偏头痛患者TCD、MRA及其相关生化因子变化的意义

THE SINGIFICANCE OF TCD,MRA AND CHANGES OF THE CORRELATIVE BIOCHEMICAL AGENTS IN MIGRAINEURS

目的 :观察颅内血管形态 ,血管舒缩变化 ,相关生化因子的变化与偏头痛的关系和在评价临床意义中的价值。方法 :30例临床确诊为偏头痛的患者 ,经颅多谱勒 (TCD)和复式彩码双功能多谱勒测定颅内外血流情况、头颅磁共振血管像 (MRA)探查颅内血管形态 ,此外 ,采用放免等方法测定发作间歇期血小板 5 羟色胺 ( 5 HT)、β 内啡肽 ( β EP)、神经降压素 (NT)、精氨酸加压素 (AVP)和血栓烷A2 (TXA2 )含量 ,并与 2 0例健康对照组进行比较。结果 :偏头痛间歇期双侧大脑中动脉(MCA)和基底动脉 (BA)血流速度明显增高 (P <0 .0 1) ,颞浅动脉 (STA)没有显著性变化 (P >0 .0 5) ;MRA显示 6例患者颅内动脉异常 ;血浆 5 HT、NT含量偏头痛组显著高于对照组 (P <0 .0 1) ,血浆 β EP、AVP、TXB2 偏头痛组显著低于对照组 (P <0 .0 5)。结论 :偏头痛患者可能有先天血管发育异常 ,发作间歇期颅内动脉存在血流速度增快 ,血浆 5 HT、β EP、NT、AVP和TXB2 与偏头痛发病有关。

Objdctive:To investigate the relationship between migraine and the morphology of the encephalic blood vessels,the vascular contraction and relaxation and the changes of the correlative biochemical agents,and to evaluate their clinical implication. Methods: To determine the intracranial and extracranial blood flow by transcranial doppler(TCD)and color code duplex ultrasound and magnetic resonance angiography(MRA),and the contents of 5 hydroxytryptamine(5 HT), β endorphin(β EP), neurotensin(NT), arginine vasopressin(AVP), thromboxane A2(TXA 2)of platelet in plasma in 30 patients with migraine diagnosed clinically,and then compared with 20 normal controls in this hospital. Results: The blood flow rate of bilateral middle cerebral arteries(MCA)and basal arteries(BA)increased significantly ( P <0.01) during the intermission,superficial temporal arteries(STA)showed no significant changes( P >0.05);MRA revealed abnormal intracranial arteries in 6 patients; the contents of 5 HT and NT in plasma were higher ( P <0.01), and the contents of β EP,AVP and TXB 2 were lower( P <0.05) in migraineurs compared with normal controls. Conclusions: The blood vessels of migraineurs may have abnormal development congenitally,the blood flow rate of intracranial arteries may increase during the intermission, and 5 HT,β EP,NT,AVP and TXB 2 in plasma may be implied in the onset of migraine.