Chen Chien-Hua, Lin Cheng-Li, Kao Chia-Hung
Digestive Disease Center, Changbing Show-Chwan Memorial Hospital, Lukang 505, Taiwan.
Digestive Disease Center, Show-Chwan Memorial Hospital, Changhua 500, Taiwan.
J Clin Med. 2018 Nov 21;7(11):455. doi: 10.3390/jcm7110455.
Several pathophysiological mechanisms are shared in both gallbladder stone disease (GSD) and migraines. We assessed the migraine risk for patients diagnosed with GSD. We identified 20,427 patients who were diagnosed with GSD between 2000 and 2011 from Taiwan's National Health Insurance Research Database (NHIRD) as the study cohort. We randomly selected 81,706 controls from the non-GSD population with frequency matching by age and index year for the control cohort. All patient cases were followed until the end of 2011 to measure the incidence of migraines. The cumulative incidence of migraines was greater in patients with GSD than in those without GSD (log-rank test: < 0.001). The risk of migraine (3.89 vs. 2.30 per 10,000 person-years, adjusted hazard ratio (aHR) = 1.56, 95% confidence interval (CI) = 1.41⁻1.73) was greater for the GSD cohort than that for the non-GSD cohort. The risk of migraine increased with the time of follow-up after a diagnosis of GSD. The risk of migraine contributed by GSD was greater for all age groups. The risk of migraine for GSD patients with depression (aHR = 2.89, 95% CI = 2.21⁻3.77), anxiety (aHR = 2.07, 95% CI = 1.58⁻2.70), and coronary artery disease (CAD) (aHR = 2.05, 95% CI = 1.69⁻2.48) tended to be greater than that for GSD patients without depression (aHR = 1.54, 95% CI = 1.39⁻1.72), anxiety (aHR = 1.62, 95% CI = 1.46⁻1.81), and CAD (aHR = 1.65, 95% CI = 1.47⁻1.85), respectively. Compared with the patients without GSD, the risk of developing migraines was greater in those GSD patients either with (aHR = 1.39, 95% CI = 1.19⁻1.63) or without (aHR = 1.67, 95% CI = 1.48⁻1.88) cholecystectomy. Compared with the GSD patients that have not had a cholecystectomy, the risk of developing migraines was lower in the GSD patients that had a cholecystectomy (aHR = 0.83, 95% CI = 0.69⁻0.99). GSD is associated with an increased risk of migraines in the Taiwanese population, but the risk diminishes after a cholecystectomy. Furthermore, in the development of migraines, GSD is synergic with some migraine-associated comorbidities, such as CAD, depression, and anxiety. Further study is necessary to clarify whether GSD is a causal risk factor for migraine.
胆结石病（GSD）和偏头痛有几种共同的病理生理机制。我们评估了被诊断为GSD的患者患偏头痛的风险。我们从台湾国民健康保险研究数据库（NHIRD）中确定了20427名在2000年至2011年期间被诊断为GSD的患者作为研究队列。我们从非GSD人群中按年龄和索引年份进行频率匹配，随机选择81706名对照作为对照队列。所有患者病例均随访至2011年底，以测量偏头痛的发病率。GSD患者偏头痛的累积发病率高于无GSD患者（对数秩检验：<0.001）。GSD队列患偏头痛的风险（每10000人年3.89例对2.30例，调整后风险比（aHR）=1.56，95%置信区间（CI）=1.41⁻1.73）高于非GSD队列。偏头痛的风险随着GSD诊断后的随访时间增加。GSD导致的偏头痛风险在所有年龄组中都更高。患有抑郁症（aHR = 2.89，95%CI = 2.21⁻3.77）、焦虑症（aHR = 2.07，95%CI = 1.58⁻2.70）和冠状动脉疾病（CAD）（aHR = 2.05，95%CI = 1.69⁻2.48）的GSD患者患偏头痛的风险往往分别高于无抑郁症（aHR = 1.54，95%CI = 1.39⁻1.72）、焦虑症（aHR = 1.62，95%CI = 1.46⁻1.81）和CAD（aHR = 1.65，95%CI = 1.47⁻1.85）的GSD患者。与无GSD的患者相比，接受过胆囊切除术（aHR = 1.39，95%CI = 1.19⁻1.63）或未接受过胆囊切除术（aHR = 1.67，95%CI = 1.48⁻1.88）的GSD患者患偏头痛的风险更高。与未接受胆囊切除术的GSD患者相比，接受过胆囊切除术的GSD患者患偏头痛的风险更低（aHR = 0.83，95%CI = 0.69⁻0.99）。在台湾人群中，GSD与偏头痛风险增加相关，但胆囊切除术后风险降低。此外，在偏头痛的发生过程中，GSD与一些偏头痛相关的合并症如CAD、抑郁症和焦虑症具有协同作用。有必要进一步研究以阐明GSD是否是偏头痛的因果风险因素。
