偏头痛患者发作期间听觉诱发电位和经颅多谱勒的变化

Changes of transcranial doppler sonography and brain-stem auditory evoked potential in patients with migraine attack

目的:研究偏头痛患者经颅彩色多谱勒(TCD)和脑干听觉诱发电位(BAEP)变化并探讨其临床意义.方法:偏头痛患者350(男128,女222)例,年龄17～49岁,病程5mo～12a.典型偏头痛185例(单侧头痛105例,双侧头痛80例),普遍偏头痛165例(单侧头痛95例,双侧头痛70例).对照选择健康体检者135(男55,女80)例,年龄20～48岁.全部患者在偏头痛发作期间同时进行TCD和TBAEP检查.结果:在350例偏头痛患者中脑血流增快224例(64.0%),血流减慢110例(31.4%),血流正常16例(4.6%),总异常率95.43%.典型偏头痛患者MCA(cm/s,大脑中动脉)和PCA(cm/s,大脑后动脉)均高于对照[(70±7)vs(62±8),P<0.05;(48±9)vs(37±8),P<0.05]和普通偏头痛(61±6,P<0.05;40±9,P<0.05).偏头痛患者发作期脑干听觉诱发电位(BAEP)异常率为52.9%(185/350),表现为Ⅰ,Ⅲ,Ⅴ波潜伏期及Ⅲ～Ⅴ峰间期延长.偏头痛发作间期BAEP正常.偏头痛病程越长BAEP异常率越高,听神经损害的可能性越大.结论:偏头痛发作期间有部分脑血流改变,同时有BAEP改变,病程越长BAEP异常率越高,听神经损害的可能性越大.提示TCD和BAEP对偏头痛有一定诊断价值.

AIM： To study the changes of transcranial doppler sonography （TCD） and brain-stem auditory evoked potential （BAEP） in patients with migraine attack and their clinical significance. METHODS： Data were analyzed in 350 patients （ male 128, female 222, aged from 17 to 49） with migraine attack, of whom 185 cases had classical migraine （one-side 105, two-side 80） and 165 （one-side 95, two-side 70） cases had common migraine. One hundred and thirty-five （male 55, female 80, aged from 20 to 48） subjects under routine medical check-up served as controls. Both the patients and controls had TCD and BAEP functional examinations. RESULTS： In the 350 cases of migraine attack, fast cerebral blood flow was observed in 224 cases （64.0%）, slow cerebral blood flow was observed in 110 cases （31.4%） and normal in 16 cases （4.6%）, with the total abnormity rate reaching 95.43%. In patients with classical migraine, MCA （cm/s, middle cerebral artery） and PCA （cm/s, posterior cerebral artery） were significant- ly higher than those in controls [ （70±7） vs （62±8）, P〈 0.051 （48±9） vs （37±8）, P〈0.05] and those with common migraine（61 ＋6, P〈0.05：40±9, P〈0.05） respectively. In patients with attack, BAEP abnormity rate was 52. 9% （185/350）, displaying prolongations of latency phase in Ⅰ, Ⅲ and Ⅴ waves and in Ⅲ-Ⅴ interspike interval. BAEP was normal during migraine attack. The course of disease in the patients was associated with BAEP changes and auditory nerve lesion. CONCLUSION： In patients with migraine attack, there are changes of part cerebral blood flow and BAEP. The disease course is associated with BAEP changes and auditory nerve lesion, indicating that TCD and BAEPmay be important indices for clinical diagnosis of migraine.