偏头痛慢性转化的研究现状

偏头痛(chronic migraine,CM)是原发性头痛中最常见的两种类型之一,高发于中青年。综合近年来文献研究结果显示:偏头痛慢性转换的常见危险因素主要包括可干预的危险因素及不可干预的危险因素,前者包括肥胖、受教育程度、经济收入水平、药物的过度服用情况、睡眠质量、精神共患疾病等因素,不可干预的危险因素包括患者的性别、年龄、病程、基础头痛频率及程度,家族史等。     

偏头痛多种危险因素的分析

目的：研究偏头痛的危险因素。方法：用1：1配对对照的方法进行单因素分析,再用Mc Nemar‘s test公式计算卡方,求得P值,并计算相对危险度。结果：家族遗传史、过敏性疾病史,在病例组与对照间有非常 显著性;睡眠不足、夜间工作,病例组与对照组间有显著性差异。结论：家族遗传史、过敏性疾病史是偏头痛的危险因素。     

短暂性脑缺血发作的危险因素研究进展

颅内血管病变导致一过性或短暂性、局灶性脑或视网膜功能障碍,称为短暂性脑缺血发作。以反复发作的短暂性失语、瘫痪或感觉障碍为特点,每次发作持续数分钟,通常在60min内完全恢复。目前该病尚不能通过影像、生理指标等进行预测,给该病的预防及治疗带来较大难度。因此,探讨该病的发作危险因素,针对这些危险因素做一些针对性的预防工作,对患者具有重要意义。     

慢性心力衰竭急性发作院内死亡相关危险因素的研究

目的 对因慢性心力衰竭急性发作而入院患者的院内死亡率及与其相关的危险因素进行分析,旨在找出有价值的预警指标指导临床实践.方法 对434例慢性心力衰竭急性发作患者进行回顾性分析,检测其入院时的各项指标,包括性别、年龄及入院后的第一次临床检查和实验室检查指标.结果 慢性心力衰竭急性发作的院内死亡率为11.9%;发现6个与院内死亡率相关的危险因素:冠心病史(OR值1.845,95%置信区间1.016～3.351)、高钠血症(OR值3.631,95%置信区间1.571～8.391)、低钠血症(OR值2.310,95%置信区间1.133～4.713)、高钾血症(OR值3.188,95%置信区间1.542～6.590)、血尿素氮升高(OR值3.450,95%置信区间1.699～7.005)和血肌酐升高( OR值2.334,95%置信区间1.256～4.339).结论 既往冠心病史、合并肾功能不全、异常血钠、高钾血症提示慢性心力衰竭患者预后不良.     

慢性乙型肝炎并发肝源性糖尿病的危险因素分析及治疗

目的分析慢性乙型肝炎患者易患糖尿病的危险因素及治疗后的转归情况,为临床预防及诊治提供参考。方法选择35例慢性乙型肝炎并发肝源性糖尿病患者及随机选取38例无血糖升高的慢性乙型肝炎患者作为对照,进行糖尿病的危险因素分析及观察治疗效果。结果合并脂肪肝和r-GT为慢性乙型肝炎并发肝源性糖尿病的危险因素;经有效治疗所有患者血糖均恢复正常;对照组有14例患者存在糖耐量异常。结论对慢性乙型肝炎患者,应常规检测空腹及餐后血糖,同时注意监测r—GT,预防脂肪肝,以减少发生肝源性糖尿病的可能性。     

进展性脑梗死危险因素分析

目的:探讨导致急性脑梗死患者急性期病情进展的危险因素。方法:对本院进展性脑梗死住院患者40例的临床资料进行回顾性分析,并与非进展性脑梗死患者40例进行比较。结果:进展性脑梗死患者合并高血压、糖尿病、高脂血症、高纤维蛋白原血症及血管狭窄的例数明显高于非进展性脑梗死患者。结论:高血压、糖尿病、高脂血症、高纤维蛋白原血症及脑血管狭窄可能与脑梗死患者急性期病情进展有关。     

短暂性脑缺血发作相关危险因素对预后的影响

目的：了解短暂性脑出血发作（T IA）相关危险因素及其对预后的影响。方法：参照英国ABCD评分标准,结合本组68例T IA住院患者,应用相关危险因素资料改良ABCD评分进行危险分层,分为高、中、低危组,观察30 d内相关危险因素对预后的影响。结果：68例T IA患者,颈内动脉系统27例,7例进展为脑梗死,占颈内动脉系统T IA的25.92%;椎-基底动脉系统41例,2例进展为脑梗死,占椎-基底动脉系统T IA的4.88%。9例进展为脑梗死的患者,7例为高危组,2例为中危组。结论：T IA的预后与其危险分层呈正相关。     

男性尖锐湿疣反复发作的危险因素调查

目的 调查男性尖锐湿疣(CA)反复发作的危险因素,并探讨防护对策.方法 选取医院2018年7月—2019年8月收治的240例男性CA患者为研究对象,将反复发作的127例患者纳为病例组,未反复发作的113例患者纳为对照组.收集相关信息,进行多因素Logistic逐步回归分析,确定影响CA疾病反复发作的相关因素.结果 单因...     

