偏头痛患者视网膜动脉闭塞的风险。

Risk of Retinal Artery Occlusion in Patients with Migraine.

机构信息

Department of Ophthalmology, Byers Eye Institute, Horngren Family Vitreoretinal Center, Stanford University School of Medicine, Palo Alto, California, USA.

出版信息

Am J Ophthalmol. 2021 May;225:157-165. doi: 10.1016/j.ajo.2020.11.004. Epub 2020 Dec 24.

DOI:10.1016/j.ajo.2020.11.004

PMID:33359716

Abstract

PURPOSE

We sought to determine if migraine is associated with increased risk of retinal artery occlusion (RAO).

DESIGN

Retrospective cohort study.

METHODS

We reviewed a large insurance claims database for patients with migraine and matched control subjects without migraine between 2007 and 2016. Cox proportional hazard regression models were used to investigate the association between migraine and risk of all RAO, central RAO (CRAO), branch RAO (BRAO), and "other" RAO, which includes transient and partial RAO. Primary outcome measures included the incidence of all RAO, including CRAO, BRAO, and other RAO, after first migraine diagnosis.

RESULT

There were 418,965 patients with migraine who met the study criteria and were included in the analysis with the appropriate matched control subjects. Among the 418,965 patients with migraine, 1060 (0.25%) were subsequently diagnosed with RAO, whereas only 335 (0.08%) of the patients without migraine were diagnosed with RAO. The hazard ratio (HR) for incident all RAO in patients with migraine compared with those without migraine was 3.48 (95% confidence interval [CI] 3.07-3.94; P < .0001). This association was consistent across all types of RAO, including CRAO (HR 1.62 [95% CI 1.15-2.28]; P = .004), BRAO (HR 2.09 [95% CI 1.60-2.72]; P < .001), and other types of RAO (HR 4.61 [95% CI 3.94-5.38]; P < .001). Patients with migraine with aura had a higher risk for incident RAO compared with those with migraine without aura (HR 1.58 [95% CI 1.40-1.79]; P < .001). This association was consistent for BRAO (HR 1.43 [95% CI 1.04-1.97]; P < .03) and other types of RAO (HR 1.67 [95% CI 1.45-1.91]; P < .001) but was not statistically significant for CRAO (HR 1.18 [95% CI 0.75-1.87]; P = .475). Significant risk factors for this association included increased age, male sex, acute coronary syndrome, valvular disease, carotid disease, hyperlipidemia, hypertension, retinal vasculitis or inflammation, and systemic lupus erythematosus.

CONCLUSIONS

Migraine is associated with increased risk of all types of RAO and migraine with aura is associated with increased risk of RAO compared with migraine without aura.

摘要

目的

我们旨在确定偏头痛是否与视网膜动脉阻塞（RAO）风险增加有关。

设计

回顾性队列研究。

方法

我们在 2007 年至 2016 年间，对患有偏头痛和无偏头痛的匹配对照患者进行了一项大型保险索赔数据库研究。使用 Cox 比例风险回归模型来研究偏头痛与所有 RAO、中央 RAO（CRAO）、分支 RAO（BRAO）和“其他”RAO（包括短暂性和部分性 RAO）风险之间的关联。主要结局指标包括首次偏头痛诊断后所有 RAO（包括 CRAO、BRAO 和其他 RAO）的发生率。

结果

有 418965 名符合研究标准的偏头痛患者被纳入分析，并与适当的匹配对照患者一起纳入分析。在 418965 名偏头痛患者中，有 1060 名（0.25%）随后被诊断为 RAO，而无偏头痛的患者中只有 335 名（0.08%）被诊断为 RAO。与无偏头痛的患者相比，偏头痛患者发生所有 RAO 的风险比（HR）为 3.48（95%置信区间[CI]3.07-3.94；P<0.0001）。这种关联在所有类型的 RAO 中均一致，包括 CRAO（HR 1.62[95%CI 1.15-2.28]；P=0.004）、BRAO（HR 2.09[95%CI 1.60-2.72]；P<0.001）和其他类型的 RAO（HR 4.61[95%CI 3.94-5.38]；P<0.001）。有先兆偏头痛患者发生 RAO 的风险高于无先兆偏头痛患者（HR 1.58[95%CI 1.40-1.79]；P<0.001）。这种关联在 BRAO（HR 1.43[95%CI 1.04-1.97]；P<0.03）和其他类型的 RAO（HR 1.67[95%CI 1.45-1.91]；P<0.001）中一致，但在 CRAO 中无统计学意义（HR 1.18[95%CI 0.75-1.87]；P=0.475）。这种关联的显著危险因素包括年龄增加、男性、急性冠状动脉综合征、瓣膜病、颈动脉疾病、血脂异常、高血压、视网膜血管炎或炎症以及系统性红斑狼疮。