偏头痛患者脑白质高信号与右向左分流相关性的福建地区单中心研究

目的观察偏头痛患者脑白质高信号(white matter hyperintensities,WMHs)的发生率和右向左分流(right-to-left shunt,RLS)的阳性率分布情况,探讨偏头痛患者WMHs与RLS是否相关。方法入选确诊为偏头痛的106例患者为研究对象,收集基本资料和头痛的临床信息,行头颅MRI检查评估WMHs,通过经颅多普勒超声(transcranial doppler,TCD)发泡试验进行RLS的诊断和分级,分析WMHs和RLS两者的相关性。结果 106例偏头痛患者中,"WMHs+"组33例(31.1%),"WMHs-"组73例(68.9%)。RLS总阳性率为48.1%(51/106),各分流级别分布情况为:Ⅰ级分流27例(25.5%),Ⅱ级分流4例(3.8%),Ⅲ级分流6例(5.6%),Ⅳ级分流14例(13.2%)。"WMHs+"组中,Ⅰ级分流5例,Ⅱ级分流1例,Ⅲ级分流3例,Ⅳ级分流10例;"WMHs-"组中,Ⅰ级分流22例,Ⅱ级分流3例,Ⅲ级分流3例,Ⅳ级分流4例。"WMHs+"组和"WMHs-"组相比较,两组发泡试验总体阳性率没有统计学差异(P 0.05,χ~2=1.719),但"WMHs+"组的大量分流率显著高于"WMHs-"组,具有统计学意义(P 0.01,χ~2=13.188)。结论偏头痛患者的WMHs与RLS无明显相关,但大量分流的RLS会增加偏头痛患者WMHs发生的风险。     

偏头痛脑白质病变的相关因素

目的 分析偏头痛脑白质病变(WML)的相关因素.方法 收集135例偏头痛患者(偏头痛组)及118名健康对照者(正常对照组)的临床资料.对入组者进行头颅MRI检查,并采用Fazekas量表评分评价WML情况;采用TCD声学造影检查右向左分流(RLS)情况.结果 偏头痛组WML发生率及深部WML(DWML)发生率显著高于正...     

对比增强经颅多普勒超声对偏头痛与右向左分流相关性的福建地区单中心研究

目的观察偏头痛患者右向左分流(right-to-left shunt,RLS)的发生率,分析偏头痛与右向左分流的相关性。方法入选116例确诊为偏头痛的患者为病例组,75例健康志愿者为对照组,应用对比增强经颅多普勒超声(contrast-enhanced transcranial Doppler,c-TCD)诊断RLS并对分流量进行分级,分析两组的阳性率,进行统计分析。结果病例组中,RLS的阳性率为50.9%(59/116),其中,Ⅰ级分流35例(30.2%),Ⅱ级分流3例(2.6%),Ⅲ级分流7例(6.0%),Ⅳ级分流14例(12.1%)。对照组中,RLS的阳性率为30.6%(23/75),其中,Ⅰ级分流18例(24.0%),Ⅱ级分流1例(1.3%),Ⅲ级分流0例(0%),Ⅳ级分流4例(5.3%)。两组RLS总阳性率的比较,病例组的RLS总阳性率高于对照组,统计学有显著差异(P=0.006,χ~2=7.583);病例组的大量分流率显著高于对照组(P=0.011,χ~2=6.530),但两组的小量分流率比较无统计学差异(P=0.273,χ~2=1.199)。结论偏头痛与右向左分流存在相关,大量分流可能是偏头痛的病因,应引起临床重点关注。     

青年隐源性卒中和卵圆孔未闭的相关性研究

目的探讨卵圆孔未闭(PFO)与青年隐源性卒中(CS)的相关性。方法择取60例青年CS患者为研究组,选取同期60例非CS患者为对照组。2组均给予常规实验室检查、颅脑多普勒超声检查(TCD)、头颅MRI检查,并进行TCD发泡试验(c-TCD),比较2组生化检验、TCD发泡试验、TCD检查结果。结果研究组PFO发生率(53.33%)显著高于对照组(10%),差异有统计学意义(P0.05)。组间饮酒吸烟史、糖尿病、高血压、冠心病发生率以及血脂指标比较差异无统计学意义(P0.05)。结论 CS患者多发生PFO,临床可针对此危险因素进一步诊断,必要时可组织会诊,采用介入治疗。     

