前庭性偏头痛与心脏右向左分流的相关性

Relationship between vestibular migraine and right-to-left shunt of heart

目的采用经颅多普勒超声(TCD)发泡试验研究前庭性偏头痛(VM)患者心脏右向左分流(RLS)的发生率。方法收集2016年6月至2017年1月就诊于陕西省人民医院的VM患者的临床资料。选取同期无心脏病史及反复发作头痛史的健康志愿者为对照组。采集人口学资料及病史,行TCD发泡试验检查。统计各组心脏RLS的发生率,以及RLS分流量与VM伴发症状的关系。结果纳入VM患者139例(男23例,女116例);正常对照组30名。VM组和正常对照组的RLS发生率分别为25.9%、23.3%,两组比较差异无统计学意义(P>0.05)。RLS阳性的VM患者出现心慌症状的比例高于RLS阴性的VM患者(P<0.05)。视觉先兆在RLS阳性和阴性人群中的发生率差异无统计学意义(P>0.05)。心脏RLS的分流量与VM的眩晕发病年龄、症状持续时间无显著相关性(P>0.05)。RLS阳性的VM患者中,小分流量组眩晕发作频率为7.35次/年,而大分流量组为7.27次/年,两组间差异有统计学意义(P<0.05)。结论 VM患者的RLS发生率与正常人群相比无明显差异;小分流量RLS阳性的VM患者的症状发作更频繁,RLS阳性VM患者出现心慌症状的比例也高于RLS阴性患者。

Objective To investigate the incidence of right-to-left shunt(RLS)of heart in patients with vestibular migraine(VM)using transcranial Doppler(TCD)foaming test.Methods The clinical data of patients with VM who were diagnosed in Shaanxi Provincial People's Hospital from Jun.2016 to Jan.2017 were collected,and the volunteers without history of cardiac disease or headache during the same period were included as controls.The incidences of RLS of heart in each group were determined using TCD foaming test,and the relationship between the volume of RLS and the concomitnta symptoms of VM was analyzed.Results A total of 139 VM patients(23 males and 116 females)and 30 volunteers were included in this study.There was no significant difference in the incidence of RLS between the VM and control groups(25.9% vs 23.3%,P>0.05).RLS-positive VM patients had a significantly higher rate of palpitation than those with negative RLS(P<0.05).There was no significant difference in visual aura between RLS-positive and RLS-negative VM patients(P>0.05).The shunt volume of RLS was not related to the age of onset or the duration of VM(P>0.05).Among RLS-positive VM patients,the frequency of vertigo in the small shunt amount group(air slug signal of RLS≤10)was significantly higher than that in the large shunt amount group(air slug signal of RLS>10)(7.35 times per year vs 7.27 times per year,P<0.05).Conclusion There is no significant difference in the incidence of RLS between VM patients and normal population.RLS-positive VM patients with small shunt amount are more likely to experience palpitation,and palpitation is more common in RLS-positive VM patients than in RLS-negative patients.