探討過敏性發炎疾患與罹患帕金森氏症之風險-回溯性的追蹤世代研究

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题名:	探討過敏性發炎疾患與罹患帕金森氏症之風險-回溯性的追蹤世代研究 Allergic disorder and risk of Parkinson's disease-a retrospective cohort study
作者:	譚弘熙;Hung-Hsi Tan
贡献者:	公共衛生學系碩士班
关键词:	帕金森氏症;過敏性疾患;氣喘;異位性皮膚炎;過敏性結膜炎;過敏性鼻炎;蕁麻疹;asthma;atopic dermatitis;allergic conjunctivitis;allergic rhinitis;urticaria
日期:	2017-01-26
上传时间:	2018-01-15 09:08:33 (UTC+8)
出版者:	中國醫藥大學
摘要:	背景：帕金森氏症(Parkinson’s disease)由黑質(Substantia nigra)中多巴胺分泌細胞死亡所致，而多巴胺分泌細胞死亡之原因未明。近來神經發炎(Neuroinflammation)被認為是神經退化疾病的原因之一，而發炎、感染、自體免疫疾病、頭部外傷等皆與神經發炎相關。而過敏性疾患是身體對刺激引發的發炎反應，這些發炎反應也很可能引發神經的發炎，並進而造成神經退化性的疾病如帕金森氏症的發生。方法: 以回溯性的追蹤研究設計，使用健保資料庫2000年的百萬抽樣歸人檔，比較2000-2004年間被診斷新發生的過敏性疾患和同期間未有過敏性疾患的人加以對照，觀察這兩組至2011年底前發生帕金森氏症的風險比(hazard ratio)。過敏性性發炎疾患包括氣喘、異位性皮膚炎、過敏性結膜炎、過敏性鼻炎及蕁麻疹。以三次門診或一次住院被診斷如上述疾患為個案組，共有50,810人，並以診斷日為指標日(index day)，依個案之指標日、年齡、性別以1:2方式隨機匹配對照組，分析對象排除指標日前患有帕金森氏症、高血壓、缺血性心臟病等與帕金森氏症有關的疾病後，對照組有101,620人。使用SAS 9.3版統計軟體，以Cox Proportional Hazard Model 分析患有過敏性疾患者爾後發生帕金森氏症的風險是否較無者高。結果: 患有任一項過敏性疾患者於觀察期間罹患帕金森氏症的累積發生率為每千人年0.59人，而對照組為每千人年0.31人。不同類型的過敏疾患中，累積發生率以過敏性結膜炎最高、其次是氣喘、再其次是蕁麻疹。多變項分析結果顯示年紀越大風險越高，即比起小於35歲，65歲或以上者有最高罹病風險(HR=19.1,95%CI=13.8-26.5),其次是50-64歲(HR=3.86)。性別和都市化程度皆無顯著關係。過敏性疾患罹患帕金森氏症的風險為無者的2倍 (HR=2.00,95% CI=1.65-2.42)；不論是個案組或對照組，之前的風濕性關節炎病史並不會增加後來罹患帕金森氏症的風險。結論: 本研究發現在考慮老化即年齡這項因素下，過敏性疾患會顯增加罹患帕金森氏症的風險。由於使用的是次級資料，此結論仍須有更進一步相關的臨床和致病機轉的研究之支持。 Backgrond: Parkinson's disease is a neurodegenerative disorder related to death of dopaminergic neurons in the substantia nigra. The mechanisms of Parkinson's disease are not fully understood. In recent years, neuroinflammation is thought to play an important role in neurodegenerative disorder. Inflammation, infection, autoimmune disease and head trauma are associated with neuroinflammation. Allergic disease may induce systematic inflammation and cause neuroinflammation which lead to neurodegenerative disorder such as Parkinson's disease. Methods: We conducted a retrospective cohort study, and use NHIRD to observe the subject since 2000-2011. Patient with any diagnosis of the allergic disease as asthma, atopic dermatitis, allergic conjunctivitis, allergic rhinitis and urticaria was selected as the case cohort, and matching strategy with a ratio of 1 to 2 by index date of the diagnosis, sex and age was applied to obtain the control cohort, patients with Parkinson's disease and disease related to Parkinson's disease such as hypertension, ischemic heart disease were excluded. We used Chi-square tests to compare the distribution of age, sex, comorbidity between two cohort and The Cox Proportional Hazard Model for examining the temporal relation between the allergic inflammatory disease and the subsequent of Parkinson's disease. Result: We collected 50,810 new diagnosed allergic disease patient as the case group, and 101,620 controls. After analysis, an elevated risk for Parkinson's disease in case group was noted (HR=2.00,95% CI=1.65-2.42). Patient with allergic conjunctivitis has the highest risk for Parkinson's disease, followed by patient with asthma and urticaria. Patient older the 65 years old has the highest risk to develop Parkinson's disease. There was no significant relation between Parkinson's disease and sex, urbanization, rheumatoid arthritis. Conclusion: Under the influence of aging, allergic disease elevated the risk for Parkinson's disease. However, our research is based on secondary data, more research based on clinical observation and disease mechanism are needed.
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