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DPCデータを用いた緑内障患者の手術に至る因子に関する疫学研究

白井 千華子 東北大学

2021.09.24

概要

【背景】緑内障患者の身体的・経済的な負担を軽減するためには、ベースラインの患者背景から緑内障手術に至る因子を早期に認識し対応策を講じることが極めて重要である。しかしながら、医療の実態を反映したリアルワールドデータを用いた緑内障手術と患者背景との関係についての検討は国内外で報告されていない。2003 年から全国急性期病院の一部に導入された診断群分類（Diagnosis Procedure Combination; DPC）を用いた包括評価のための調査データ（以下、DPC データ）には、患者の複数の傷病名、提供された医療サービスの詳細な内容が含まれている。

【目的】DPC データを用いて、日本人緑内障患者における緑内障手術に至る因子を明らかにすることを目的とした。

【方法】本研究は、断面研究である。データは、2012 年から 2018 年に全国急性期病院の DPC 参加病院に入院した患者から、緑内障と診断された患者を抽出した。主要評価項目は緑内障手術に至る因子である。緑内障手術と患者背景（ベースライン特性）との関係について、多変量ロジスティック回帰モデルを用いて緑内障の手術群と非手術群で比較した。副次評価項目は併存症の有病率、併用薬の使用率、緑内障点眼薬の治療パターンとした。さらにサブグループ解析として、緑内障の手術群において、白内障手術に至る因子を評価した。

【結果】解析対象 29,599 例のうち、緑内障の手術群は 12,038 例、非手術群は 17,561例であった。緑内障と白内障の同時手術群は 2,991 例であった。緑内障手術との関係が高い因子は、併存症としてアレルギー、併用薬としてうつ病、虚血性心疾患、消化性潰瘍などの治療薬、原発性開放隅角緑内障（primary open angle glaucoma; POAG）、長期在院日数であった。一方、緑内障手術との関係が低い因子は高血圧、高血圧治療薬、80 歳以上、女性であった。緑内障と白内障の同時手術との関係が高い因子は、70歳代、POAG であった。緑内障の手術群と非手術群における緑内障点眼薬の治療パターンは、両群間で同様であり、プロスタグランジン（prostaglandin analog; PG）関連薬が最も多く（約 23% ）、α２刺激薬、炭酸脱水酵素阻害薬(carbonic anhydrase inhibitor; CAI)、β 遮断薬、CAI・β 遮断薬配合剤、ROCK 阻害薬、PG 関連薬・β遮断薬配合剤の順に続いた。緑内障と白内障の同時手術群においても、ほぼ同様の傾向が見られた。

【考察・結論】日本人緑内障患者において、緑内障手術の適応症例となる可能性の高 い因子として、併存症がアレルギー、併用薬が精神系・循環器系・消化器系の治療薬であることが示唆された。これらの有無を問診で聞くことが重要であると考えられる。

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