■最近的研究表明,在患有某些自身免疫性炎症性风湿性疾病(AIIRDs)的患者中,缺血性卒中的发生率增加。然而,年轻卒中与AIRD之间的关联尚未得到充分调查.本研究旨在评估年轻AIRD患者发生缺血性卒中的风险。
■利用台湾国家健康保险研究数据库建立2004年至2015年间诊断为AIRD的患者队列,并与1,000,000名对照参与者进行比较。Cox比例风险回归模型用于在校正相关危险因素后计算个体AIRD的缺血性卒中和年轻缺血性卒中的风险比。
■在研究期间,共确认了64,120例AIIRDss患者和1,000,000例对照患者.总体平均随访时间为5.33年。有223(0.8%)和1,923(0.3%)年轻缺血性卒中相关的住院患者AIRD和对照组,分别。类风湿关节炎患者中青年缺血性脑卒中的发病率为0.08,干燥综合征患者为0.08,0.26在系统性红斑狼疮患者中,特发性炎性肌炎患者为0.17,0.24在系统性硬化症患者中,贝赫塞氏病患者为0.05,系统性血管炎患者为0.44,而普通人群中每100人年0.05。对于类风湿关节炎,年轻缺血性卒中的调整风险比为1.07(95%CI0.70-1.43),干燥综合征的1.39(95%CI0.94-2.06),系统性红斑狼疮5.79(95%CI4.68-7.17),特发性炎性肌炎为2.07(95%CI0.98-4.38),系统性硬化症为2.79(95%CI1.38-5.63),贝赫塞氏病为0.82(95%CI0.26-2.55),和4.15(95%CI1.96-8.82)为系统性血管炎。
■50岁以下系统性红斑狼疮患者,系统性硬化症,或全身性血管炎发生缺血性卒中的风险显著升高。需要进一步的研究来阐明这些AIRD中加速动脉粥样硬化的发病机理。
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.
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.
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.
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.