评估风湿免疫性疾病患者年轻时发生缺血性脑卒中的风险：台湾基于人群的队列研究。
Evaluating the risk of ischemic stroke at a young age in patients with autoimmune inflammatory rheumatic diseases: a population-based cohort study in Taiwan.
机构信息
Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
出版信息
Front Immunol. 2024 Feb 9;15:1272557. doi: 10.3389/fimmu.2024.1272557. eCollection 2024.
BACKGROUND
Recent studies have demonstrated an increased incidence of ischemic stroke among patients with certain autoimmune inflammatory rheumatic diseases (AIIRDs). However, the associations between young stroke and AIIRDs have not been fully investigated. This study aimed to evaluate the risk of ischemic stroke among young patients with AIIRDs.
METHODS
The National Health Insurance Research Database in Taiwan was utilized to establish cohorts of patients with AIIRDs diagnosed between 2004 and 2015, who were compared with 1,000,000 control participants. Cox proportional hazards regression models were used to calculate the hazard ratio of ischemic stroke and young ischemic stroke for individual AIIRDs after adjustment for relative risk factors.
RESULTS
During the study period, a total of 64,120 patients with AIIRDss and 1,000,000 control patients were identified. The overall mean follow-up time was 5.33 years. There were 223 (0.8%) and 1,923 (0.3%) young ischemic stroke-related hospitalizations among patients with AIIRDs and controls, respectively. The incidence rate of young ischemic stroke was 0.08 in patients with rheumatoid arthritis, 0.08 in patients with Sjögren's syndrome, 0.26 in patients with systemic lupus erythematosus, 0.17 in patients with idiopathic inflammatory myositis, 0.24 in patients with systemic sclerosis, 0.05 in patients with Behçet's disease, and 0.44 in patients with systemic vasculitis, versus 0.05 per 100 person-years in the general population. The adjusted hazard ratios for young ischemic stroke were 1.07 (95% CI 0.70-1.43) for rheumatoid arthritis, 1.39 (95% CI 0.94-2.06) for Sjögren's syndrome, 5.79 (95% CI 4.68-7.17) for systemic lupus erythematosus, 2.07 for idiopathic inflammatory myositis (95% CI 0.98-4.38), 2.79 for systemic sclerosis (95% CI 1.38-5.63), 0.82 for Behçet's disease (95% CI 0.26-2.55), and 4.15 (95% CI 1.96-8.82) for systemic vasculitis.
CONCLUSIONS
Patients younger than 50 years with systemic lupus erythematosus, systemic sclerosis, or systemic vasculitis have a significantly elevated risk of developing ischemic stroke. Further research is needed to elucidate the pathogenesis of accelerated atherosclerosis in these AIIRDs.
背景
最近的研究表明，某些自身免疫性炎症性风湿病（AIIRDs）患者发生缺血性中风的发病率增加。然而，年轻患者中风与 AIIRDs 之间的关联尚未得到充分研究。本研究旨在评估年轻 AIIRDs 患者发生缺血性中风的风险。
方法
本研究利用台湾全民健康保险研究数据库，建立了 2004 年至 2015 年间确诊为 AIIRDs 的患者队列，并与 100 万名对照参与者进行了比较。使用 Cox 比例风险回归模型，在调整相对风险因素后，计算了个体 AIIRDs 发生缺血性中风和年轻缺血性中风的风险比。
结果
在研究期间，共确定了 64120 名 AIIRDs 患者和 100 万名对照患者。总的平均随访时间为 5.33 年。AIIRDs 患者中有 223 例（0.8%）和对照患者中有 1923 例（0.3%）发生了年轻缺血性中风相关住院治疗。类风湿关节炎患者的年轻缺血性中风发生率为 0.08/100 人年，干燥综合征患者为 0.08/100 人年，系统性红斑狼疮患者为 0.26/100 人年，特发性炎性肌病患者为 0.17/100 人年，系统性硬化症患者为 0.24/100 人年，贝赫切特病患者为 0.05/100 人年，系统性血管炎患者为 0.44/100 人年，而普通人群为 0.05/100 人年。年轻缺血性中风的调整后的风险比为类风湿关节炎 1.07（95%CI 0.70-1.43），干燥综合征 1.39（95%CI 0.94-2.06），系统性红斑狼疮 5.79（95%CI 4.68-7.17），特发性炎性肌病 2.07（95%CI 0.98-4.38），系统性硬化症 2.79（95%CI 1.38-5.63），贝赫切特病 0.82（95%CI 0.26-2.55），系统性血管炎 4.15（95%CI 1.96-8.82）。
结论
年龄小于 50 岁的系统性红斑狼疮、系统性硬化症或系统性血管炎患者发生缺血性中风的风险显著增加。需要进一步研究阐明这些 AIIRDs 中加速动脉粥样硬化的发病机制。
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