偏头痛脑白质高信号与临床特征及右向左分流的相关分析

目的从临床特征角度探索偏头痛脑白质高信号(WMHs)的危险因素,并研究右向左分流(RLS)是否与偏头痛WMHs有关。方法纳入偏头痛患者,采集头痛资料,进行对比增强TCD检查是否存在RLS以及分流量大小,并行头颅MRI检查评估WMHs。结果共纳入57例偏头痛患者,其中合并WMHs共18例(31.6%),主要位于额、顶叶,病变程度较轻。在对年龄、性别、头痛特征、焦虑抑郁评分以及RLS等因素的分析中,发现合并WMHs组与不合并WMHs组之间,仅年龄(P=0.002)、病程(P=0.046)存在统计学差异。结论偏头痛患者中发现的WMHs,主要位于额、顶叶,年龄、病程可能是其危险因素,未发现先兆、发作频率、持续时间、疼痛程度、焦虑抑郁等临床特征与其相关,也未发现RLS会增加偏头痛患者WMHs的风险。     

对比增强经颅多普勒评价偏头痛与心脏右向左分流关系的研究

目的观察中国偏头痛患者右向左分流(right-to-left shunt,RLS)的阳性率、分流类型以及分流量大小,分析偏头痛与RLS分流量的相关性。方法本研究共纳入204例偏头痛患者及122例健康志愿者,应用对比增强经颅多普勒造影(contrast-enhanced transcranial Doppler,c-TCD)诊断RLS并对阳性率、分流量进行统计分析。结果先兆偏头痛组RLS阳性率和大分流显著高于无先兆偏头痛组(65. 5%vs 32. 2%,P <0. 001; 32. 8%vs11. 6%,P <0. 001),而中量及小量分流无差异(P=0. 767; P=0. 095);先兆偏头痛组RLS阳性率和大分流均显著高于正常组(65. 5%vs 20. 5%,P <0. 001; 32. 8%vs 4. 1%,P <0. 001);无先兆偏头痛组RLS阳性率和大分流显著高于正常组(32. 2%vs 20. 5%,P=0. 038; 11. 6%vs 4. 1%,P=0. 027)。结论偏头痛患者(包括有先兆和无先兆偏头痛患者),右向左分流阳性率高于正常照组,且以大量右向左分流为主,中至小量右向左分流及分流的类型与正常组相比无差异。提示右向左分流,特别是大量的右向左分流,可能与偏头痛有关。     

经颅多普勒超声在不明原因缺血性脑卒中的应用研究

目的探讨经颅多普勒超声(transcranial Doppler,TCD)技术结合生理盐水发泡试验在不明原因缺血性脑卒中患者卵圆孔未闭(PFO)筛查中的应用价值。方法收集51例55岁以下不明原因缺血性脑卒中患者,行TCD结合生理盐水发泡试验和经胸超声心动图(TTE)检查。结果 51例患者中,23例患者TCD检查栓子信号阳性,其中18例患者TTE检查发现PFO,而在28例TCD检查栓子信号阴性的患者中未发现PFO;TCD检查阳性患者中偏头痛发病率、合并下肢深静脉血栓比例以及房间隔瘤比例较阴性者高(P<0.05)。结论 TCD结合生理盐水发泡试验是筛查PFO的有效手段,可以作为不明原因缺血性脑卒中病因筛查的手段。     

TCD对偏头痛发作期颅内动脉功能状态的分析

目的　采用经颅多普勒超声 (TCD)探讨偏头痛发作期颅内动脉的功能状态。方法　对 80例发作期偏头痛患者和 6 0例健康者行TCD检查 ,并进行对照分析。结果　偏头痛组颅内动脉的收缩峰 (Vs)明显高于健康对照组。结论　颅内动脉管壁紧张度增高是偏头痛发作的原因之一。     

