偏头痛右向左分流患者与脑白质病变的关系研究

目的探讨偏头痛右向左分流患者与脑白质病变之间的关系。方法自2014年7月至2017年2月就诊于北京天坛医院门诊,诊断符合国际头痛诊断分类的偏头痛患者。收集基线信息及临床特征等相关资料。所有入组患者均进行经颅多普勒发泡试验及头颅磁共振检查。右向左分流定义为:经颅多普勒发泡试验提示双侧大脑中动脉监测到至少一个及以上栓子信号。脑白质病变的评定为:深部或皮质下白质T2加权像及FLAIR成像高信号。脑白质病变使用Fazekas量表评分。结果最终纳入254个患者(57.1%为女性)。143例受试者存在右向左分流(56.3%)。149例患者存在脑白质病(58.7%)。与脑白质病变阴性组(n=105)相比,右向左分流在脑白质病变阳性组(n=149)明显增高(69.1%vs38.1%,P0.05)。结论偏头痛患者脑白质病变可能与右向左分流相关。

Association between right-to-left shunt and white matter lesions in patients with migraine

Objective To investigate the association between right-to-left shunt (RLS) and white matter lesions (WML) in patients with migraine.Methods The patients with migraine who attended the outpatient service of Beijing Tiantan Hospital from July 2014 to February 2017 and met the International Classification of Headache Disorders (ICHD) criteria were enrolled, and related data including baseline data and clinical features were collected. All patients underwent transcranial Doppler (TCD) foaming test and magnetic resonance imaging (MRI). RLS was defined as at least one embolus signal in bilateral middle cerebral arteries on TCD foaming test, and WMLs were identified as hyperintense lesions on both T2-weighted and FLAIR imaging of deep or subcortical white matter. The severity of WMLs was evaluated based on the Fazekas scale.Results A total of 254 patients were enrolled, among whom 57.1% were female. Of all patients, 143 (56.3%) had RLS and 149 (58.7%) had WMLs. Compared with the WMLs-negative group with 105 patients, the WMLs-positive group with 149 patients had a significantly higher proportion of patients with RLS (69.1% vs 38.1%, P<0.05).Conclusions WMLs may be associated with RLS in patients with migraine.