全因损伤的诊断。采用Kaplan-Meier方法确定MD队列和非MD队列中损伤的累积发生率,并使用对数秩检验分析队列之间的差异。采用Cox比例风险模型计算每个队列的18年风险比。

结果

在随访期间,共有80151例患者被诊断为受伤:MD队列和非MD队列分别为24031例和56,120例。在调整人口统计学特征和合并症后,调整后的风险比(aHR)为2.19(95%CI,2.16 - 2.35)。亚组分析显示,MD与意外伤害和故意伤害的发生率增加相关(aHR分别为2.24 [95%CI,2.21 - 2.41]和2.05 [95%CI,2.01 - 2.19])。使用利尿剂、抗眩晕药物或手术治疗并未降低受伤风险(aHR分别为0.98 [95%CI,0.59 - 1.54]、0.94 [95%CI, 0.58 - 1.50]和0.99 [95%CI, 0.61 - 1.54])。

结论

MD与受伤风险增加独立相关。MD的药物或手术治疗并未降低MD患者的受伤风险。医生应向MD患者提供关于避免后续受伤的预防措施的建议。

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