儿童哮喘发作危险因素的分析

目的探讨汕头市城区儿童哮喘发病的危险因素,为制订干预对策与措施提供依据。方法选择汕头市城区3～14岁儿童哮喘患者100例和非哮喘儿童100例,按1：1配对进行病例对照分析,应用单因素和多元逐步回归和多因素logistie回归分析,调查和分析儿童哮喘的危险因素。结果儿童呼吸道感染史、过敏史、特应性体质、家族哮喘史、家庭装修、被动吸烟、气质类型和婴儿期喂养方式等因素对儿童哮喘发病有统计学意义。结论儿童呼吸道感染史、过敏史、特应性体质、家族哮喘史、家庭装修、被动吸烟是儿童哮喘的危险因素。气质类型和婴儿期喂养方式对于儿童哮喘发病亦起重要作用。     

慢性偏头痛和慢性紧张型头痛临床特征分析

目的:分析比较慢性偏头痛(CM)和慢性紧张型头痛(CTTH)的临床特征.方法:回顾性研究66例CM和CTTH的人口学特征及临床特征.结果:CM 46例,CTTH 20例.单因素分析显示CM组与CTTH组患者间的发病年龄,病程均有显著性差异(P＜0.05);CM组头痛程度多为中到重度,过度服用止痛药物的情况在CM组也更常见(P＜0.001);两组患者的性别和年龄没有差异.结论:CM患者的发病年龄早于CTTH患者,同时CM患者的头痛严重程度以及止痛药物过度使用情况均高于CTTH患者,CM患者应该与CTTH患者区别对待.在临床工作中,全面评估慢性头痛的临床特征,明确头痛的严重程度,正确诊断慢性头痛的类型,可以有效提高CDH患者的预后.     

手术后慢性疼痛的流行病学调查和危险因素分析

目的:了解手术后慢性疼痛(chronic post-surgical pain,CPSP)的发生率及严重程度,明确CPSP的危险因素。方法:纳入2012年6月1日至2012年9月30日行择期外科手术的成人患者共3110例,术后6月调查CPSP的发生率和严重程度,评价疼痛对患者日常功能及心理状态的影响。采集受访者围术期病史信息,通过多元回归分析明确CPSP的危险因素。结果:术后6月CPSP发生率为29.6%,其中轻度疼痛占71.3%,中度疼痛占24.6%,重度疼痛占4.1%,20.8%的患者使用镇痛药物。CPSP对患者日常功能的影响随疼痛程度的加重而增大。CPSP患者中,30.3%处于焦虑状态,24.4%处于抑郁状态。术后6月发生CPSP的危险因素为:年纪较轻、女性、体重指数较高、无配偶、有吸烟史、有饮酒史、术前手术部位疼痛、腹股沟疝修补术、手术时间较长、术后48h内平均静息和运动疼痛评分较高、切口感染和术后住院日较长。结论:CPSP是一种发生率较高的手术并发症,对患者日常功能和心理状态均有明显不良影响,围术期多种危险因素与CPSP发生有关。     

麦滋林──S对慢性胃炎的疗效及其作用机理

麦滋林—S（M—S）在缓解慢性胃炎病人的腹痛和消化不良症状及减轻炎症的疗效方面明显优于得乐。M－S对慢性胃炎的治疗作用可能是通过增加胃可溶性粘蛋白的分泌和胃粘膜及血浆中的生长抑素（SS）含量，从而增加胃粘膜屏障功能而实现的。     

偏头痛大鼠的尿液代谢组学研究

目的:通过代谢组学方法,观察大鼠尿液中的代谢物的变化,探讨偏头痛可能的发病机制。方法:实验选用SPF级Wistar大鼠20只,体重(200±20)g左右,随机分为空白组和模型组,每组10只。采用改进的Christina Tassorelli方法复制偏头痛模型,采用代谢笼法,收集大鼠造模后6 h尿液。采用超高效液相色谱和高分辨率质谱联用(UPLC-Q-TOF/MS)技术对偏头痛大鼠尿样进行代谢图谱检测。结果:与空白组的尿液相比,模型组的代谢图谱中出峰量明显增加。空白组样本和模型组样本具有一定的聚类作用,分类运动的趋势明显。从总体趋势来看,相对于空白组,模型组的代谢特征有逐渐向右运动的趋势。对模型组样本与空白组样本所得的荷载图进行分析,发现尿中5-羟吲哚乙酸、1,3-二硝酸甘油、顺乌头酸、苹果酸明显增多。结论:尿中5-羟吲哚乙酸、1,3-二硝酸甘油、顺乌头酸、苹果酸可以作为偏头痛潜在的生物标志物。     

