卵圆孔未闭介入封堵术治疗偏头痛疗效的观察

Observation on the efficacy of patent foramen ovale closure in treating migraine

目的本研究旨在探讨介入封堵术治疗卵圆孔未闭(PFO)并发偏头痛的疗效。方法选取2019年4月至2022年8月在河北医科大学第二医院诊断并完成介入封堵术的209例PFO并发偏头痛患者作为研究对象。在术前及术后3、6、12个月对患者的偏头痛症状进行评估,包括头痛影响测试-6(HIT-6)、数字评分表(NRS)、月均头痛发作次数和平均头痛持续时间,根据最后一次随访节点的头痛结局判断疗效:HIT-6评分结果较术前下降一级或NRS评分、月均头痛发作次数、平均头痛持续时间较术前下降50%及以上者认为治疗有效,对临床资料和PFO解剖结构进行统计分析。结果先兆性偏头痛患者治疗有效率为88.4%,无先兆偏头痛患者治疗有效率为77.2%,两组有效率差异有统计学意义(差值0.11,差值95%CI0.01-0.21,P=0.034)。复杂型PFO患者治疗有效率为87.9%,简单型PFO患者治疗有效率为77.3%,两组有效率差异有统计学意义(差值0.11,差值95%CI 0.00~0.20,P=0.045)。有隐源性卒中病史的患者治疗有效率为94.6%,无隐源性卒中的患者治疗有效率为79.7%,两组效率差异有统计学意义(差值0.15,差值95%CI 0.05~0.24,P=0.031)。结论PFO合并先兆性偏头痛、隐源性卒中或有复杂型PFO结构的患者经介入封堵术治疗后偏头痛症状有明显的改善。

Objective Explore the efficacy of patent foramen ovale(PFO)closure in the treatment of migraine associated with PFO.Methods 209 patients with PFO complicated with migraine who were diagnosed and underwent PFO closure at the Second Hospital of Hebei Medical University from April 2019 to August 2022were selected as the study subjects.Evaluate the patient's migraine symptoms before and 3,6,and 12 months after surgery,including Headache Impact Test(HIT-6),Numeric Rating Scale(NRS),monthly migraine attack frequency,and average migraine duration.Evaluate the therapeutic effect based on the headache outcome at the last followup node:the HIT-6 score results decrease by one level or NRS score,the monthly migyaine attack frequency,and the average migyaine duration decrease by 50%or more compared to preoperative,consider the treatment effective.Conduct statistical analysis on clinical data and PFO anatomical structure.Results The effective rate of treatment for migraine with aura was 88.4%,while for migraine without aura was 77.2%.There was a statistical difference in the effective rate between the two groups(difference 0.11,difference 95%CI 0.01-0.21,P=0.034).The effective rate of complex PFO patients was 87.9%,while the effective rate of simple PFO patients was 77.3%.There was a statistical difference in the effective rate between the two groups(difference 0.11,difference 95%CI 0.00-0.20,P=0.045).The effective rate of treatment for patients with a history of cryptogenic stroke was 94.6%,while the effective rate for patients without cryptogenic stroke was 79.7%.There was a statistical difference in the effective rate between the two groups(difference 0.15,difference 95%CI 0.05-0.24,P=0.031).Conclusion Patients with PFO combined with migraine with aura,cryptogenic stroke,or complex PFO structures showed significant improvement in migraine symptoms after PFO closure surgery.