| 摘要: | 研究目的:腸激躁症不同於常見的腸胃疾病，並非腸胃出現發炎的病理狀況，也和細菌或病毒感染無關，而是腸道出現功能性問題，伴有腹部不適、腹脹或疼痛，病因不明。大腸憩室症是臨床上常見的問題，近年來隨著年齡老化與生活西化，憩室疾病發生率與重要性也持續上升，常見的併發症是憩室出血和憩室炎，一些大腸憩室症患者有類似腸激躁症的症狀。而在近來的研究發現腸激躁症患者有較高的風險發生大腸憩室症。因此，本研究旨在評估臺灣大腸激躁症與大腸憩室症之相關性、臨床特點及相關因素。
研究方法:本研究使用臺灣全民健保資料庫進行了一項為期10年的全國性人口世代研究。以2001年至2005年篩選出33,908名腸激躁症患者，並根據性別、年齡和共病症以1:5的比例配對出169,540名對照組，以探討有無腸激躁症患者10年內是否發生大腸憩室症，運用Cox比例風險模式探討腸激躁症與發生大腸憩室症之縱向風險關係。
研究結果:在納入本研究的203,448名患者中，來自腸激躁症組的328名（337,589人年）和來自對照組的505名（1,694,095人年）在隨訪期間被診斷為大腸憩室症（發病率分別為0.97/1000人年和0.30/1000人年）。腸激躁症患者發生大腸憩室症的風險高於無腸激躁症患者（校正風險比=3.24，95%信賴區間=2.82-3.73，P<0.001）。此外，男性與女性發生大腸憩室症的風險均達到顯著差異（校正風險比=3.04，95%信賴區間=2.52-3.68，P<0.001），女性（校正風險比=3.51，95%信賴區間=2.86–4.30，P<0.001）。中年（40-59歲，校正風險比= 4.25，95%信賴區間=3.26–5.53）及老年（≥60歲，校正風險比=2.92， 95%信賴區間=2.46–3.47）患者發生大腸憩室的風險特別高。在基於隨訪期（即1年、3年、5年、8年和10年）的亞組分析中，腸激躁症與大腸憩室症的相關性仍然顯著（均P<0.001）。
結論:本研究顯示腸激躁症患者比起一般人具有較高的風險罹患大腸憩室症，臨床醫生應該仔細留意這層關係並仔細研究腸激躁症患者大腸憩室症發生的可能性。
INTRODUCTION: Irritable bowel syndrome (IBS) is different from common gastrointestinal diseases. It is not a pathological condition of inflammation of the stomach, nor has anything to do with bacterial or viral infection, but a functional problem of the intestine, accompanied by abdominal discomfort, abdominal distension or pain, with unknown etiology. Colonic diverticulosis (CD) of is a common clinical problem. In recent years, with the aging of age and westernization of life, the incidence and importance of diverticulum diseases continue to rise. Hemorrhage of diverticulum and diverticulitis are common complications of this disease. Some patients with diverticulosis of large intestine have symptoms similar to IBS. In recent studies, patients with irritable bowel disease are more likely to have colonic diverticulosis than patients without irritable bowel disease. Therefore, the aim of this study was to evaluate the correlation, clinical characteristics and related factors between irritable bowel syndrome and colonic diverticulosis in Taiwan.
METHODS: Data from Taiwan’s Longitudinal Health Insurance Database were analyzed to compile (1) 33,908 patients newly diagnosed with IBS between 2001 and 2005 as well as (2) a comparison cohort of 169,540 matched non-IBS enrollees (according to sex, age and comorbidity, control group patients were matched in a ratio of one to five). Each patient was followed for 10 years to identify cases in which CD subsequently developed. Cox proportional hazards regressions were used to calculate adjusted hazard ratios (HRs).
RESULTS: Among the 203,448 patients enrolled in this study, 328 (337,589 person-years) from IBS cohort and 505 (1,694,095 person-years) from the comparison cohort were diagnosed with CD during the follow-up period (incidence rates, 0.97/1000 and 0.30/1000 person-years, respectively). The hazard ratio (HR) for CD was 3.24 times higher (95% confidence interval [C.I.]=2.82-3.73; P < 0.001) in the IBS cohort than in the non-IBS cohort after adjustment for potential confounders. Furthermore, the risk of CD was significant in both men (adjusted HR = 3.04;95% C.I.=2.52-3.68) and women (adjusted HR=3.51; 95% C.I.=2.86–4.30). Middle-aged (40–59 years; adjusted HR=4.25; 95% C.I.=3.26–5.53) and older (≥60 years; adjusted HR=2.92 95% C.I.=2.46–3.47) patients had a particularly high risk of stroke. In subgroup analyses based on follow-up periods (i.e. 1, 3, 5, 8, and 10 years), the association between IBS and CD remained significant (all P<0.01).
CONCLUSIONS: This study shows that patients with irritable bowel syndrome have a higher risk of suffering from colorectal diverticulosis than the general population. Clinicians should pay close attention to this relationship and timely e |
