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DPCデータを利用した日本の摂食障害に関する臨床疫学研究

道端, 伸明 東京大学 DOI:10.15083/0002002698

2021.10.27

概要

摂⾷障害は、精神疾患の⼀つで⾝体・⼼理・社会的な障害を伴う。特に低栄養により様々な⾝体的合併症を引き起こす神経性やせ症が問題になる。初期治療では栄養療法が重要となる。しかし、治療初期は患者本⼈が⾷事を摂ることへの強い恐怖や拒否があり、⾃発的に経⼝摂取を⾏うことはしばしば困難である。本研究は、摂⾷障害の補助栄養療法である経管栄養と中⼼静脈栄養のどちらが副作⽤が少なく、治療効果が⾼いかを⼀般社団法⼈診断群分類研究⽀援機構のDiagnosis Procedure Combinationデータを⽤いて明らかにすることを⽬的とした。本研究では、2010年から2013年までの期間に、摂⾷障害と確定診断された患者を抽出し、年齢が10歳未満あるいは60歳以上、body mass indexが5kg/m2以下あるいは、17kg/m2以上、脳性⿇痺の患者を除外した。その上で経管栄養群と中⼼静脈栄養群の間で、院内死亡割合や⾝体合併症割合、⼊院期間について⽐較検討した。統計⼿法は、院内死亡には、2:1傾向スコアマッチング解析とinverse probability of treatment weighting法を、⼊院期間には、Cox回帰分析をそれぞれ使⽤した。結果は、経管栄養群と中⼼静脈栄養群との⽐較では、⼊院期間には有意な差は無かったが、中⼼静脈栄養群では経管栄養群に⽐べて、院内死亡割合や⾝体合併症割合が⼤きかった。

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