偏头痛发作频率及类型与MRI下脑白质损害的相关性研究

Correlation between the frequency and type of migraine and the white matter damage on MRI

目的探讨偏头痛发作频率、类型与MRI下脑白质损害的相关性。方法选取104例偏头痛患者作为偏头痛组,另以100名健康体检者作为对照组。2组均行MRI检查明确脑白质损害情况,比较2组脑白质损害的发生率。根据MRI结果将偏头痛组分为脑白质损害组与非损害组,比较两者的偏头痛类型、发作频率、持续时间、汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分、匹兹堡睡眠质量指数(PSQI)、血清同型半胱氨酸(Hcy)水平等各项临床指标,分析它们与脑白质损害的相关性。结果观察组脑白质损害发生率38.5%高于对照组的10.0%(P<0.05)。2组脑白质损害的发生部位均以额叶(36.8%及37.5%)与顶叶(2组均为25.0%)为主。脑白质损害组与非损害组性别、年龄、糖尿病史、高血压病史、冠状动脉粥样硬化性心脏病史、吸烟史、饮酒史、家族史、HAMA评分、HAMD评分、PSQI比较差异均无统计学意义(P均>0.05)。脑白质损害组的病程[(3.30±1.30)年]长于无损害组[(2.10±0.98)年],血清Hcy水平[(19.49±3.77)μmol/L]高于非损害组[(15.00±4.02)μmol/L](P均<0.05)。脑白质损害组有先兆症状、发作频率>3次/月、持续时间>24 h的百分比[62.5%、72.5%、67.5%]均高于无损害组[35.9%、48.4%、53.1%](P均<0.05)。脑白质损害与偏头痛持续时间无明显相关性(P>0.05);脑白质损害与偏头痛病程、类型、发作频率均呈正相关(P<0.01)。结论偏头痛患者额叶与顶叶易出现脑白质损害,且脑白质损害发生率高于健康者。偏头痛发作频率、类型、血清Hcy水平均与脑白质损害相关。

Objective To investigate the correlation between the frequency and type of migraine and the white matter damage on magnetic resonance imaging（ MRI）. Methods A total of 104 patients diagnosed with migraine were recruited in the migraine group,and 100 healthy subjects receiving physical examination were assigned into the control group. The severity of white matter damage was assessed on MRI in two groups.The incidence of white matter damage was statistically compared between two groups. Based upon the MRI findings,patients in the migraine group were further divided into white matter damage and non-damage groups. Migraine type,frequency of onset and duration, Hamilton Anxiety Rating Scale（ HAMA） score,Hamilton Depression Rating Scale（ HAMD） scores,Pittsburgh Sleep Quality Index（ PSQI）,serum homocysteine（ Hcy） levels were observed and statistically compared between two groups. The correlation between these parameters and white matter damage was analyzed. Results The incidence of white matter damage was 38. 5%in the migraine group,significantly higher compared with 10. 0% in the control group（ P 〈0. 05）. In two groups,the white matter damage was mainly observed in the frontal lobe（ 36. 8% and 37. 5%） and parietal lobe（ 25. 0% and 25. 0%）. There were no significant differences in the gender,age,history of diabetes mellitus,hypertension,CHD,smoking history,drinking history,family history,HAMA,HAMD and PSQI scores between the white matter damage and non-damage groups（ all P 〉0. 05）. In the white matter damage group,the course of disease was（ 3. 30 ± 1. 30） years,significantly longer than（ 2. 10 ± 0. 98） years in the non-damage group（ P〈 0. 05）. The serum Hcy level in the white matter damage group was（ 19. 49 ± 3. 77） μmol/L,significantly higher than（ 15. 00 ± 4. 02） μmol/L in the non-damage group（ P〈 0. 05）. In the white matter damage group, the proporation of premonitory symptoms（ 62. 5%）, onset frequency 〉3 times/month（ 72. 5%）,duration time〉 24 h（ 67. 5%） was significantly higher compared with 35. 9%,48. 4% and53. 1% in the non-damage group（ all P 〈0. 05）. There was no significant correlation between the duration of migraine and white matter damage（ P 〉0. 05）. The white matter damage was positively correlated with the duration,type and frequency of migraine（ all P〈 0. 01）. Conclusions Migraine patients are prone to present with white matter damage in the frontal and parietal lobes. The incidence of white matter damage in migraine patients is significantly higher than that in the healthy counterparts. The frequency and type of migraine and serum Hcy level are positively correlated with the white matter damage.