经导管封堵术治疗伴卵圆孔未闭偏头痛患者的临床效果

Clinical effect of transcatheter closure on migraine with patent foramen ovale

目的 评价经导管封堵术对合并卵圆孔未闭（PFO）偏头痛患者的治疗效果。方法 选取2014年3月至2015年3月于首都医科大学附属北京安贞医院就诊的偏头痛伴PFO（经食管超声心动图和经颅多普勒超声造影同时阳性确诊）的患者43例。根据是否接受PFO封堵手术分为手术组（9例）和非手术组（34例）。采用头痛影响测试问卷6（HIT-6）评估偏头痛程度。比较2组患者的头痛特征，追踪随访1年，比较2组患者的头痛缓解情况。结果 手术组的手术成功率为100%；1年后复查仅见右向左分流残留1例，分级为2级。手术组术前HIT-6评分明显高于非手术组［（68±5）分比（62±6）分］；手术组经手术治疗后HIT-6评分、头痛发作频率及持续时间均明显低于非手术组［（49±4）分比（57±4）分、（1.8±1.1）次/月比（2.4±1.3）次/月、（4.3±2.1）h/次比（5.6±3.2）h/次］，差异均有统计学意义（均P＜0.05）。随访1年后与治疗前HIT-6评分降低差值在手术组女性、先兆型偏头痛和持续性右向左分流患者中大于非手术组［（17.5±3.7）分比（5.4±2.8）分、（17.3±2.8）分比（7.2±3.5）分、（18.2±3.9）分比（10.3±3.7）分］，差异均有统计学意义（均P＜0.05）。结论 PFO封堵术对女性、静息状态下存在右向左分流的先兆型偏头痛患者是一种安全有效的治疗选择。

Objective To investigate the effect of transcatheter closure on migraine patients with patent foramen ovale（PFO）. Methods Forty-three migraine patients with PFO diagnosed by transesophageal echocardiography plus contrast-enhanced transcranial color doppler were enrolled from March 2014 to March 2015 in Beijing Anzhen Hospital, Capital Medical University; 9 patients had transcatheter closure for PFO（operation group） 34 patients had routine drug treatment（non-operation group）. Headache Impact Test-6（HIT-6） was used to assess the degree of headache. Migraine characteristics were analyzed during 1 year after operation. Results The success rate of transcatheter closure was 100%. The operation group had 1 case of grade 2 right-to-left shunt in 1 year after operation. The HIT-6 score in operation group before operation was significantly higher than that in non-operation group[（68±5）points vs （62±6）points]（P〈0.05）; HIT-6 score, frequency and duration of headache in operation group after operation were significantly lower than those in non-operation group[（49±4）points vs （57±4）points, （1.8±1.1）times/month vs （2.4±1.3）times/month, （4.3±2.1）h/times vs （5.6±3.2）h/times]（P〈0.05）. The 1 year difference values of HIT-6 score in female, migraine with aura and persistent right-to-left shunt patients in operation group were significantly higher than those in non-operation group[（17.5±3.7）points vs （5.4±2.8）points, （17.3±2.8）points vs （7.2±3.5）points, （18.2±3.9）points vs （10.3±3.7）points]（P〈0.05）. Conclusion Transcatheter PFO closure is safe and effective in treating migraine, especially for female migraine with aura and persistent right-to-left shunt.