偏头痛与开角型青光眼发病风险增加：一项基于人群的队列研究。
Migraine and increased risk of developing open angle glaucoma: a population-based cohort study.
作者信息
Huang Jehn-Yu, Su Chien-Chia, Wang Tsing-Hong, Tsai I-Ju
机构信息
Department of Ophthalmology, National Taiwan University Hospital College of Medicine, National Taiwan University, No. 7, Chung-Shan S. Rd., Taipei, Taiwan.
National Taiwan University College of Medicine, Taipei, Taiwan.
出版信息
BMC Ophthalmol. 2019 Feb 13;19(1):50. doi: 10.1186/s12886-019-1062-9.
BACKGROUND
Migraine is linked to endothelial dysfunction and is considered to be a systemic vasculopathy. Interestingly, systemic vascular diseases also occur in glaucoma patients and are considered to be vascular risk factors. Whether migraine is simply a concomitant condition in glaucoma patients or a risk factor per se for glaucoma remains unknown. Thus, in the present study, we investigated the risk for open angle glaucoma (OAG) in migraineurs using a 10-year follow-up study that employed a nationwide population-based dataset in Taiwan.
METHODS
This retrospective matched-cohort study used data sourced from the Longitudinal Health Insurance Database 2000. We included 17,283 subjects with migraine in the study cohort and randomly selected 69,132 subjects from the database for the comparison group. Each subject in this study was individually traced for a 10-year period to identify those subjects who subsequently received a diagnosis of OAG. The age-adjusted Charlson's comorbidity index (ACCI) score was utilized to compute the burden of comorbidity in each subject. Multivariate regression analysis was used to assess risk factors for OAG in migraineurs. Cox proportional hazards regression was performed to compare the 10-year risk of OAG between the migraineurs and the comparison cohort.
RESULTS
Migraineurs had more vascular comorbidities than the comparison cohort. The overall incidence of OAG (per 1000 person-years) was 1.29 and 1.02, respectively, for migraineurs and the comparison cohort during the 10-year follow-up period. Age, hyperlipidemia, and diabetes mellitus were three significant risk factors for OAG in migraineurs. After adjusting for patients' age and vascular comorbidities, migraineurs were found to have a 1.68-fold (95% confidence interval [CI], 1.20-2.36) greater risk of developing OAG than the comparison cohort, in subjects with an ACCI score of 0. This association became statistically nonsignificant in subjects with ACCI scores of 1-2 or ≥ 3.
CONCLUSION
Migraine is associated with a higher risk of OAG for patients with no comorbidity who are aged under 50 years.
背景
偏头痛与内皮功能障碍有关，被认为是一种全身性血管病。有趣的是，全身性血管疾病也见于青光眼患者，被视为血管危险因素。偏头痛在青光眼患者中仅仅是一种伴随病症，还是其本身就是青光眼的一个危险因素，目前尚不清楚。因此，在本研究中，我们利用一项为期10年的随访研究，采用台湾全国性基于人群的数据集，调查偏头痛患者患开角型青光眼（OAG）的风险。
方法
这项回顾性匹配队列研究使用了来自2000年纵向健康保险数据库的数据。我们在研究队列中纳入了17283名偏头痛患者，并从数据库中随机选择69132名受试者作为对照组。对本研究中的每名受试者进行为期10年的个体追踪，以确定那些随后被诊断为OAG的受试者。采用年龄调整后的查尔森合并症指数（ACCI）评分来计算每名受试者的合并症负担。多变量回归分析用于评估偏头痛患者发生OAG的危险因素。进行Cox比例风险回归以比较偏头痛患者与对照队列之间10年的OAG风险。
结果
偏头痛患者比对照组有更多的血管合并症。在10年随访期内，偏头痛患者和对照组的OAG总体发病率（每1000人年）分别为1.29和1.02。年龄、高脂血症和糖尿病是偏头痛患者发生OAG的三个重要危险因素。在调整患者年龄和血管合并症后，发现ACCI评分为0的偏头痛患者发生OAG的风险比对照组高1.68倍（95%置信区间[CI]，1.20 - 2.36）。在ACCI评分为1 - 2或≥3的受试者中，这种关联在统计学上无显著性。
结论
对于年龄小于50岁且无合并症的患者，偏头痛与发生OAG的较高风险相关。
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