偏头痛急性发作期SPECT脑血流灌注显像的研究

Cerebral Blood Flow Measured by SPECT During Migraine Attacks

目的观察偏头痛急性发作期局部脑血流灌注(rCBF)分布的特点及氟桂利嗪(西比灵)治疗后脑血流灌注的改变情况,进一步探讨偏头痛的发病机制及单电子发射计算机断层扫描(SPECT)在其临床诊疗中的应用价值。方法利用99mTc-ECD标记的放射性药物对22例偏头痛病人于急性发作期行SPECT脑灌注显像,对图像进行目测及半定量分析。比较头痛部位与脑灌注异常部位的相关性;自身头痛侧与非头痛侧脑血流灌注的不对称性;以及脑灌注异常程度与偏头痛的严重程度、发作频率之间的关系。结果82%病人在偏头痛急性发作期,SPECT表现为相关部位局部脑血流量减低;脑灌注改变的部位与头痛部位相关;对于一侧头痛病人,头痛侧与非头痛侧的脑血流量有明显差异,尤其在额叶、顶叶、颞叶明显(P<0.05或P<0.01);局部脑灌注减低的程度在一定条件下与头痛的严重程度和发作频率成正比,但不成线性关系;10例病人在西比灵治疗前后rCBF比较,4例恢复正常,3例低灌注仍然存在,但rCBF评分增加,3例无明显变化。结论偏头痛病人在急性期普遍存在脑血流灌注异常。与CT、磁共振成像(MRI)、颅多普勒超声(TCD)等辅助检查工具相比,SPECT可以反映脑细胞功能及脑血流的变化,在偏头痛的临床诊疗中有一定的参考价值。

Objective To observe the regional cerebral blood flow （rCBF） during migraine attacks and following treatment with flunarizine HCI by SPECT. Methods Brain SPECT was performed in twentytwo patients （pts） with migraine attacks. The relationship between the areas of brain peffusion abnormality and the site of headache, the asymmetry of the rCBF between the headache side and the non- headache side as well as the relationship among the rCBF scores, the seriousness （grade 0 to 10） and frequencies of headache were evaluated. Results During attacks, hypoperfusion was observed in 82 % of pts; Low - flow areas were related with the site of pain; For the pts with unilateral headache, the rCBF in the headache side and the non- headache side was different significantly, especially in the frontal, temporal and parietal part;The hypoperfusion of rCBF was related positively to the severity and frequency of headache in some conditions. After treatment with flunarizine HCI, perfusion was normal in 4 pts, improved in 5 pts and non changed in 1 patient among pts with the hypoperfusion. Conclusion SPECT could be used to assess the rCBF that reflect the cerebral function and blood circulation.