心脏右向左分流对偏头痛患者临床症状的影响

Effect of Right-to-left Shunt on Clinical Symptoms of Migraine Patients

目的:探讨心脏右向左分流(RLS)对偏头痛患者临床特征是否存在影响,并研究RLS分级与头痛强度之间的关系。方法:选择2016年6月-2018年12月青岛大学附属医院收治的偏头痛患者216例作为偏头痛组,选择于青岛大学附属医院体检的健康志愿者60例作为对照组。216例偏头痛患者根据有无RLS分为有RLS偏头痛组(127例)和无RLS偏头痛组(89例)。有RLS偏头痛患者根据RLS分级将其分为大分流组(n=51)、中分流组(n=11)和小分流组(n=65)。观察对照组与偏头痛组RLS情况,比较有RLS偏头痛组和无RLS偏头痛组患者的一般资料情况,比较大分流组、中分流组和小分流组患者的一般资料情况,采用多因素Logistic回归分析偏头痛患者产生RLS的危险因素。结果:对照组与偏头痛组小分流、中分流患病率比较差异无统计学意义(P>0.05),而偏头痛组大分流患病率高于对照组(P<0.05)。有RLS偏头痛组患者的视觉先兆、感觉先兆的比例均大于无RLS偏头痛组,头痛初始年龄均小于无RLS偏头痛组,头痛强度均高于无RLS偏头痛组(P<0.05),两组患者年龄、性别、吸烟、饮酒、高血压、糖尿病、高血脂、运动先兆、遗传、头痛频率、头痛持续时间比较差异无统计学意义(P>0.05)。不同RLS分级的偏头痛患者的视觉先兆、感觉先兆、头痛初始年龄、头痛强度整体比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,视觉先兆、感觉先兆、头痛初始年龄是偏头痛患者产生RLS的独立危险因素(P<0.05)。结论:偏头痛发病年龄较小或有视觉先兆、感觉先兆可能提示偏头痛患者伴有RLS,RLS分级与头痛强度没有关系。

Objective: To investigate the influence of right-to-left shunt(RLS) on the clinical characteristics of migraine patients,and to study the relationship between RLS classification and headache intensity. Methods: 216 migraine patients admitted to the Affiliated Hospital of Qingdao University from June 2016 to December 2018 were selected as the migraine group, and 60 healthy volunteers in the Affiliated Hospital of Qingdao University were selected as the control group. 216 migraine patients were divided into RLS migraine group(127 cases) and non-RLS migraine group(89 cases) according to the presence or absence of RLS. Migraine patients with RLS were divided into large shunt group(n=51), medium shunt group(n=11) and small shunt group(n=65) according to RLS classification. The RLS was observed in control group and migraine group. The general data of migraine group with RLS and migraine group without RLS were compared. The general data of large shunt group, medium shunt group and small shunt group were compared.Multivariate Logistic regression analysis was used to analyze the risk factors of RLS in migraine patients. Results: There was no significant difference in the prevalence of small shunt and medium shunt between the control group and the migraine group(P>0.05),while the prevalence of large shunt in the migraine group was higher than that in the control group(P<0.05). The percentages of visual and sensory precursors in RLS migraine group were higher than those in non-RLS migraine group, initial age of headache was less than that in non-RLS migraine group, headache intensity was higher than that in non-RLS migraine group(P<0.05). There was no significant difference in age, sex, smoking, alcohol consumption, hypertension, diabetes, hyperlipidemia, exercise precursors, heredity, frequency of headache and duration of headache between the two groups(P>0.05). There were significant differences in visual precursors, sensory precursors, initial age of headache and headache intensity among migraine patients with different RLS classification(P<0.05).Multivariate Logistic regression analysis showed that visual precursors, sensory precursors, initial age of headache were independent risk factors for RLS in migraine patients(P<0.05). Conclusion: The younger age of migraine onset or visual and sensory precursors may indicate that migraine patients have RLS, RLS classification has no relationship with headache intensity.