Ligthart Lannie, Boomsma Dorret I, Martin Nicholas G, Stubbe Janine H, Nyholt Dale R
Department of Biological Psychology, Vrije Universiteit, Amsterdam, Netherlands.
Twin Res Hum Genet. 2006 Feb;9(1):54-63. doi: 10.1375/183242706776403019.
It is often debated whether migraine with aura (MA) and migraine without aura (MO) are etiologically distinct disorders. A previous study using latent class analysis (LCA) in Australian twins showed no evidence for separate subtypes of MO and MA. The aim of the present study was to replicate these results in a population of Dutch twins and their parents, siblings and partners (N = 10,144). Latent class analysis of International Headache Society (IHS)-based migraine symptoms resulted in the identification of 4 classes: a class of unaffected subjects (class 0), a mild form of nonmigrainous headache (class 1), a moderately severe type of migraine (class 2), typically without neurological symptoms or aura (8% reporting aura symptoms), and a severe type of migraine (class 3), typically with neurological symptoms, and aura symptoms in approximately half of the cases. Given the overlap of neurological symptoms and nonmutual exclusivity of aura symptoms, these results do not support the MO and MA subtypes as being etiologically distinct. The heritability in female twins of migraine based on LCA classification was estimated at .50 (95% confidence intervals [CI] .27 - .59), similar to IHS-based migraine diagnosis (h2 = .49, 95% CI .19-.57). However, using a dichotomous classification (affected-unaffected) decreased heritability for the IHS-based classification (h2 = .33, 95% CI .00-.60), but not the LCA-based classification (h2 = .51, 95% CI .23-.61). Importantly, use of the LCA-based classification increased the number of subjects classified as affected. The heritability of the screening question was similar to more detailed LCA and IHS classifications, suggesting that the screening procedure is an important determining factor in genetic studies of migraine.
有先兆偏头痛（MA）和无先兆偏头痛（MO）在病因上是否为不同的疾病一直存在争议。之前一项对澳大利亚双胞胎进行潜在类别分析（LCA）的研究没有发现MO和MA存在不同亚型的证据。本研究的目的是在荷兰双胞胎及其父母、兄弟姐妹和伴侣群体（N = 10,144）中重复这些结果。对基于国际头痛协会（IHS）标准的偏头痛症状进行潜在类别分析，结果识别出4类：一类是未受影响的受试者（0类），一类是轻度非偏头痛性头痛（1类），一类是中度严重的偏头痛类型（2类），通常无神经症状或先兆（8%报告有先兆症状），还有一类是严重的偏头痛类型（3类），通常有神经症状，约一半病例有先兆症状。鉴于神经症状的重叠以及先兆症状并非相互排斥，这些结果不支持MO和MA亚型在病因上是不同的。基于LCA分类的女性双胞胎偏头痛遗传度估计为0.50（95%置信区间[CI] 0.27 - 0.59），与基于IHS标准的偏头痛诊断相似（h2 = 0.49，95% CI 0.19 - 0.57）。然而，使用二分法分类（患病 - 未患病）会降低基于IHS分类的遗传度（h2 = 0.33，95% CI 0.00 - 0.60），但不会降低基于LCA分类的遗传度（h2 = 0.51，95% CI 0.23 - 0.61）。重要的是，使用基于LCA的分类增加了被归类为患病的受试者数量。筛查问题的遗传度与更详细的LCA和IHS分类相似，这表明筛查程序是偏头痛遗传研究中的一个重要决定因素。
