Lee Kyung-Ann, Jeon Hyeji, Kim Hyun-Sook, Choi Kyomin, Seo Gi Hyeon
Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University School of Medicine, Seoul, Korea.
Department of Neurology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University School of Medicine, Cheonan, Korea.
Korean J Intern Med. 2025 Mar;40(2):330-338. doi: 10.3904/kjim.2023.536. Epub 2025 Feb 21.
BACKGROUND/AIMS: This nationwide cohort study aimed to evaluate (1) whether primary Sjogren's syndrome (pSS) can contribute to the development of dementia and (2) whether the use of hydroxychloroquine (HCQ) can decrease the incidence of dementia in patients with pSS using the Health Insurance Review and Assessment database.
We established a cohort between 2008 and 2020 of 20,160 patients with pSS without a history of dementia. The control group comprised sex- and age-matched individuals with no history of autoimmune disease or dementia. Cox proportional hazard analyses were performed to identify the association between pSS and dementia development. We also assessed the hazard ratio (HR) of dementia in early users of HCQ (within 180 days of the diagnosis of pSS) compared to non-users, adjusted for age, sex, and comorbidities.
The incidence of dementia was 0.68 (95% CI 0.64-0.72) cases per 100 person-years in pSS, and it was 0.58 (0.56-0.60) in the controls. The adjusted HR (aHR) of developing dementia was 1.16 (1.09-1.25) times greater in the pSS group than in the controls. The risk of dementia did not increase in HCQ users (aHR 1.07 [0.94-1.21]), but HCQ non-users had a 1.22 (1.12-1.33) higher risk of developing dementia than the matched controls. The use of HCQ lowered the risk of dementia in comparison with non-users in patients with pSS (aHR 0.82 [0.71-0.94]).
Our results suggest that pSS is associated with an increased risk of dementia. HCQ may prevent dementia in patients with pSS.
背景/目的：这项全国性队列研究旨在利用健康保险审查与评估数据库评估：（1）原发性干燥综合征（pSS）是否会导致痴呆的发生；（2）使用羟氯喹（HCQ）是否能降低pSS患者患痴呆症的发病率。
我们建立了一个队列，纳入2008年至2020年间20160例无痴呆病史的pSS患者。对照组由年龄和性别匹配、无自身免疫性疾病或痴呆病史的个体组成。进行Cox比例风险分析以确定pSS与痴呆发生之间的关联。我们还评估了HCQ早期使用者（pSS诊断后180天内）与非使用者相比患痴呆症的风险比（HR），并对年龄、性别和合并症进行了调整。
pSS患者中痴呆症的发病率为每100人年0.68例（95%可信区间0.64 - 0.72），对照组为每100人年0.58例（0.56 - 0.60）。pSS组患痴呆症的调整后风险比（aHR）比对照组高1.16倍（1.09 - 1.25）。HCQ使用者患痴呆症的风险没有增加（aHR 1.07 [0.94 - 1.21]），但HCQ非使用者患痴呆症的风险比匹配对照组高1.22倍（1.12 - 1.33）。与非使用者相比，使用HCQ降低了pSS患者患痴呆症的风险（aHR 0.82 [0.71 - 0.94]）。
我们的结果表明，pSS与痴呆风险增加有关。HCQ可能预防pSS患者患痴呆症。
