探讨SPECT/CT显像对偏头痛临床治疗疗效预测

A study on the value of SPECT/CT in assessing therapeutic efficacy in patients with migraine

目的检测偏头痛大脑结构及局部脑血流(regional cerebral blood flow,rCBF),分析其与治疗疗效关系。方法对34例临床诊断为偏头痛患者及11名正常对照者,应用SPECT/CT进行脑rCBF显像和CT显像。统计参数图(statistical parametric mapping,SPM)分析偏头痛患者大脑rCBF变化特点。并在西比灵、丙戊酸钠及黛力新治疗前及治疗后3个月,分别应用头痛程度量表评价头痛程度变化。结果34例中CT均未发现大脑结构异常,但32例(94.1%)患者存在rCBF降低。与正常对比的SPM分析显示偏头痛患者的额叶、颞叶rCBF降低(t=6.48,P<0.001)。29例患者经过治疗后头痛程度量化得分明显降低(P<0.001),但存在额叶rCBF降低患者,治疗后头痛程度量化分显著高于颞叶rCBF降低者(P<0.01)。结论偏头痛患者一般大脑无器质性病变,但大多有额叶及颞叶rCBF降低,额叶rCBF受损者的治疗疗效较差。

Objective To analyze the change of the regional cerebral blood flow （rCBF） and its correlation with the therapeutic efficacy in patients with migraine using SPEST. Methods The rCBF and CT imaging were performed on 34 migraineurs and 11 normal controls using the single photon emission computed tomography （SPECT） and computed tomography（CT）. The rCBF tomography data were normalized and smoothed, and statistically processed using the statistical parametric mapping （ SPM ） software with two-sample t-test. The headache was evaluated using the headache severity measuring scale. Results CT brain scans were normal in all 34 migraineurs whereas SPECT scan revealed 94. 1% migraineurs with the low rCBF focuses. The result of the SPM t - test showed that the patients with migraine exhibited lower rCBF in the frontal and temporal lobe compared with normal control （P 〈 0. 01 ）. The headache scores in 29 cases were markedly decreased after than before treatment （ 12.9 ± 2.4 vs 4. 7 ± 3.4, P 〈 0. 001 ）. After treatment, the headache scores in patients with low rCBF focuses in the frontal lobe were higher than those with low rCBF focuses in temporal lobe （ 3.1 ± 3.2 vs 7. 0 ± 2.0, P 〈 0. 01 ）. Conclusions Most patients with migraine have the lower rCBF focuses in the frontal and temporal lobe. Migraine treatment is less effective in patients with low rCBF in the frontal lobe than in those with lower rCBF in temporal lobe.