药物过度使用性头痛患者脑白质结构的变化

Changes of cerebral white matter in patients with medication-overuse headache

目的利用磁共振弥散张量成像技术研究药物过度使用性头痛患者脑白质结构的变化。方法药物过度使用性头痛患者(病例组)及年龄、性别相匹配的同期健康体检者(对照组)各80例,收集一般临床资料,进行颅脑磁共振弥散张量成像(diffusion tensor imaging,DTI)检查,测取部分各向异性(fractional anisotropy,FA)值、表观弥散系数(apparent diffusion coefficient,ADC)值,并结合临床特点进行相关性分析。结果 (1)病例组眶额皮质、前后扣带回皮质、胼胝体压部、右侧内囊前肢FA值较对照组明显降低,差异有统计学意义(P<0.05);(2)病例组右侧眶额皮质、左侧额下回皮质及前扣带回皮质ADC值较对照组明显升高,差异有统计学意义(P<0.05);(3)病例组双侧眶额部皮质以及右侧内囊后肢FA值与患者头痛病程及发作频率呈负相关;左侧内囊后肢FA值与头痛频率呈负相关;(4)病例组左侧眶额皮质ADC值与患者头痛病程及发作频率呈正相关;右侧眶额皮质以及前扣带回皮质ADC值与患者头痛发作频率呈正相关;后扣带回皮质ADC值与患者头痛病程呈正相关。结论药物过度使用性头痛患者双侧额叶皮质及扣带回皮质存在白质微观结构异常变化,FA值与患者头痛病程及发作频率呈负相关,ADC值则呈正相关。

Objective To investigate the microstructural abnormalities of cerebral white matter in patients with medication-overuse headache with diffusion tensor imaging. Methods Diffusion tensor magnetic resonance imaging （DT-MRI） was carried out in 80 migraine patients with medication-overuse headache （case group） and 80 age-and sex-matched healthy controls （control group）. Fractional anisotropy （FA） and apparent diffusion coefficient （ADC） were measured and the correlation between clinical characteristics and the changes was examined. Results ① The FA values at the bilateral orbitofrontal cortex, cingnlate cortex, splenium of the corpus callosum and the right anterior limb of the capsula interna were significantly lower than those in the controls（P〈0.05）.② The ADC values at the right orbitofrontal cortex, left inferior frontal gyrus and anterior cingulate cortex were significantly higher than those in the controls （P〈0.05）.③ There were negative correlations between FA values at the bilateral orbitofrontal cortex and right hind legs of the capsula interna and headache course as well as frequency. There was negative correlation between FA values at the left hind legs of capsula interna and headache frequency. ④ There were positive correlations between ADC values at the left orbitofrontal cortex and headache course as well as frequency. There were positive correlations between ADC values at the right orbitofrontal cortex and prior cingulate cortex and headache frequency. There was positive correlation between ADC values at the posterior cingnlate cortex and headache course. Conclutions There might be an integrity change of neurofibrotic microstructures in the bilateral orbitofrontal cortex and cingulate cortex in patients with medication-overuse headache, FA values are negatively associated with headache course and frequency whereas ADC values are positively associated with headache course and frequency.