心脏右向左分流与家族聚集性前庭性偏头痛的相关性研究

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

目的探讨家族聚集性及散发性前庭性偏头痛(VM)患者的心脏右向左分流(RLS发生情况及严重程度与症状之间的相关性。方法纳入VM患者427例,根据是否有家族聚集倾向将其分为家族聚集型组(136例)和散发型组(291例),比较两组患者心脏RLS的发生率。再根据心脏RLS严重程度将427例VM患者分为无RLS组(263例)、轻度RLS组(57例)、中度RLS组(78例)及重度RLS组(29例),比较4组患者头痛及视觉先兆症状的发生率。结果 4组不同心脏RLS严重程度组VM患者头痛发生率比较差异有统计学意义,心脏RLS程度越重,患者头痛发生率越高(P <0.001)。轻、中、重度RLS组患者视觉先兆发生率均高于无RLS组,中、重度RLS组患者视觉先兆症状发生率均高于轻度RLS组(P <0.001)。结论 VM的家族聚集性与心脏RLS无明显相关性,VM患者的头痛及视觉先兆症状与心脏RLS关系更为密切,且卵圆孔未闭(PFO)引起的RLS程度越严重,越容易出现头痛及视觉先兆症状。

Objective To investigate the relationship between the incidence and severity of rightto-left shunt( RLS) of heart with symptoms in patients with familial clustered and sporadic vestibular migraine( VM). Methods A total of 427 VM patients were included. According to whether they had a tendency of family aggregation,they were divided into familial group( 136 cases) and sporadic group( 291 cases),and the incidence of heart RLS in the two groups was compared. According to the severity of heart RLS,427 VM patients were divided into 4 groups: non-RLS group( 263 cases),mild RLS group( 57 cases),moderate RLS group( 78 cases) and severe RLS group( 29 cases). The incidence of headache and visual aura symptoms in the four groups were compared. Results There were statistically significant differences in the incidence of headache among VM patients in the 4 groups with different heart RLS severity. The more severe the heart RLS severity was,the higher the incidence of headache was( P < 0. 001). The incidence of visual aura symptoms in the mild,moderate and severe RLS groups was higher than that in the non-RLS group,and the incidence of visual aura symptoms in the moderate and severe RLS groups was higher than that in the mild RLS group( P < 0. 001). Conclusion There is no significant correlation between the familial clustering of VM and heart RLS. VM patients with headache or visual aura are more closely related to heart RLS,and the more severe the RLS caused by patent foramen ovale( PFO),the more likely they are to have headache and visual aura symptoms.