Risk of Headache-Related Healthcare Visits in Patients With Celiac Disease: A Population-Based Observational Study.
Risk of Headache-Related Healthcare Visits in Patients With Celiac Disease: A Population-Based Observational Study.
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DOI：
10.1111/head.12784
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发表时间：
2016-05
期刊：
影响因子：
5
通讯作者：
Ludvigsson JF
中科院分区：
文献类型：
--
作者：
Lebwohl B;Roy A;Alaedini A;Green PHR;Ludvigsson JF
据报道，乳糜泻（CD）患者头痛的风险增加，但缺乏大型研究。我们的目的是研究在全国范围内的人群为基础的设置与CD患者头痛相关的医疗保健遭遇的风险。在这项基于人群的回顾性队列研究中，我们检索了瑞典所有（n=28）病理科，并根据绒毛萎缩（VA）的存在确定CD患者。每名患者按年龄、性别、日历周期和地区与最多5名对照组相匹配。使用考克斯比例风险，我们测试了CD和随后的头痛相关访问之间的关联。我们还检测了肠道炎症但绒毛正常的患者和CD血清学阳性但组织学正常的受试者的这种相关性。在28，638例CD患者和143，126例对照组中，分别有1，337例（4.7%）和4，102例（2.9%）发生头痛相关就诊。CD患者头痛相关就诊的发生率为423/100，000人-年，对照组为254/100，000人-年（HR 1.66; 95%CI 1.56-1.77; p<0.0001）。在小肠活检中没有VA的炎症个体（n= 12，898; HR 2.08; 95%CI 1.90-2.27; p<0.0001）和粘膜正常但CD血清学阳性的个体（n= 3，617; HR 1.83; 95%CI 1.57-2.12; p<0.0001）也增加了头痛相关就诊的风险。在这项基于人群的研究中，我们发现CD患者头痛相关就诊的风险显著增加;肠道炎症患者和CD血清学阳性但小肠活检粘膜结构正常的患者也存在这种增加。虽然受到监测偏差的限制，但这项研究表明，头痛相关的就诊在这些人群中更为常见。
Patients with celiac disease (CD) are reported to be at increased risk for headaches, though large studies are lacking. We aimed to examine the risk of headache-related healthcare encounters in patients with CD in a nationwide population-based setting. In this population-based retrospective cohort study, we searched all (n=28) pathology departments in Sweden and identified patients with CD based on the presence of villous atrophy (VA). Each patient was matched to up to five controls, by age, gender, calendar period, and region. Using Cox proportional hazards, we tested for an association between CD and subsequent headache-related visit. We also tested this association for those with intestinal inflammation but normal villi, and subjects with positive CD serologies but normal histology. Among 28,638 patients with CD and 143,126 controls, headache-related visit occurred in 1,337 (4.7%) and 4,102 (2.9%) respectively. The incidence of headache-related visit was 423 per 100,000 person-years in CD patients and 254 per 100,000 person-years in controls (HR 1.66; 95% CI 1.56–1.77; p<0.0001). Individuals having inflammation without VA on small intestinal biopsy (n=12,898; HR 2.08; 95% CI 1.90–2.27; p<0.0001) and those with normal mucosa but positive CD serology (n=3,617; HR 1.83; 95% CI 1.57–2.12; p<0.0001) were also at increased risk for headache-related visit. In this population-based study we found a significantly increased risk of headache-related visits in patients with CD; this increase was also present in patients with intestinal inflammation and those with positive CD serology but with normal mucosal architecture on small bowel biopsy. Though limited by surveillance bias, this study indicates that headache-related visits are more common in these populations.
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