三叉神經痛之病患並未有較高冠狀動脈疾病之風險：族群基礎之世代研究報告

Trigeminal Neuralgia Patients Are Not Associated with an Increased Risk of Coronary Heart Disease: A Population-Based Cohort Study

背景：吾人探討三又神經痛之病患是否有較高冠狀動脈疾病之風險。方法：吾人擷取並分析2000年至2007年台灣健保資料庫數據。三又神經痛病患族群（TN）乃以被診斷為三叉神經痛並於後續連續三個月內每月至少接受一次治療之病患為收案標準；而非三叉神經痛病患族群（non-TN）則以性別及年齡相對應、未被診斷為三叉神經痛之病患為收案標準；另外，為求足夠代表性，non-TN族群人數設定為TN族群之三倍。實驗之終點乃是個案發生等冠狀動脈疾病事件，包括急性心肌梗塞、經皮冠狀動脈介入治療術及冠狀動脈繞道術。個案之排除標準包括年齡小於20歲或大於100歲，患有多發性硬化症、后顱窩腦膜瘤或神經瘤或曾有癌症相關疼痛者。結果：相較於non-TN族群（n=8811），TN族群（n=2937）有較高的比例會同時罹患糖尿病、高血壓、高血脂、酒精相關疾病、肥胖及憂鬱症，TN族群亦有較高的比例會抽菸及使用抗憂鬱劑、非類固醇止痛消炎藥、鴉片類止痛藥及心臟血管藥物（所有P<0.001）。為平衡前述組間之差異，吾人以邏輯式迴歸並以Cox比例風險校正之模式估算出傾向分數；於校正過傾向分數後，吾人數據顯示TN族群相較於非TN族群而言，並未有較高冠狀動脈疾病之風險（風險比值= 0.86，95% 信賴區間= 0.681.10，P=0.224）.結論：三叉神經痛之病患並未有較高冠狀動脈疾病之風險。

Background: We elucidated whether trigeminal neuralgia (TN) patients are associated with an increased risk of developing heart disease (CHD). Methods: Data retrieved from Taiwan Longitudinal Health Insurance Database (2000-2007) were analyzed. Patients with a primary diagnosis of TN and treated for TN at least once a month for 3 consecutive months following their initial diagnosis were identified as the TN Subject. Age- and gender-matched subjects without any diagnosis of TN were randomly selected at a ratio of 1:3 (TN vs. non-TN) and identified as the non-TN subjects. Study endpoint was the composite of CHD events, including acute population-based study myocardial infarction, percutaneous coronary intervention and coronary artery bypass grafting. Subjects younger than 20 years or older than 100 years or with a history of CHD events, multiple sclerosis, posterior fossa meningioma or neuroma or cancer related pain were excluded. Results: TN subjects (n=2937) had significantly higher incidences of diabetes mellitus, hypertension, hyperlipidemia, alcohol-related illnesses, obesity, smoking history, depression, and use of antidepressants, non-steroid anti-inflammatory drugs, opioids, and cardiovascular drugs (all P<0.001) than non-TN subjects (n=8811). A propensity score was calculated using a logistic regression method and was then adjusted in the Cox proportional hazards regression model to balance the between group differences in the distribution of observed baseline covariates. Our data revealed that the risk of developing CHD events in TN subjects was not significantly different from non-TN subjects (Hazard ratio= 0.86, 95% confidence intervals=0.68-1.10, P=0.224). Conclusions: Trigeminal neuralgia patients are not associated with an increased risk of developing CHD.