BoNT-A联合文拉法辛治疗慢性偏头痛共病焦虑抑郁的疗效分析

目的:探究A型肉毒毒素(botulinum toxin type-A, BoNT-A)及其联合文拉法辛治疗慢性偏头痛(chronic migraine, CM)共病焦虑抑郁病人的头痛及焦虑抑郁的改善情况。方法:依据慢性偏头痛诊断标准及焦虑自评量表(self-rating anxiety scale, SAS)和抑郁自评量表(self-rating depression scale, SDS)的评价标准,筛选慢性偏头痛共病焦虑或(和)抑郁状态的病人并排序。依照随机数字表法,将病人分为3组:单用文拉法辛组(A组)、单用A型肉毒毒素注射组(B组)、文拉法辛联合A型肉毒毒素注射组(C组)。采用视觉模拟评分(visual analogue scale, VAS)、每月头痛天数、头痛发作期治疗次数、头痛影响测定-6 (headache impact test-6, HIT-6)、偏头痛残疾程度评估问卷(the migraine disability assessment questionnaire, MIDAS)、SAS及SDS量表评估病人治疗前及接受治疗12周时的病情。结果:A组经治疗焦虑抑郁状态及部分头痛状况(每月头痛天数、每月头痛发作治疗次数和MIDAS)明显改善(P <0.05),而VAS及MIDAS评分未见差异;B组经治疗病人在头痛状况及焦虑抑郁状态方面都有显著改善(P <0.05);C组经治疗后头痛状况及焦虑抑郁状态也都有显著改善(P <0.05)。并且其改善量在VAS、每月头痛天数及头痛对病人生活影响方面显示出了"1+1> 2"的趋势,BoNT-A与文拉法辛联合治疗效果明显优于分别单独使用的效果(P <0.05)。结论:慢性偏头痛共病焦虑抑郁病人,单用A型肉毒毒素注射治疗后不仅可改善头痛情况,还可明显改善焦虑抑郁状态;且联合文拉法辛后治疗效果明显优于分别单独使用的效果。     

Safety and tolerability of eptinezumab in patients with migraine: a pooled analysis of 5 clinical trials

BackgroundThe humanized anti-CGRP monoclonal antibody eptinezumab has been evaluated in five large-scale clinical trials conducted in patients with migraine. This integrated analysis was conducted to evaluate the comprehensive safety and tolerability of eptinezumab in patients with migraine across these studies.MethodsData were pooled from four randomized, double-blind, placebo-controlled studies and the first year of one open-label study.ResultsThe pooled population comprised 2867 adults with migraine: eptinezumab, n = 2076 (4797 infusions); placebo, n = 791 (1675 infusions). A total of 1137/2076 (54.8%) patients who received eptinezumab and 414/791 (52.3%) patients who received placebo experienced ≥1 treatment-emergent adverse event (TEAE); rates were similar across eptinezumab dose groups (10–1000 mg). For most patients with TEAEs, the events were mild or moderate in severity and considered unrelated to study drug by the investigators. Thirty infusion-site AEs occurred in 27/2076 (1.3%) patients who received eptinezumab and 7 in 7/791 (0.9%) patients who received placebo. Infusion-site AEs led to infusion interruption in 19/2076 (0.9%) and 5/791 (0.6%) patients in the eptinezumab and placebo groups, respectively. Nasopharyngitis occurred in ≥2% of patients in the eptinezumab 300-mg group and with an incidence of at least 2 percentage points greater than in the placebo group; however, in most patients (eptinezumab, 139/140; placebo 40/41), its occurrence was considered not related to study treatment. Adverse events coded to hypersensitivity occurred for 23/2076 (1.1%) patients treated with eptinezumab and no patients in the placebo group. If additional TEAE terms that could indicate hypersensitivity are considered (e.g., urticaria, flushing/hot flush, rash, and pruritus), hypersensitivity reactions in the two pivotal placebo-controlled phase 3 studies occurred in ≥2% of patients in the eptinezumab 100-mg and 300-mg groups, and the incidence was at least 2 percentage points greater in either of these groups than in the placebo group. Most hypersensitivity reactions were not serious and resolved with standard medical treatment or observation without treatment, usually within 1 day.ConclusionsIn adults with migraine, the intravenous administration of eptinezumab every 12 weeks demonstrated a favorable safety and tolerability profile.Trial registrationClinicalTrials.gov (Identifiers: {"type":"clinical-trial","attrs":{"text":"NCT01772524","term_id":"NCT01772524"}}NCT01772524, {"type":"clinical-trial","attrs":{"text":"NCT02275117","term_id":"NCT02275117"}}NCT02275117, {"type":"clinical-trial","attrs":{"text":"NCT02559895","term_id":"NCT02559895"}}NCT02559895, {"type":"clinical-trial","attrs":{"text":"NCT02974153","term_id":"NCT02974153"}}NCT02974153, {"type":"clinical-trial","attrs":{"text":"NCT02985398","term_id":"NCT02985398"}}NCT02985398).Supplementary InformationThe online version contains supplementary material available at 10.1186/s10194-021-01227-5.     