TCD发泡试验阳性的隐源性卒中临床分析

目的分析发泡试验阳性的隐源性卒中(CS)患者的临床特点。方法收集急性缺血性卒中患者350例;TOAST分型,118例确定为CS;对此组患者进行TCD发泡试验检查,并详细记录临床、生化与神经影像学等资料。结果 118例患者TCD发泡试验阳性46例(39.0%);阳性患者平均年龄为54.28±8.56岁,男性36例(78.3%),女性10例(21.7%);高血压病的发生率为65.2%。临床上表现为脑梗死39例/46例(占84.8%)、TIA7例/46例(占15.2%);前循环脑梗死33例/46例(占84.6%),后循环脑梗死6例/46例(占15.4%);多发病灶34例/46例(占87.2%),单发病灶5例/46例(占12.8%);NIHSS评分0~3分27例/46例(占69.2%),4~10分8例/46例(占20.5%),11分以上4例/46例(占10.3%);微泡分级Ⅰ~Ⅱ级39例/46例(占84.8%),Ⅲ~Ⅳ级7例/46例(占15.2%)。结论 TCD发泡试验阳性的CS患者的临床特点是多发于中青年男性患者,以前循环多发脑梗死为主,神经功能缺损相对较轻,65.2%合并高血压。     

共患不宁腿综合征对偏头痛患者情绪和睡眠的影响

目的探讨偏头痛患者的不宁腿综合征(RLS)的发病率及其对情绪和睡眠的影响。方法对200例偏头痛患者(偏头痛组)和100名正常成人(对照组)进行RLS发病率、严重程度、睡眠质量和焦虑及抑郁程度评分,比较偏头痛人群与对照组之间的差异。并对共患有RLS的偏头痛患者的情绪和睡眠情况进行分析。结果成人慢性偏头痛组的RLS发病率(16.25%)较对照组(5%)高,差异有统计学意义(P0.05);发作性偏头痛组的RLS发病率(12.5%)与对照组(5%)比较,差异无统计学意义(P0.05)。共患RLS的偏头痛患者较单纯偏头痛者的睡眠质量差、焦虑及抑郁评分高,差异有统计学意义(均P0.05)。头痛频率及RLS为抑郁、焦虑及睡眠障碍的影响因素(均P0.05)。偏头痛患者的汉密尔顿抑郁量表(HAMD)评分、汉密尔顿焦虑量表(HAMA)评分及匹茨堡睡眠质量量表(PSQI)评分与国际RLS评估量表(IRLS)的相关系数分别为rHAMD=0.397、rHAMA=0.434和rPSQI=0.500;RLS严重程度与抑郁、焦虑及睡眠障碍的严重程度呈正相关关系(均P0.05)。结论慢性偏头痛患者的RLS发病率更高,且RLS症状更严重。RLS的严重程度与抑郁、焦虑和睡眠障碍程度呈正相关关系。     

中国偏头痛患者右向左分流阳性率及分流类型——一项全国多中心研究

背景 偏头痛与右向左分流（right-to-left shunt,RLS）的关系尚有争议。本研究旨在明确中国偏头痛 患者右向左分流的阳性率、分流类型以及分流量大小,分析偏头痛与右向左分流的关系。 方法 该研究为多中心-病例对照研究（北美临床研究注册号NCT0242569)。由中国9家分中心共同完 成,连续纳入2015年6月-2016年8月就诊于分中心且符合据第三版国际头痛疾病分类-β测试版（The International Classification of Headache Disorders 3rd Edition Beta Version,ICHD-3β）诊断偏头痛的患 者（18～65周岁）,为偏头痛组。偏头痛组共纳入931例（女性695例）,其中先兆偏头痛240例（女性174 例）,无先兆偏头痛691例（女性521例）。健康对照组共282例。 结果 先兆偏头痛组RLS阳性率和大量分流比例高于无先兆偏头痛组（63.7% vs 39.9%,P＜0.001; 32.1% vs 16.5%,P＜0.001）,两组中量和小量分流比例无差异（P =0.141;P =0.061）。无先兆偏头痛 组RLS阳性率和大量分流比例高于对照组（39.9% vs 29.4%,P＜0.001;16.5% vs 6.4%,P＜0.001）, 两组间中量和小量分流的比例无差异。 结论 偏头痛患者（包括有先兆和无先兆偏头痛患者）,右向左分流阳性率高于正常对照组,且以大 量右向左分流为主,中至小量右向左分流及分流的类型与对照组相比无差异。右向左分流,特别是大 量的右向左分流,可能与偏头痛有关。     

