偏头痛与出血性卒中发病风险的meta分析

Migraine and risk of hemorrhagic stroke:a meta-analysis

目的采用meta分析方法综合评价偏头痛与出血性卒中发病风险的相关性。方法计算机检索PubMed、EMbase、Cochrane library、中国生物医学文献数据库、中国期刊全文数据库、万方数据库和维普数据库中公开发表的有关偏头痛与出血性卒中发病风险的观察性研究,检索时限均为建库至2019年12月31日。由2名评价者独立进行文献筛选和资料提取,并按照纽卡斯尔-渥太华量表进行质量评价。采用Stata SE 12.1软件进行meta分析。结果有6项病例对照研究和7项队列研究符合纳入标准,全部为英文文献。Meta分析结果显示,暴露于偏头痛可增高出血性卒中发病风险[优势比(odds ratio,OR)1.47,95%可信区间(confidence interval,CI)1.23~1.76;P<0.001]。敏感性分析显示结果稳健性好。亚组分析显示,有先兆偏头痛(OR 1.38,95%CI 1.05~1.81;P=0.019)、无先兆偏头痛(OR 1.46,95%CI 1.19~1.80;P<0.001)、男性(OR 2.10,95%CI 1.72~2.56;P<0.001)和女性(OR 1.53,95%CI 1.22~1.92;P<0.001)偏头痛均可增高出血性卒中发病风险。结论无论患者性别如何以及有无先兆,偏头痛均可显著增高出血性卒中的发病风险。

Objective To comprehensively evaluate the correlation between migraine and the risk of hemorrhagic stroke using Meta-analysis.Methods The published observational studies on migraine and the risk of hemorrhagic stroke in PubMed, EMbase, Cochrane library, Chinese Biomedical Database, China Journal Full-text Database, Wanfang Database and VIP Database were retrieved by computers. The retrieval time limit was from the establishment of the databases to December 31, 2019. Two reviewers independently conducted the literature screening and data extraction, and evaluated the quality according to Newcastle Ottawa scale. Stata SE 12.1 software was used for Meta-analysis.Results Six case-control studies and 7 cohort studies met the inclusion criteria, all of which were in English. The results of Meta-analysis showed that exposure to migraine increased the risk of hemorrhagic stroke (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.23-1.76;P<0.001). Sensitivity analysis showed that the results were robust. Subgroup analysis showed that migraine with aura (OR 1.38, 95% CI 1.05-1.81;P=0.019), migraine without aura (OR 1.46, 95% CI 1.19-1.80;P<0.001), male (OR 2.10, 95% CI 1.72-2.56;P<0.001) and female (OR 1.53, 95% CI 1.22-1.92;P<0.001) migraine could increase the risk of hemorrhagic stroke.Conclusion Regardless of the gender of patients and presence or absence of migraine aura, migraine can significantly increase the risk of hemorrhagic stroke.