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    Title: 使用全民健康保險研究資料庫進行膽囊切除術患者發生心房顫動風險之關聯分析
    Analyze the association of risk for atrial fibrillation after cholecystectomy using the Taiwan National Health Insurance Research Database
    Authors: 何東錦
    HO, TUNG-CHING
    Contributors: 生物資訊與醫學工程學系
    Keywords: 膽囊結石疾病;風險因子;心房顫動;膽囊切除手術
    gallstone disease;risk factor;atrial fibrillation;cholecystectomy
    Date: 2022-07-28
    Issue Date: 2022-10-31 02:53:43 (UTC+0)
    Publisher: 亞洲大學
    Abstract: 背景與目標：膽囊結石疾病(Gallstone disease, GD) 與心血管疾病一直有高風險的相關，但心血管疾病與膽結石關係的確切機制目前並不清楚。目前臨床證據顯示，當膽結石疾病與缺血性心臟病同時發生，會加重心絞痛，且可能誘發多種型態的心律不整。然而膽囊結石是否會導致心房顫動 (Atrial Fibrillation, AF) 尚不清楚；故本研究針對膽囊結石和心房顫動之間進行關聯分析。結果：本研究使用2001年至2011年間之台灣全民健康保險研究資料庫數據，進行了回溯性世代研究。一共收錄230,076名的膽囊結石患者，並從年齡、性別、心血管併發症等方面進行分類研究。在實驗組與對照組中分別有5,992名（49.8/10,000人年）患者和5,804名（44.5/10,000人年）患者發生心房顫動。研究顯示，膽囊結石可能會增加心房顫動風險，風險比為1.20 [95%信賴區間 (CI)，1.16–1.25]。在沒有執行膽囊切除術的膽囊結石患者中，其發生心房顫動的HR達到1.57 (95% CI = 1.50–1.63)。一旦膽結石患者執行膽囊切除術後，其心房顫動發生的HR顯著降低至0.85（95% CI = 0.81-0.90）。在三個不同年齡層（<45、45–64和?65歲）的有膽囊結石患者中，其發生心房顫動調整後之HR分別為1.59（95% CI = 1.08–2.33）、1.31（95% CI = 1.18–1.45）和1.18（95% CI = 1.13–1.22）。然與CHA2DS2-VASc評分等於0的患者相比，所有患者和評分為1、2、3和? 4的患者，其發生心房顫動風險的HR分別為1.28（95% CI = 1.15-1.43）、2.26（95% CI = 2.00–2.56)、3.81 (95% CI = 3.35–4.34) 和5.09 (95% CI = 4.42–5.87)。結論：本研究發現，膽囊結石患者的心房顫動風險增加。此外，膽囊切除手術與降低心房顫動風險似乎有相關。因此，建議膽囊結石患者需進行心血管檢查，尤其是那些不具有其他典型心血管危險因子的年輕患者。
    Background: Gallstone disease (GD) is known to be highly possible to lead to cardiovascular disease. Nevertheless, it is still unclear that if GD leads to atrial fibrillation (AF) or not. Therefore, an investigation was made to clarify the relationship between GD and AF.Method: A population-based cohort study was conducted based on the Taiwan National Health Insurance Research Database between 2001 and 2011. There are 230,076 patients, who were diagnosed with GD and were classified as experimental group. While the same number of people with matching age, sex, cardiovascular and gastrointestinal comorbidities were treated as control group.Result: 5,992 (49.8/10,000 person-years) patients in the experimental group developed AF, while 5,804 (44.5/10,000 person-years) patients in control group were diagnosed with AF as well. This study indicates that the AF risk might increase by GD and its hazard ratio (HR) is 1.20 [95% confidence interval (CI), 1.16-1.25]. On the other hand, the HR of AF is 1.57 (95% CI=1.50-1.63) in those GD patients but without cholecystectomy. However, the HR has a significant decrease to 0.85(95% CI=0.81-0.90) in GD patients performing the cholecystectomy. The experimental group was classified by age (≦45, 45-64,≧64 year old) or sex, the adjusted HR of atrial fibrillation in gallstone group are higher than control group, both in male and female, and in both symptoms or asymptoms of gallstones. HR are much lower after cholecystectomy (HR=0.54), as compared to those gallstones without cholecystectomy. Compared with patients without gallstones, the incidence and HR of AF were calculated according to different subtypes of gallstones. The HR of AF were 1.33 and 1.07 in patients with asymptomatic and symptomatic gallstones relative to control group. No matter GD patients performing cholecystectomy or not, the AF rate and HR increased progressively and statistically significantly according to the increase of CHA2DS2-VASC score from 0 to ≧4.Conclusions: The population-based longitudinal follow-up study has displayed that patients with GD might have higher possibility to develop AF. Furthermore, conducting cholecystectomy might have a relation to reduce AF risk. To sum up, cardiovascular checkups should be made for those diagnosed with GD, particularly for the youth and those who have other typical risk factors.
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