无先兆偏头痛脑灰质结构改变及认知功能下降的相关性研究

The study of correlations between structural changes of gray matter and cognitive decline in patients with migraine without aura

目的:探讨无先兆偏头痛(MWoA)患者认知功能、灰质体积的改变及与临床表征的相关性。方法:纳入30例MWoA及与之年龄、性别及教育年限匹配的30例健康对照组(HC),问询并记录MWoA患者病程、发作频率、头痛程度(VAS视觉模拟评分)及头痛的影响程度(HIT头痛影响测评)的临床评分。测查两组总体认知功能(MoCA)、语言流畅性(VFT-动物命名)评分,进行组间比较。分析认知功能(MoCA、VFT评分)与临床表征间的相关性。采用MR扫描三维高分辨T1结构像,采用VBM方法计算脑区灰质体积,并进行组间比较。分析MWoA患者兴趣区脑区灰质体积与认知功能(MoCA、VFT评分)的相关性。结果:MWoA组较对照组VFT评分低(19.63±5.26 vs.22.9±5.43,t=-2.37,P=0.021),且MWoA患者中有畏光主诉者VFT评分更低(P<0.001)。MWoA组MoCA评分较对照组低[27.5(24.75,28.25)vs.28.0(27,29),Z=-8.30,P<0.001]。MWoA患者MoCA评分与发作频率呈负相关(r=-0.465,P=0.011)。VBM分析发现MWoA患者右侧枕中回灰质(RMOG)体积较大(P<0.001,cluster size=292),且MWoA患者中有畏光主诉患者RMOG体积更大(P=0.023)。MWoA患者RMOG体积与VFT评分呈负相关(r=-0.448,P=0.013),与MoCA评分无显著相关性(r=-0.184,P=0.331)。结论:MWoA患者认知障碍风险增加,较低语言流畅功能与视觉皮层通路的损伤重塑相关。

Objective:To investigate the changes of cognitive function,gray matter volume and their correlations with the clinical characterizations in patients with migraine without aura(MWoA).Methods:Thirty patients with MWoA and 30 healthy controls(HC)were enrolled,with matched age,sex and education time.The duration of the illness,the frequency of attacks,and the degree of headache(VAS,visual analogue scale),and the headache impact score(HIT,headache impact test)of patients with MWoA were recorded.We acquired overall cognitive function(MoCA)and vocabulary fluency scores(VFT,vocabulary fluency test-animal naming)of the two groups,and compared the differences between them;and their correlations with the clinical characterizations were analyzed in patients with MWoA.3 D T1 high resolution MRI images were performed for all subjects,using the VBM method to calculate gray matter volume of brain,then the differences between the two groups were compared with two-sample t-test.We also analyzed the correlation between the gray matter volume of the regions of interest and the cognitive function(MoCA,VFT scores).Results:Compared to the healthy controls,patients with MWoA had lower VFT scores(19.63±5.26 vs.22.9±5.43,t=-2.367,P=0.021),and patients with photophobia had lower VFT scores(P<0.001)in MWoA group.And there was a significant decrease of the MoCA scores in MWoA group[27.5(24.75,28.25)v s.28.0(27,29),Z=-8.298,P<0.001].Correlation analysis between the cognitive function and clinical characterization showed a significantly negative correlation between MoCA scores and attack frequency in patients with MWoA(r=-0.465,P=0.011).VBM analysis revealed a larger volume of right occipital gray matter(RMOG)in patients with MWoA(P<0.001,cluster size=292),and a larger volume of RMOG in patients with photophobia(P=0.023).There was a significantly negative correlation between RMOG volume and VFT score in patients with MWoA(r=-0.448,P=0.013),but no significant correlation between RMOG volume and MoCA score(r=-0.184,P=0.331).Conclusion:The risk of cognitive impairment increases in patients with MWoA,and lower language fluency function may associate with remodeling of the damage to visual pathways.