偏头痛相关性脑白质病变的危险因素

Risk factors of migraine with white matter lesion

目的研究偏头痛、卵圆孔未闭（PFO）、脑白质病变（WML）之间的关系并分析偏头痛相关性WML的危险因素。方法连续选取2014年1月至2015年12月于首都医科大学附属北京安贞医院神经内科门诊就诊的126例偏头痛患者作为观察组，同期选取153例无偏头痛患者作为对照组。所有入选患者均进行头部磁共振成像检查WML。观察组患者均进行经食管超声心动图及增强经颅多普勒超声造影检查确认PFO和右向左分流（RLS）情况。记录2组患者的临床资料，头痛严重程度采用头痛影响测试问卷6（HIT-6）评估。分析偏头痛患者发生WML的危险因素。结果观察组WML发生率明显高于对照组［26.2%（33/126）比10.5%（16/153）］（P＜0.05）。观察组中WML亚组33例，无WML亚组93例。WML亚组年龄、先兆型偏头痛比例、头痛病程、头痛持续时间、HIT-6评分、合并PFO、持续性RLS、严重RLS（3级和4级）比例均明显高于非WML亚组［（38±6）岁比（34±6）岁、36.4%（12/33）比22.6%（21/93）、（8.2±3.6）年比（5.3±2.7）年、（6.3±1.3）h/次比（4.4±1.2）h/次、（68.5±2.4）分比（63.2±5.1）分、57.6%（19/33）比29.0%（27/93）、45.5%（15/33）比15.0%（14/93）、12.1%（4/33）比9.7%（9/93）、36.4%（12/33）比6.5%（6/93）］（均P＜0.05）。Logistic回归分析显示，先兆型偏头痛、头痛病程长、合并PFO和RLS 4级是偏头痛患者WML的独立危险因素（均P＜0.05）。结论偏头痛患者有更高发生WML的风险。先兆型偏头痛、长病程以及合并PFO和高级别RLS是WML的独立危险因素。

ObjectiveTo investigate the relation among migraine, patent foramen ovale（PFO） and white matter lesion（WML）; to analyze risk factors of migraine-related WML. MethodsFrom January 2014 to December 2015, 126 migraine patients were enrolled from Department of Neurology of Capital Medical University, Beijing Anzhen Hospital as observation group; 153 patients without migraine were enrolled as control group. WML was examined by brain magnetic resonance imaging in all patients. Migraine patients had transesophageal echocardiography and contrast-enhanced transcranial Doppler ultrasonography to diagnose PFO and right-to-left shunt（RLS）. Severity of migraine was evaluated by the Headache Impact Test-6（HIT-6）. Risk factors of WML in migraine patients were analyzed. ResultsThe incidence of WML in observation group was significantly higher than that in control group[26.2%（33/126） vs 10.5%（16/153）]（P〈0.05）. The observation group was divided into WML group（33 cases） and non-WML group（93 cases）. There were significant differences of age, migraine with aura, course of migraine, duration of headache, score of HIT-6, PFO, persistent RLS, severe RLS（grade 3-4） between WML group and non-WML group[（38±6）years vs （34±6）years, 36.4%（12/33） vs 22.6%（21/93）, （8.2±3.6）years vs （5.3±2.7）years, （6.3±1.3）h/time vs （4.4±1.2）h/time, （68.5±2.4）points vs （63.2±5.1）points, 57.6%（19/33） vs 29.0%（27/93）, 45.5%（15/33） vs 15.0%（14/93）, 12.1%（4/33） vs 9.7%（9/93）, 36.4%（12/33） vs 6.5%（6/93）]（P〈0.05）. Logistic regression analysis demonstrated that migraine with aura, course of migraine, PFO and grade 4 RLS were independent risk factors of migraine-related WML（P〈0.05）. ConclusionsMigraine patients have high risk of WML. Migraine with aura, long course of disease, PFO and severe RLS are independent risk factors of WML in patients with migraine.