DT-MRI动态观察无先兆偏头痛患者治疗前后脑白质结构完整性的改变

Dynamic investigations of white matter abnormalities in patients with migraine without aura before and after treatment with diffusion tensor magnetic resonance imaging

目的研究无先兆偏头痛患者脑白质可能存在的微细结构异常，并探讨其在药物治疗前后的动态变化。方法选择自2010年7月113至2011年6月30日在广州医学院第二附属医院神经内科门诊连续就诊的无先兆偏头痛患者f病例组）及年龄、性别相匹配的同期健康体检者（对照组）各32例，于药物治疗前及治疗第6个月、治疗第12个月后进行磁共振弥散张量成像（DT．MRj）检查，分别于胼胝体膝部、体部及压部最厚的部位设置感兴趣区，测取部分各向异性值（FA值）和表观弥散系数值（ADC值）。结果（1）治疗前，病例组胼胝体膝部、体部及压部FA值均较对照组明显更低，差异有统计学意义（p〈0．05）；治疗第6个月后，胼胝体膝部、体部FA值较治疗前明显升高，差异有统计学意义（P〈0．05）；治疗第12个月后，胼胝体膝部、体部及压部FA值较治疗前及治疗第6个月均明显升高，差异有统计学意义（P〈0．05）。（2）病例组治疗前后各时间点胼胝体膝部、体部及压部ADC值与对照组比较差异均无统计学意义（p〉0．05）。（3）治疗前，病例组病程与胼胝体膝部、体部及压部FA值均呈明显负相关（r：=-0．850，P=0．000；r==-0．856，P=-0．000；r==-0．430，p=O．014）；治疗第6个月后，病例组月均头痛次数与胼胝体膝部、体部及压部FA值均呈明显负相关fr==-0．824．P=-0．000；r=-0．792，P=-0．000；r=-0．425，P=-0．015）；治疗第12个月后，病例组月均头痛次数与胼胝体膝部、体部FA值均呈明显负相关（r==-0．452，P=-0．009；F-0．440，P=-0．012）。结论无先兆偏头痛患者存在胼胝体神经纤维微细结构完整性的损害，经有效治疗后此种损害是可逆的。DT—MRI可动态观察无先兆偏头痛患者胼胝体神经纤维微细结构完整性的改变，值得临床推广应用。

Objective To investigate the possible microstructural abnormalities of the cerebral white matter and its dynamic changes in patients with migraine without aura before and after treatment. Methods Diffusion tensor magnetic resonance imaging （DT-MRI） was carried out before drug treatment in 32 patients with migraine without aura （case group） and 32 age- and sex-matched healthy controls （control group） who were collected in our hospital from July 1, 2010 to June 30, 2011. DT-MRI was also carried out in case group 6 and 12 months after treatment. Fractional anisotropy （FA） and apparent diffusion coefficient （ADC） were measured at genu, body, and splenium of the corpus callosum （CC）, respectively. Results （1） The FA values at the genu, body, and splenium of the CC from patients with migraine without aura before treatment were significantly lower than those in the controls （P〈0.05）. The FA values at the genu and body of the CC 6 months after treatment increased significantlyas compared with those before treatment （P〈0.05）. The FA values at the genu, body, and splenium of the CC 12 months after treatment were significantly higher than those before treatment and 6 months after treatment （P〈0.05）. （2） The ADC values at the genu, body, and splenium of the CC were not significantly different between the two groups at each time point before and after treatment （P〉0.05）. （3） There were negative correlations between disease course and FA values at the genu, body, and splenium of the CC （r=-0.850, P=-0.000; r=-0.856, P=-0.000; r=-0.430, P---0.014）. Negative correlations were also found between headache fi＇equency and FA values at the genu, body, and splenium of the CC before treatment and 6 months after treatment （r=-0.824, P=0.000; r=-0.792, P=-0.000; r=-0.425, P=-0.015）, and between headache fxequeney and FA values at the genu and body of the CC 12 months after treatment （r=-0.452, P=0.009; r=-0.440, /^-0.012）. Conclusion There might be an integrity change of neurofibrotic microstructures in the CC in patients with migraine without aura, which may be reversible through effective treatment and these changes can be detected dynamically by DT-MRI, which is worth widely popularization and application.