偏头痛脑白质高信号与临床特征及右向左分流的相关分析

Association analysis of the white matter hyperintensities and clinical characteristics and right-to-left shunt in migraine

目的从临床特征角度探索偏头痛脑白质高信号(WMHs)的危险因素,并研究右向左分流(RLS)是否与偏头痛WMHs有关。方法纳入偏头痛患者,采集头痛资料,进行对比增强TCD检查是否存在RLS以及分流量大小,并行头颅MRI检查评估WMHs。结果共纳入57例偏头痛患者,其中合并WMHs共18例(31.6%),主要位于额、顶叶,病变程度较轻。在对年龄、性别、头痛特征、焦虑抑郁评分以及RLS等因素的分析中,发现合并WMHs组与不合并WMHs组之间,仅年龄(P=0.002)、病程(P=0.046)存在统计学差异。结论偏头痛患者中发现的WMHs,主要位于额、顶叶,年龄、病程可能是其危险因素,未发现先兆、发作频率、持续时间、疼痛程度、焦虑抑郁等临床特征与其相关,也未发现RLS会增加偏头痛患者WMHs的风险。

Abstract ： Objective To explore the risk factors of white matter hyperintensities （WMHs） in migraine patients from the perspectives of clinical characteristics and to investigate whether right-to-left shunt （ RLS ） relates to the WMHs. Methods Migraine patients were recruited to complete a questionnaire involving headache features, and underwent contrast-enhanced TCD for detecting the presence and grade of RLS and brain MRI scanning for WMHs evaluation. Results Fifiy-seven migraine patients were enrolled. WMHs were detected in 18 cases （3 1. 6% ）. The WMHs were mainly located in the frontal and parietal lobe and the lesions were generally mild. The differences of age, gender, headache features, scores of anxiety and depression and RLS between WMHs group and non-WMHs group were compared, and only age （ P = 0. 002） and disease duration （ P = O. 046 ） showed significant differences. Conclusions WMHs in migraine are mainly located in frontal and parietal lobe. Age and disease duration may be the risk factors of the WMHs. The associations between the presence of WMHs and the presence of aura, attack frequency, headache duration, headache degree or anxiety and depression are not found. RLS is neither associated with the risk of WMHs in migraine.