Abstract：
BACKGROUND: Few studies have implied the incidence of diaphragmatic hernia (DH) after spontaneous pneumothorax (SP) with unknown mechanisms. The current study aimed to identify whether there is an association between the DH and SP.
METHODS: We selected 46,897 patients with SP (SP cohort) and 46,897 without SP (non-SP matched cohort) from the National Health Insurance Database. Patients were frequency matched according to age, sex, and index year. The incidence of DH and its association with SP were assessed after stratifying different characteristics and comorbidities. Statistical analysis including chi-square test, t-test, cox proportional hazard model, and Kaplan-Meier method were used.
RESULTS: The results suggested there were significant associations between SP and DH, especially in the subgroup of patients with older age (aged 40-64 years: 2.61-fold in adjusted hazard ratio (aHR), 95% confidence interval (CI): 1.27-5.36; aged > 65 years: 1.97-fold in aHR, 95% CI 1.43-2.71), male sex (2.11-fold in aHR, 95% CI 1.56-2.85), hypertension (2.05-fold in aHR, 95% CI 1.30-3.23), diabetes mellitus (2.58-fold in aHR, 95% CI 1.37-4.86), and smoking-related disease (1.86-fold in aHR, 95% CI 1.28-2.71). The SP cohort has significantly correlated with DH within 5-year follow-up (< 2 years: 3.22-fold in aHR, 95% CI 2.10-4.94; 2-5 years: 1.70-fold in aHR, 95% CI 1.05-2.75).
CONCLUSIONS: The SP cohort had a higher incidence of DH than the non-SP matched cohort. A prospective study of indications based on the findings of the current research should be performed.
METHODS: We selected 46,897 patients with SP (SP cohort) and 46,897 without SP (non-SP matched cohort) from the National Health Insurance Database. Patients were frequency matched according to age, sex, and index year. The incidence of DH and its association with SP were assessed after stratifying different characteristics and comorbidities. Statistical analysis including chi-square test, t-test, cox proportional hazard model, and Kaplan-Meier method were used.
RESULTS: The results suggested there were significant associations between SP and DH, especially in the subgroup of patients with older age (aged 40-64 years: 2.61-fold in adjusted hazard ratio (aHR), 95% confidence interval (CI): 1.27-5.36; aged > 65 years: 1.97-fold in aHR, 95% CI 1.43-2.71), male sex (2.11-fold in aHR, 95% CI 1.56-2.85), hypertension (2.05-fold in aHR, 95% CI 1.30-3.23), diabetes mellitus (2.58-fold in aHR, 95% CI 1.37-4.86), and smoking-related disease (1.86-fold in aHR, 95% CI 1.28-2.71). The SP cohort has significantly correlated with DH within 5-year follow-up (< 2 years: 3.22-fold in aHR, 95% CI 2.10-4.94; 2-5 years: 1.70-fold in aHR, 95% CI 1.05-2.75).
CONCLUSIONS: The SP cohort had a higher incidence of DH than the non-SP matched cohort. A prospective study of indications based on the findings of the current research should be performed.
摘要：
背景：很少有研究暗示自发性气胸（SP）后膈疝（DH）的发生机制未知。本研究旨在确定DH和SP之间是否存在关联。
方法：我们从国家健康保险数据库中选择了46,897例SP患者（SP队列）和46,897例无SP患者（非SP匹配队列）。患者根据年龄进行频率匹配，性别,和指数年。在对不同特征和合并症进行分层后，评估DH的发生率及其与SP的关联。统计分析包括卡方检验，t检验,cox比例风险模型，采用Kaplan-Meier法。
结果：结果表明SP和DH之间存在显著关联，尤其是在年龄较大的患者亚组中（年龄40-64岁：校正风险比（aHR）为2.61倍，95%置信区间（CI）：1.27-5.36；年龄>65岁：AHR1.97倍，95%CI1.43-2.71），男性（AHR的2.11倍，95%CI1.56-2.85），高血压（AHR的2.05倍，95%CI1.30-3.23），糖尿病（AHR为2.58倍，95%CI1.37-4.86），和吸烟相关疾病(AHR为1.86倍，95%CI1.28-2.71）。在5年的随访中，SP队列与DH显着相关（<2年：aHR的3.22倍，95%CI2.10-4.94；2-5年：AHR1.70倍，95%CI1.05-2.75）。
结论：SP组的DH发生率高于非SP组。应根据当前研究结果对适应症进行前瞻性研究。
方法：我们从国家健康保险数据库中选择了46,897例SP患者（SP队列）和46,897例无SP患者（非SP匹配队列）。患者根据年龄进行频率匹配，性别,和指数年。在对不同特征和合并症进行分层后，评估DH的发生率及其与SP的关联。统计分析包括卡方检验，t检验,cox比例风险模型，采用Kaplan-Meier法。
结果：结果表明SP和DH之间存在显著关联，尤其是在年龄较大的患者亚组中（年龄40-64岁：校正风险比（aHR）为2.61倍，95%置信区间（CI）：1.27-5.36；年龄>65岁：AHR1.97倍，95%CI1.43-2.71），男性（AHR的2.11倍，95%CI1.56-2.85），高血压（AHR的2.05倍，95%CI1.30-3.23），糖尿病（AHR为2.58倍，95%CI1.37-4.86），和吸烟相关疾病(AHR为1.86倍，95%CI1.28-2.71）。在5年的随访中，SP队列与DH显着相关（<2年：aHR的3.22倍，95%CI2.10-4.94；2-5年：AHR1.70倍，95%CI1.05-2.75）。
结论：SP组的DH发生率高于非SP组。应根据当前研究结果对适应症进行前瞻性研究。
