Rate of Comorbidities in Giant Cell Arteritis: A Population-based Study
Rate of Comorbidities in Giant Cell Arteritis: A Population-based Study
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DOI：
10.3899/jrheum.160249
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发表时间：
2017-01-01
影响因子：
3.9
通讯作者：
Merkel, Peter A.
中科院分区：
文献类型：
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作者：
Mohammad, Aladdin J.;Englund, Martin;Merkel, Peter A.
目标。比较瑞典南部以人群为基础的活检证实的巨细胞动脉炎（GCA）患者与参考人群合并症（包括严重感染）的发生率。该研究纳入了一个基于人群的队列，该队列是1998年至2010年间在瑞典南部Skane地区（人口：120万）诊断的经活检证实的GCA病例。对于每名患者，从一般人群中确定4名参考受试者，并根据年龄、性别、居住地区和GCA诊断日期进行匹配。使用Skane Healthcare Register，确定GCA发病后诊断的合并症和严重感染（需要住院治疗）。每一种共病的首次发生率是将患有某一共病的受试者人数除以随访的人-年的结果。并计算了发病率比（RR； GCA：参考人群）。共有768名GCA患者（571名女性）和3066名对照者纳入研究。骨质疏松症（2.81,95% CI 2.33-3.37）、静脉血栓栓塞性疾病（2.36,95% CI 1.61-3.40）、严重感染（1.85,95% CI 1.57-2.18）、甲状腺疾病（1.55,95% CI 1.25-1.91）、脑血管意外（1.40,95% CI 1.12-1.74）和糖尿病（1.29,95% CI 1.05-1.56）的RR显著升高。缺血性心脏病的RR升高，但无统计学意义（1.20,95% CI 1.00-1.44）。与参考人群相比，GCA患者有更高的合并症发生率，包括严重感染。这些合并症中的一些可能与糖皮质激素治疗有关，强调了寻找替代治疗GCA的未满足需求。
Objective. To compare the rate of occurrence of comorbidities, including severe infections, in a population-based cohort of patients with biopsy-proven giant cell arteritis (GCA) with a reference population in Southern Sweden.Methods. The study included a population-based cohort of biopsy-proven GCA cases diagnosed between 1998 and 2010 from the Skane region in Southern Sweden (population: 1.2 million). For each patient, 4 reference subjects were identified from the general population and matched for age, sex, area of residence, and date of diagnosis of GCA. Using the Skane Healthcare Register, comorbidities and severe infections (requiring hospitalization) diagnosed after GCA onset were identified. The rate of the first occurrence of each comorbidity was the result of dividing the number of subjects with a given comorbidity by the person-years of followup. The rate ratio (RR; GCA: reference population) was also calculated.Results. There were 768 patients (571 women) with GCA and 3066 reference persons included in the study. The RR were significantly elevated for osteoporosis (2.81, 95% CI 2.33-3.37), followed by venous thromboembolic diseases (2.36, 95% CI 1.61-3.40), severe infections (1.85, 95% CI 1.57-2.18), thyroid diseases (1.55, 95% CI 1.25-1.91), cerebrovascular accidents (1.40, 95% CI 1.12-1.74), and diabetes mellitus (1.29, 95% CI 1.05-1.56). The RR for ischemic heart disease was elevated, but did not reach statistical significance (1.20, 95% CI 1.00-1.44).Conclusion. Patients with GCA have higher rates of selected comorbidities, including severe infections, compared with a reference population. Several of these comorbidities may be related to treatment with glucocorticosteroids, emphasizing the unmet need to find alternative treatments for GCA.