延边地区中青年偏头痛与脑白质病变的相关性

Correlation between migraine and white matter lesions in young and middle-aged in Yanbian area

[目的]观察延边地区中青年偏头痛患者出现脑白质病变(WMLs)的发生率和右向左分流(RLS)的阳性率,分析延边地区朝鲜族、汉族偏头痛患者RLS分流量大小与发生WMLs的相关性.[方法]偏头痛组为根据国际头痛分类Ⅲ-β版诊断标准纳入18~50岁的偏头痛患者142例,对照组为性别匹配且无偏头痛病史的健康志愿者52例.收集基本资料和头痛的临床信息,行头部MRI检查评估WMLs,分为WMLs+和WMLs-;采用经颅多普勒超声发泡试验进行RLS的诊断和分级,分为RLS+和RLS-;进一步分析WMLs与RLS间的相关性.[结果]偏头痛组中WMLs+为86例(60.1%),WMLs-为56例(39.9%),对照组中WMLs+为16例(30.8%),WMLs-为36例(69.2%),两组间差异有统计学意义(χ^(2)=13.55,P<0.05).偏头痛组中RLS-为51例(35.9%),RLS+为91例(64.1%),RLS+合并WMLs+者61例(67.0%),其中Ⅰ级分流7例(11.4%),Ⅱ级分流12例(20.0%),Ⅲ级分流26例(42.6%),Ⅳ级分流16例(26.2%),RLS+合并WMLs-者30例(33.0%),其中Ⅰ级分流10例(33.3%),Ⅱ级分流12例(40.0%),Ⅲ级分流3例(10.0%),Ⅳ级分流5例(16.7%).对照组中RLS+为15例(28.9%),RLS-为37例(71.1%).偏头痛组与对照组RLS+发生率间存在明显差异(χ^(2)=19.07,P<0.05).偏头痛组中RLS+合并WMLs+与合并WMLs-者间差异有统计学意义(χ^(2)=4.44,P<0.05),且Ⅲ、Ⅳ级分流合并WMLs+发生率明显高于合并WMLs-(χ^(2)=19.07,P<0.05).有无WMLs的偏头痛患者民族、性别、年龄、家族史等基线资料间差异无统计学意义(P>0.05).[结论]偏头痛患者较正常人RLS阳性率及WMLs发生率均高,且大量以上分流量的偏头痛患者WMLs发生率更高.

OBJECTIVE To observe the incidence of white matter lesions(WMLs)and the positive rate of right-to-left shunt(RLS)in young and middle-aged migraine patients in Yanbian area,and to analyze the correlation between the shunt volume of RLS and WMLs in Korean and Han nationality migraine patients in Yanbian area.METHODS A total of 142 migraine patients aged 18 to 50 were included in the migraine group according to the diagnostic criteria of the international classification of HeadacheⅢ-βedition,and 52 gender-matched healthy volunteers without a history of migraine were included in the control group.Basic Data and clinical information of headache were collected,and head MRI was performed to evaluate WMLs,which were divided into WMLs+and WMLs-.The diagnosis and grading of RLS were performed by transcranial Doppler ultrasound foaming test,divided into RLS+and RLS-.The correlation between WMLs and RLS was further analyzed.RESULTS In the migraine group,86 cases(60.1%)were WMLs+and 56 cases(39.9%)were WMLs-,and in the control group 16 cases(30.8%)were WMLs+and 36 cases(69.2%)were WMLs-,the difference between the two groups was statistically significant(χ^(2)=13.55,P<0.05).In the migraine group,there were 51 cases(35.9%)with RLS-,91 cases(64.1%)with RLS+,and 61 cases(67.0%)with RLS+combined with WMLs+,among them,there were 7 cases(11.4%)with gradeⅠshunt,12 cases(20.0%)with GradeⅡshunt,26 cases(42.6%)with GradeⅢshunt and 16 cases(26.2%)with gradeⅣshunt.There were 30 cases(33.0%)with RLS+combined with WMLs-,including 10 cases(33.3%)with gradeⅠshunt,12 cases(40.0%)with gradeⅡshunt,3 cases(10.0%)with gradeⅢshunt and 5 cases(16.7%)with gradeⅣshunt.In the control group,15 cases(28.9%)had RLS+and 37 cases(71.1%)had RLS-.There was a significant difference in RLS+incidence between the migraine group and the control group(χ^(2)=19.07,P<0.05).The difference between RLS+combined with WMLs+and WMLs-was statistically significant in the migraine group(χ^(2)=4.44,P<0.05),and the incidence of GradeⅢandⅣcombined with WMLS+was significantly higher than that with WMLs-(χ^(2)=19.07,P<0.05).There was no significant difference in baseline data of migraine patients with and without WMLs,such as nationality,gender,age and family history(P>0.05).CONCLUSION The positive rate of RLS and the incidence of WMLs in migraine patients are higher than those in normal people,and the incidence of WMLs is higher in migraine patients with a large amount of shunt.