偏头痛患者脑白质损害情况及影响因素分析

Analysis of white matter damage and influencing factors in patients with migraine

目的探讨偏头痛患者脑白质损害情况及影响因素分析。方法对114例偏头痛患者行磁共振成像、经食道超声心动图及经颅多普勒超声声学造影检查,明确患者脑白质损伤及右向左分流情况,采用单因素及多元Logistic回归分析探讨偏头痛患者脑白质损伤的影响因素。结果本组114例患者,发生脑白质损伤35例(30.7%),无脑白质损伤79例(69.3%)。脑白质损伤患者中存在单发病灶7例,多发病灶28例,共计72个病灶;脑白质损伤部位以额叶(36.1%)、顶叶(23.6%)为主。脑白质损伤患者头痛病程、头痛持续时间显著高于无损伤患者(P<0.05),其他资料比较差异无统计学意义(P>0.05)。有无脑白质损伤患者右向左分流分级比较差异有统计学意义(P<0.01),其中脑白质损伤患者大量分流占比为50.0%,显著高于无脑白质损伤患者(P<0.01)。回归分析显示,头痛病程、右向左分流分级是偏头痛患者脑白质损害的危险因素(OR=2.440、3.174,P<0.01)。结论部分偏头痛患者存在脑白质损害,主要病灶在脑额叶、顶叶;头痛病程及右向左分流分级是偏头痛患者脑白质损害的危险因素。

Objective To investigate the white matter damage and influencing factors in patients with migraine.Methods A total of 114 patients with migraine were examined by magnetic resonance imaging(MRI),transesophageal echocardiography(TEE)and contrast transcranial Doppler ultrasonography(c-TCD)to determine the white matter injury and right to left shunt.Univariate and logistic regression analysis were used to investigate the influencing factors of white matter damage in patients with migraine.Results Of the 114 patients in this group,there were 35 cases(30.7%)of white matter injury and 79(69.3%)cases without white matter damage.Among the patients with white matter injury,there were 7 cases of single lesions and 28 cases of multiple lesions,a total of 72 lesions.The location of white matter injury were mainly frontal lobe(36.1%)and parietal lobe(23.6%).The course of headache,the duration of headache in patients with white matter injury were significantly higher than those in patients without injury(P<0.05),and there was no significant difference in other data(P>0.05).There was a statistically significant difference in RLS grading between patients with and without white matter injury(P<0.01),and the proportion of massive shunt in patients with white matter injury was 50.0%,which was significantly higher than that in patients without white matter injury(P<0.01).The results of logistic regression analysis showed that the course of the headache and the right to left shunt were the risk factors for the white matter damage in migraine patients(OR=2.440,3.751,P<0.05).Conclusions Some migraine patients have white matter damage,mainly in the frontal and parietal lobes.The course of headache and the classification of right to left shunt are the risk factors of white matter damage in patients with migraine.