Relationship between non-headache symptoms and right to left shunt in episodic migraine. A single-center cross-sectional study

The relationship between right to left shunt (RLS) and non-headache symptoms (NHS) in episodic migraine is unknown. This study aimed to investigate the incidence and classification of RLS in episodic migraineurs, calculate the occurrence rate of NHS, and analyze the associations between RLS and NHS. We consecutively recruited 204 episodic migraine patients. Contrast-enhanced transcranial doppler was adopted to screen RLS. Structured questionnaire via face-to-face survey was conducted to collect clinical data. A total of 172 episodic migraineurs were included in the final analysis, of which 20 cases were migraine with aura. The positive rate of RLS was 47.1%, of which 50 cases (29.0%) had small shunt (Grade 1) and 31 cases (18.1%) had mid-large shunt (Grade 2–4). The most common NHS was nausea (115 (66.9%)), followed by headache aggravation with physical activity (96 (55.8%)), dizziness (93 (54.1%)), vomiting (77 (44.8%)) and phonophobia (74 (43.0%)). Yawning was more common in Grade 2–4 group than Grade 0 group (p = 0.012), while no statistical differences among other groups. Grade 2–4 group had a higher rate of headache aggravation with physical activity than grade 0 group (p = 0.008). Binary logistic regression analysis showed that yawning at premonitory phase, headache aggravation with physical activity and cranial autonomic symptoms during attack are independent predictors of RLS. In conclusion, yawning and headache aggravation with physical activity are more common in migraine patients with RLS. Besides aura, particular NHS may also serve as indicators for screening RLS in episodic migraineurs.     

无先兆偏头痛患者的经颅多普勒和皮肤交感反应的对比分析

目的探讨无先兆偏头痛(MWA)患者发作间期的脑血管血液动力学异常和自主神经功能失常。方法对48例MWA患者和36例健康人群(HC)的经颅多普勒(TCD)和皮肤交感反应(SSR)进行对比分析。结果 MWA组的TCD大脑中动脉最高平均流速(MFV-MCA)异常率和SSR异常率分别为64.6%和58.3%,与HC组相比,均具有非常显著性差异(P<0.01);MWA组的SSR主要异常表现为潜伏期延长,与HC组相比,差异具有显著性(P<0.05)。MWA组TCD的异常改变和SSR的异常具有较好的一致性(总符合率=68.7%,Kappa值=0.343,P=0.017)。结论在发作间期无先兆偏头痛患者确实存在脑血液动力学的改变和自主神经功能的异常;TCD与SSR存在一致性异常有助于鉴别无先兆偏头痛患者的发病机制和原因。     

Prevalence and characteristics of right-to-left shunt in migraine with aura: a survey on 120 Italian patients

Many lines of research have suggested a relationship between migraine with aura (MA) and patent foramen ovale. Right-to-left shunt (RLS) of blood might explain both the occurrence of MA attacks, as well as the increased risk of ischaemic stroke in these patients. We evaluated the prevalence and the characteristics of RLS in a series of 120 MA patients, who were studied with contrast-enhanced Transcranial Doppler examination. We found RLS in 61 of them. A latent RLS was found in 28%, a permanent RLS in 72%, a shower-curtain pattern was detected in 52% of the studied patients.     

Prevalence and characteristics of right-to-left shunt in migraine with aura: a survey on 120 Italian patients

Many lines of research have suggested a relationship between migraine with aura (MA) and patent foramen ovale. Right-to-left shunt (RLS) of blood might explain both the occurrence of MA attacks, as well as the increased risk of ischaemic stroke in these patients. We evaluated the prevalence and the characteristics of RLS in a series of 120 MA patients, who were studied with contrast-enhanced Transcranial Doppler examination. We found RLS in 61 of them. A latent RLS was found in 28%, a permanent RLS in 72%, a shower-curtain pattern was detected in 52% of the studied patients.

