偏头痛与紧张型头痛认知水平与功能MRI比较研究

MRI study of cognition and functional between migraine and tension-type headache

目的比较偏头痛与紧张型头痛患者认知水平与脑功能连接差异,希望对临床鉴别诊断及理解疾病发病机制有所帮助。方法共纳入52例偏头痛患者、41例紧张型头痛患者及47例健康对照者,头痛患者均处于发作间期。联合使用MoCA量表及事件相关电位P300评估偏头痛与紧张型头痛患者是否存在认知功能障碍。采集静息态功能MRI数据,以双侧丘脑作为感兴趣区(ROI),比较二者丘脑功能连接网络差异。结果偏头痛组MoCA评分较健康对照组降低(P<0.001),而紧张型头痛与健康对照组、偏头痛与紧张型头痛组MoCA评分相比无统计学差异。与健康对照组及紧张型头痛组相比,偏头痛组的P300潜伏期延长(P<0.001,P=0.018),紧张型头痛组的P300潜伏期相较于健康对照组无统计学差异。3组间P300波幅无统计学差异。与健康对照组及紧张型头痛组相比,偏头痛组左侧丘脑与双侧颞岛叶功能连接降低,而紧张型头痛组与健康对照组相比脑区未见统计学差异。与健康对照组及紧张型头痛组相比,偏头痛组右侧丘脑与右侧颞岛叶、右侧小脑及左侧额叶功能连接降低,而紧张型头痛组与健康对照组相比脑区未见统计学差异。结论偏头痛患者总体认知水平下降,紧张型头痛患者总体认知水平无明显损害。偏头痛患者存在丘脑功能连接异常,而紧张型头痛患者丘脑功能连接网络未见明显破坏。

Objective To compare the differences in cognitive function and functional MRI between mi⁃graine and tension-type headache(TTH),and hope to be helpful for the clinical diagnosis and understanding of the pathogenesis of them.Methods A total of 52 patients with migraine,41 patients with TTH and 47 healthy controls(HCs)were included,and the headache patients were all in the interictal period.The combination of Mo⁃CA scale and event-related potential P300 was used to assess whether patients with migraine or TTH had cogni⁃tive impairment.Resting-state functional MRI data were collected for all subjects,using the bilateral thalamus as the region of interest(ROI),the differences in the functional connectivity network based on the thalamus between them were compared.Results The MoCA score of the migraine group was lower than that of the HC group(P<0.001),while there was no statistical difference between the TTH group and the HC group,and between the mi⁃graine group and TTH group.The P300 latency of the migraine group was longer than that of the HC group and TTH group(P<0.001,P=0.018),the P300 latency of the TTH group was not statistically different from that of the HC group.There was no significant difference in the P300 amplitude among the three groups.Compared with the HC group and the TTH group,the mi⁃graine group showed decreased functional connectivity between the left thalamus and bilateral temporal lobeinsula.There were no sta⁃tistically differences in brain regions between the TTH group and the HC group.Compared with the HC group and the TTH group,the migraine group showed decreased functional connectivity of the right thalamus with the right temporal lobeinsula,the right cerebellum and the left frontal lobe.There were no statistically differences in brain regions between the TTH group and the HC group.Conclu⁃sion The overall cognitive level of patients with migraine decreases,while there is no significant impairment of it in TTH patients.The functional connectivity of thalamus is abnormal in migraine patients,while it is not significantly disrupted in TTH patients.