食道超声引导经皮卵圆孔封堵术治疗偏头痛合并卵圆孔未闭患者的疗效分析

Analysis of therapeutic effect of esophageal ultrasound-guided percutaneous patent foramen ovale closure on migraine patients complicated with patent foramen ovale

目的观察经食道超声引导下经皮卵圆孔未闭封堵术在偏头痛合并卵圆孔未闭(PFO)患者治疗中的临床效果。方法回顾性纳入2020年2月至2022年1月临沂市人民医院收治的偏头痛合并PFO患者120例为研究对象。按照治疗方法不同将其分为内科治疗组(n=60)和介入封堵组(n=60)。纳入研究的偏头痛合并PFO患者中,内科治疗组有3例患者失随访,剩57例;介入封堵组有2例患者(均为有脑缺血病变患者)失随访,剩58例。内科治疗组给予常规内科治疗,介入封堵组在内科治疗基础上行经食道超声引导经皮卵圆孔未闭封堵治疗。两组均随访12个月,对患者治疗后1、6、12个月进行调查问卷评估,主要通过头痛影响测定-6评分(HIT-6)评分、视觉模拟评分法(VAS)评分和偏头痛发作频率来评估治疗的有效率。介入封堵组根据术前颅脑磁共振是否存在无症状性脑梗死(SBI)或白质高信号(WMHs)等亚临床脑缺血病变,分为有脑缺血病变(n=46)和无脑缺血病变(n=12),观察并比较两组患者治疗的有效率。结果介入封堵组治疗有效率为81.04%,高于内科治疗组(54.38%),差异有统计学意义(P<0.05)。治疗后1、6、12个月,介入封堵组HIT-6评分分别为(35.15±2.61)、(33.04±2.26)、(30.22±2.01)分,均低于内科治疗组[(47.29±3.14)、(45.19±3.03)、(43.27±2.95)分,差异均有统计学意义(P<0.05)。治疗后1、6、12个月,介入封堵组VAS评分分别为(3.05±0.76)、(2.74±0.71)、(2.22±0.65)分,均低于内科治疗组[(4.09±1.01)、(3.78±0.93)、(3.27±0.88)分],差异均有统计学意义(P<0.05)。治疗后1、6、12个月,介入封堵组偏头痛发作频率分别为(4.45±1.06)、(3.11±0.94)、(2.41±0.75)次/月,均低于内科治疗组[(6.09±1.21)、(5.82±1.03)、(4.07±0.98)次/月],差异均有统计学意义(P<0.05)。介入封堵组中,有脑缺血病变亚组治疗有效率为86.96%,高于无脑缺血病变亚组(58.33%)],差异有统计学意义(P<0.05)。结论偏头痛合并PFO患者通过内科治疗联合介入封堵治疗相比于常规内科治疗的有效性更佳,明显降低患者偏头痛的疼痛程度和发作频率;另外,对于偏头痛合并PFO的患者,术前存在脑缺血病变者经皮卵圆孔封堵治疗对于偏头痛治疗的有效性更高。

Objective To observe the clinical effect of esophageal ultrasound-guided the percutaneous patent foramen ovale closure treatment in patients with migraine and patent foramen ovale(PFO).Methods A total of 120 patients with migraine complicated with PFO who were treated in Linyi People's Hospital from February 2020 to January 2022 were selected and divided into internal treatment group(n=60)and internal treatment combined with closure treatment group(n=60)according to the different treatment methods.Among the migraine patients with PFO included in the study,3 patients in the internal medicine treatment group lost follow-up,leaving 57 patients.Two patients in the occlusion group(all patients with cerebral ischemic lesions)lost follow-up,with 58 remaining.The internal medicine treatment group received routine internal medicine treatment,while the occlusion group received percutaneous transesophageal ultrasound guided closure of patent foramen ovale on the basis of internal medicine treatment.Two groups were followed up for 12 months.The effectiveness were evaluated by mainly through headache impact test-6(HIT-6)score,visual analogue scale(VAS)score and migraine frequency of at 1,6,12 months after treatment.Internal medical treatment combined with closure treatment group was divided into ischemic lesions(n=46)and no cerebral ischemia disease(n=12),according to preoperative brain magnetic resonance presence of asymptomatic cerebral infarction(silent brain infarction,SBI)or white matter high signal(white matter high intensity,WMHs)subclinical ischemic lesions,and the effectiveness of treatment in both groups were observed and compared.Results The effective rate of intervention occlusion group was 81.04%,which was higher than that of the internal medicine treatment group(54.38%),and the difference was statistically significant(P<0.05).At 1,6,12 months after treatment,the HIT-6 scores of the interventional occlusion group were(35.15±2.61),(33.04±2.26),and(30.22±2.01)pionts,respectively,which were lower than those of the internal medicine treatment group(47.29±3.14),(45.19±3.03),and(43.27±2.95)pionts,and the differences were statistically significant(P<0.05).At 1,6,12 months after treatment,the VAS scores of the interventional occlusion group were(3.05±0.76),(2.74±0.71),and(2.22±0.65)points,respectively,which were lower than those of the internal medicine treatment group[(4.09±1.01),(3.78±0.93),and(3.27±0.88)points],and the differences were statistically significant(P<0.05).At 1,6,12 months after treatment,the frequency of migraine attacks in the interventional occlusion group was(4.45±1.06),(3.11±0.94),and(2.41±0.75)times/month,respectively,which were lower than those in the internal medicine treatment group[(6.09±1.21),(5.82±1.03),and(4.07±0.98)times/month],and the differences were statistically significant(P<0.05).In the occlusion group,the effective rate of treatment in the subgroup with cerebral ischemic lesions was 86.96%,which was higher than that in the subgroup without cerebral ischemic lesions(58.33%),and the difference was statistically significant(P<0.05).Conclusion Compared with the medical treatment,closure treatment is better for migraine patients with PFO,significantly reduce the frequency and degree of patients with migraine attack.In addition,for patients with migraine combined with PFO,percutaneous foramen ovale occlusion therapy is more effective for the treatment of migraine in patients with preoperative cerebral ischemic lesions.