偏头痛患者发生缺血性卒中的风险：一项利用韩国全国样本队列进行的纵向随访研究。
Risk of ischaemic stroke in patients with migraine: a longitudinal follow-up study using a national sample cohort in South Korea.
机构信息
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Jongno-gu, The Republic of Korea.
Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, The Republic of Korea.
出版信息
BMJ Open. 2019 Apr 2;9(4):e027701. doi: 10.1136/bmjopen-2018-027701.
OBJECTIVE
Accumulating evidence has supported the association between migraine and stroke, but the causative association remains unclear. We aimed to investigate the risks of different types of stroke in patients with migraine.
DESIGN
A longitudinal follow-up study.
SETTING
Data collected from a national cohort between 2002 and 2013 by the South Korea Health Insurance Review and Assessment.
PARTICIPANTS
We extracted the data from patients with migraine (n=41 585) and 1:4 matched controls (n=1 66 340) and analysed the occurrence of ischaemic and haemorrhagic strokes. The migraine group included participants treated for migraine (International Classification of Disease-10 (ICD-10): G43)≥2 times. Haemorrhagic stroke (I60-I62) and ischaemic stroke (I63) were determined based on the admission histories. The crude and adjusted HRs were calculated using Cox proportional hazard models, and the 95% CI were determined. Subgroup analyses stratified by age and sex were also performed.
RESULTS
Higher rates of ischaemic stroke were observed in the migraine group (2.3% [964/41,585]) than in the control group (2.0% [3294/166 340], P<0.001). The adjusted HR for ischaemic stroke was 1.18 (95% CI=1.10 to 1.26) in the migraine group (P<0.001). Compared with control subjects, participants who reported migraine with aura and migraine without aura had increased adjusted HRs of 1.44 (95% CI=1.09 to 1.89) and 1.15 (95% CI=1.06 to 1.24), respectively, for ischaemic stroke, but no increased risk of haemorrhagic stroke. In our subgroup analysis, a strong association between migraine and ischaemic stroke was observed in young patients, specifically young women. The contribution of migraine to the occurrence of ischaemic stroke was also observed in middle-aged women and old women (each P<0.05). The risk of haemorrhagic stroke did not reach statistical significance in any age group.
CONCLUSION
Migraine is associated with an increased risk of ischaemic stroke, but not haemorrhagic stroke.
目的
越来越多的证据支持偏头痛与中风之间存在关联，但因果关联仍不清楚。本研究旨在调查偏头痛患者发生不同类型中风的风险。
设计
一项纵向随访研究。
设置
本研究数据来自韩国健康保险审查与评估机构于 2002 年至 2013 年期间收集的全国队列。
参与者
我们从偏头痛患者（n=41585）和按 1:4 比例匹配的对照组（n=166340）中提取数据，并分析缺血性和出血性中风的发生情况。偏头痛组包括至少接受过 2 次偏头痛治疗（国际疾病分类第 10 版[ICD-10]：G43）的患者。出血性中风（I60-I62）和缺血性中风（I63）根据入院史确定。使用 Cox 比例风险模型计算未经调整和调整后的 HR，并确定 95%CI。还进行了按年龄和性别分层的亚组分析。
结果
偏头痛组缺血性中风的发生率高于对照组（2.3%[41585/41585]比 2.0%[3294/166340]，P<0.001）。偏头痛组缺血性中风的调整 HR 为 1.18（95%CI=1.10 至 1.26）（P<0.001）。与对照组相比，有先兆偏头痛和无先兆偏头痛患者缺血性中风的调整 HR 分别为 1.44（95%CI=1.09 至 1.89）和 1.15（95%CI=1.06 至 1.24），但出血性中风的风险无增加。在我们的亚组分析中，偏头痛与缺血性中风在年轻患者中，特别是年轻女性中存在强烈关联。在中年女性和老年女性中也观察到偏头痛对缺血性中风发生的影响（P 均<0.05）。任何年龄组的出血性中风风险均无统计学意义。
结论
偏头痛与缺血性中风风险增加相关，但与出血性中风无关。
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