     

Stathmin／Oncoprotein18（Op18）在人脑胶质瘤中的表达研究

目的探讨Stathmin／oneoprotein18（Op18）基因在人脑胶质瘤中的表达规律及意义。方法分别采用免疫组化法和Westernblot法检测10例正常脑组织和56例脑胶质瘤中Stathmin蛋白的表达。结果免疫组化法检测Stathmin蛋白在正常脑组织、低级别胶质瘤（Ⅰ～Ⅱ级）及高级别胶质瘤（Ⅲ～Ⅳ级）中阳性表达率分别为20％、65％、100％。正常脑组织分别与Ⅰ～Ⅱ级组、Ⅲ～Ⅳ级组比较，均有显著性差异（P〈0．05）；Ⅰ～Ⅱ级组与Ⅲ～Ⅳ级组比较，有显著性差异（P〈0．05）。Westernblot法检测显示，Stathmin蛋白在胶质瘤中的表达明显增高，正常脑组织分别与Ⅰ～Ⅱ级组、Ⅲ～Ⅳ级组比较，差异均有显著性（P〈0．01），Ⅰ～Ⅱ级组与Ⅲ～Ⅳ级组比较，差异有显著性（P〈0．01）。结论Stathmin在脑胶质瘤中过表达，Stathmin可能为脑胶质瘤的生物治疗提供一个新靶点。     

The extent of right-to-left shunt fails to correlate with severity of clinical picture in migraine with aura

Abstract Several investigations have documented an increased incidence of right-to-left shunt (RLS) in migraine with aura (MA) and have emphasised its role in the physiopathology of aura; so far, however, no data are available concerning a possible correlation between the extent of the RLS and the clinical picture of MA patients. To investigate the possible relationship between the extent of the RLS, revealed by the number of microbubbles (MB) detected during transcranial Doppler with IV injection of ultrasound contrast (TCDc), and the clinical characteristics of MA (age at first onset of migraine, mean annual frequency of attacks and mean duration of the aura phase), 30 consecutive patients with typical aura and migraine headache positive on TCDc evaluation for RLS were enrolled. Permanent RLS was found in 12 patients and latent RLS was found in 18 patients; of these, 6 had a high-grade RLS, 5 medium-grade RLS and 7 low-grade RLS. No correlation has been documented between the number of MBs and the clinical parameters of both patients with latent shunts and those with permanent ones, nor between the clinical parameters of the two groups of patients. These data show that RLS does not seem to affect the clinical manifestation of MA and that the extent of RLS fails to correlate with the severity of the clinical picture of the disorder.     

Prevalence of cardiac right left shunts in migraine: a population-based case–control study

We aimed to investigate the prevalence of cardiac right left shunts (RLS) in population-based samples of subjects with migraine with aura (n = 42), migraine without aura (n = 44) and controls without headache (n = 41). Cardiac RLS was assessed with transcranial Doppler sonography with intravenous injection of saline. Prevalence of RLS was highest in migraineurs with aura (45.2%) compared to migraineurs without aura (34.1%) and controls (41.5%). Permanent as opposed to latent RLS was more common among patients with migraine with aura (40.5%) than in patients with migraine without aura (23.3%) or controls (24.4%). Differences did not reach statistical significance between the three groups (p = 0.564 for RLS prevalence, p = 0.349 for prevalence of permanent shunts). Our data implicate a trend towards higher prevalence of RLS with larger shunts in subjects with migraine with aura.     

脑胶质瘤中survivin蛋白表达情况及其与肿瘤恶化程度关系的研究

目的 探讨survivin蛋白在脑胶质瘤的表达情况及其与肿瘤恶性程度之间的关系.方法收集脑胶质瘤患者组织蜡块90例,其中Ⅰ级30例,Ⅱ级30例,Ⅲ级～Ⅳ级30例.另取10例因颅脑创伤行内减压的正常脑组织蜡块作为对照.应用免疫组织化学染色方法检测脑胶质瘤组织survivin蛋白的表达情况. 结果 胶质瘤细胞胞浆中有survivin蛋白的表达,且随着肿瘤级别的增高,survivin蛋白的表达增强.其表达阳性率在Ⅰ级组中为16.67%(6/30),在Ⅱ级组中为46.67%(14/30),在Ⅲ级～Ⅳ级组中为86.67%(26/30),差异有统计学意义(P<0.05).而在正常脑组织中survivin的表达为阴性. 结论 Survivin在脑胶质瘤的恶变过程中起重要作用,针对survivin的靶向治疗有望成为治疗脑胶质瘤的一个新的途径.