卵圆孔未闭封堵术治疗偏头痛的临床疗效

Clinical observation of transcatheter patent foramen ovale closure in treatment of migraine

目的通过比较卵圆孔未闭（patent foramen ovale，PFO）封堵前后患者偏头痛症状改善程度，评估PFO封堵术治疗偏头痛的有效性和安全性。方法纳入2012年5月-2013年6月就诊并同期行经皮PFO封堵术的偏头痛患者。PFO封堵术后≥6个月电话或门诊随访，进行HIT-6量表评分，并记录偏头痛症状（包括发病频率、天数、程度）。比较封堵术前后偏头痛症状以及偏头痛对生活质量的影响变化。结果32例PFO并发偏头痛患者，年龄14-59（37.00±12.26）岁，其中男14例，女18例。随访显示封堵术后偏头痛患者的HIT-6评分显著减少（P〈0.05），术后偏头痛对生活质量的影响明显降低； 偏头痛平均发作频率明显下降（P〈0.05），头痛程度明显减轻（P〈0.05）。结论PFO封堵术安全性高，可有效改善偏头痛症状及对生活质量的影响。

AIM To assess the safety and efficacy of transcatheter patent foramen ovale （PFO） closure in reducing or curing migraine with or without aura in PFO patients. METHODS Patients with migraine and PFO were consecutively enrolled in our department from May 2012 to June 2013 and all patients underwent PFO closure under general anesthesia after definite diagnosis of PFO by transthoracic echocardiography （TILE） , transthoracic contrast echocardiography （TTCE） and, if necessary, by transesophageal echoeardiography （TEE）. Before and after PFO closure, patients were assessed by HIT-6 scores and their migraine symptoms including the frequency and degree of migraine were recorded. RESULTS A total of 32 patients （ 14 males and 18 females） aged 14 -59 years （37.00 ± 12.26） were enrolled in the study. There were 23 cases of migraine with aura （MA） and nine cases of migraine without aura （MO）. In the 32 cases, 31 cases with the sign of PFO or right to left shunt were detected by TTCE and only one case was highly suspected by TEE, which was finally confirmed by TEE. The detection rate was 65.63% by TTE and 96. 88% by TFE and TFCE. All patients successfully underwent transcatheter PFO closure and there were no complications. There were no attacks of migraine during hospitalization. Follow-up at 1, 3 and 6 months found no oeeluder displacement and residual shunt. Obvious right to left shunt was not observed by TFCE at 6 months. Follow-up results showed that HIT-6 scores were significantly reduced in patients with MA and MO after PFO closure （ P 〈 0.05 ）. Influence of migraine on the quality of life significantly decreased and the average frequency and degree of migraine obviously reduced （ P 〈 0. 05 ）. CONCLUSION TYCE can enhance the detection rate of PFO. Transcatheter PFO closure is safe and effective and can alleviate symptoms of migraine and its influence on quality of life.