以发作性头痛为主要表现的莱姆病两例报道

莱姆病是一种由蜱传播的感染性疾病，１９７５年首先在美国发现，８０年代国内陆续有人报道。本病是一种可累及多个系统的疾病。以发作性头痛为主要表现者尚未报道。本文报道两例以发作性头痛为主要表现的莱姆病，对其临床特征进行了描述，并对其治疗进行了讨论。作者指出，及时明确诊断对于莱姆病头痛的治疗十分重要。     

Efficacy and safety of fremanezumab in clinical trial participants aged ≥60 years with episodic or chronic migraine: pooled results from 3 randomized,double-blind,placebo-controlled phase 3 studies

BackgroundAlthough migraine is less common in older people, preventive treatment of migraine in these individuals may be more challenging due to the presence of multiple comorbidities and polypharmacy. Additionally, evidence for migraine treatment efficacy, safety, and tolerability is limited in this population. We evaluated efficacy, safety, and tolerability of fremanezumab, a fully humanized monoclonal antibody (IgG2Δa) that selectively targets calcitonin gene–related peptide (CGRP), in clinical trial participants aged ≥60 years with episodic migraine (EM) or chronic migraine (CM).MethodsThis analysis included data from 3 randomized, double-blind, placebo-controlled phase 3 studies: the HALO EM study, HALO CM study, and FOCUS study in participants with EM or CM and prior inadequate response to 2–4 migraine preventive medication classes. Participants in all studies were randomized 1:1:1 to receive 12 weeks of subcutaneous treatment with quarterly fremanezumab (Months 1/2/3: EM/CM, 675 mg/placebo/placebo), monthly fremanezumab (Months 1/2/3: EM, 225 mg/225 mg/225 mg; CM, 675 mg/225 mg/225 mg), or matched monthly placebo.ResultsThese pooled analyses included 246 participants aged ≥60 years. Reductions in monthly migraine days from baseline over 12 weeks were significantly greater with fremanezumab (least-squares mean change from baseline [standard error]: quarterly fremanezumab, − 4.3 [0.59]; monthly fremanezumab, − 4.6 [0.54]) versus placebo (placebo, − 2.3 [0.57]; both P < 0.01 vs placebo). As early as Week 1, significant reductions from baseline in weekly migraine days were observed with fremanezumab versus placebo (both P < 0.01). With fremanezumab treatment versus placebo, a significantly higher proportion of participants achieved ≥50% reduction in monthly migraine days, and significant improvements in disability and quality-of-life outcomes were observed (P < 0.05). Proportions of participants experiencing serious adverse events and adverse events leading to discontinuation were low and similar in the fremanezumab and placebo groups. Efficacy and safety results were comparable to the overall pooled population (N = 2843).ConclusionsThis pooled subgroup analysis demonstrates that fremanezumab treatment is efficacious and well-tolerated over 12 weeks in participants aged ≥60 years with EM or CM. These data may help healthcare providers with clinical decision making and preventive treatment selection for older patients with migraine.Trial registrationClinicalTrials.gov identifiers: HALO CM: {"type":"clinical-trial","attrs":{"text":"NCT02621931","term_id":"NCT02621931"}}NCT02621931; HALO EM: {"type":"clinical-trial","attrs":{"text":"NCT02629861","term_id":"NCT02629861"}}NCT02629861; FOCUS: {"type":"clinical-trial","attrs":{"text":"NCT03308968","term_id":"NCT03308968"}}NCT03308968.Supplementary InformationThe online version contains supplementary material available at 10.1186/s10194-021-01351-2.