系统性硬化症(SSc),一种以血管病变为特征的危及生命的自身免疫性疾病。许多SSc患者表现出胃肠道(GI)受累,但微妙的胃肠道出血风险仍然很少。我们旨在探讨SSc在确定胃肠道出血的长期风险中的作用。包括上消化道(消化性和非消化性溃疡)和下消化道出血。
从1998年至2007年的灾难性疾病患者数据库和国家健康保险研究数据库中确定了患有SSc诊断的患者。每位SSc患者按年龄与五名无SSc个体相匹配,性别,和索引日期。随访所有个体(病例=3665,对照=18,325),直至出现消化道出血事件,死亡,或2008年底。评估亚分布风险模型以评估消化道出血风险并调整年龄,性别,和时间相关的协变量,合并症,和药物。
消化道出血的发生率为2.38(95%置信区间[CI],2.02-2.79),2.06(95%CI,1.68-2.53),和3.16(95%CI,2.53-3.96),上,SSc患者的消化道出血事件减少。在具有时间协变量调整的子分布风险模型中的竞争死亡风险中,SSc是所有消化道出血事件的独立危险因素(分布风险比[sHR]2.98,95%CI,2.21-4.02),上消化道出血事件(sHR2.80,95%CI,1.92-4.08),和下消化道出血事件(sHR3.93,95%CI,2.52-6.13)。
与无SSc的人群相比,SSc患者出现总体和不同亚型消化道出血事件的风险明显更高。这些高消化道出血风险人群需要采取预防策略。
Systemic sclerosis (SSc), a life-threatening autoimmune disease characterized by vasculopathy. Numerous SSc patients demonstrate gastrointestinal (GI) involvement but the delicate GI bleeding risk remains sparse. We aimed to explore the role of SSc in determining the long-term risk of GI bleeding, including bleedings of upper (peptic and non-peptic ulcers) and lower GI tracts.
Patients with SSc diagnosis were identified from the Catastrophic Illness Patient Database and the National Health Insurance Research Database from 1998 to 2007. Each SSc patient was matched with five SSc-free individuals by age, sex, and index date. All individuals (case = 3665, control = 18,325) were followed until the appearance of a GI bleeding event, death, or end of 2008. A subdistribution hazards model was assessed to evaluate the GI bleeding risk with adjustments for age, sex, and time-dependent covariates, comorbidity, and medications.
The incidence rate ratios of GI bleeding were 2.38 (95% confidence interval [CI], 2.02-2.79), 2.06 (95% CI, 1.68-2.53), and 3.16 (95% CI, 2.53-3.96) for over-all, upper, and lower GI bleeding events in SSc patients. In the competing death risk in the subdistribution hazards model with time-covariate adjustment, SSc was an independent risk factor for over-all GI bleeding events (subdistribution hazard ratio [sHR] 2.98, 95% CI, 2.21-4.02), upper GI bleeding events (sHR 2.80, 95% CI, 1.92-4.08), and lower GI bleeding events (sHR 3.93, 95% CI, 2.52-6.13).
SSc patients exhibited a significantly higher risk of over-all and different subtype GI bleeding events compared with the SSc-free population. The prevention strategy is needed for these high GI bleeding risk groups.