不同中医证型偏头痛患者脑白质异常与认知功能损害的关系  

Relationship between Abnormal White Matter and Cognitive Impairment in Migraine Patients with Different Chinese Medicine Syndrome Types

作　　者：张燕平[1] 罗瑞琦 严美茹 刘钢敏 ZHANG Yan-ping;LUO Rui-qi;YAN Mei-ru;LIU Gang-min(No.1 District of Cerebropathy,First Affiliated Hospital,Henan University of Traditional Chinese Medicine,Zhengzhou(450000);First Clinical Medical College,Henan University of Chinese Medicine,Zhengzhou(450046))

机构地区：[1]河南中医药大学第一附属医院脑病一区,郑州450000 [2]河南中医药大学第一临床医学院,郑州450046

出　　处：《中国中西医结合杂志》2022年第1期29-33,共5页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：河南省中医药科学研究专项课题(No.2017ZY2042)。

摘　　要：目的探讨不同中医证型偏头痛患者脑白质异常与认知功能损害的关系。方法选择肝阳上亢证、痰浊证、瘀血证、肾虚证、气血亏虚证偏头痛患者共150例,每证型各30例,收集年龄、性别、病程等一般临床资料,行核磁共振(MRI)检查,采用改良Scheltens评分量表评价脑白质病变情况,采用蒙特利尔认知评估(MoCA)量表评价认知功能,分析不同证型偏头痛患者脑白质病变情况及其与认知功能的关系。结果不同证型的偏头痛患者中,肝阳上亢证、痰浊证的改良Scheltens评分高于其他3个证型(P<0.05),肝阳上亢证低于痰浊证(P<0.05)。150例偏头痛患者合并脑白质异常68例(45.33%),其中肝阳上亢证、痰浊证两组占比较高(46.67%、60.00%);肝阳上亢证、痰浊证MoCA评分低于其他3个证型(P<0.05),肝阳上亢证低于痰浊证(P<0.05);痰浊证、瘀血证中脑白质异常合并认知障碍的比例高于其他3个证型(P<0.05);多因素回归分析显示脑白质病变(OR=1.713)、头痛病程(OR=3.248)是并发认知功能障碍的危险因素。结论不同中医证型偏头痛患者引发脑白质变性不同,合并脑白质病变的痰浊证及瘀血证偏头痛对认知功能损害严重,同时脑白质病变、病程长是引发认知功能障碍的危险因素。Objective To observe the relationship between abnormal white matter and cognitive impairment in migraine patients with different Chinese medicine(CM)syndrome types.Methods Recruited were 150 migraine patients with Gan-yang hyperactivity syndrome(GYHS),phlegm-turbid syndrome(PTS),blood stasis syndrome(BSS),Shen deficiency syndrome(SDS),qi-blood deficiency syndrome(QBDS),30 with each syndrome type.Their general clinical data such as age,gender,and disease course were collected.MRI examinations were performed.Modified Scheltens score scale was used to evaluate white matter lesions.The Montreal Cognitive Assessment(MoCA)scale was used to evaluate cognitive function in migraine patients with different CM syndrome types.White matter lesions and their relationships with cognitive function in migraine patients with different CM syndrome types were analyzed.Results Among migraine patients with different syndrome types,modified Scheltens scores were higher in migraine patients with GYHS and PTS than in those with the rest three syndrome types(P<0.05),and it was lower in those with GYHS than in those with PTS(P<0.05).There were 68 patients with abnormal brain white matter(45.33%),with higher ratios in GYHS and PTS(46.67%,60.00%).The MoCA scores of GYHS and PTS were lower than the other three syndrome types(P<0.05),and it was lower in those with GYHS than in those with PTS(P<0.05).The ratios with white matter abnormalities complicated cognitive impairment were higher in those with PTS and BSS than in the other three syndrome types(P<0.05).Multivariate regression analysis showed that white matter lesions(OR=1.713)and the duration of headache(OR=3.248)were risk factors for the concurrence of cognitive dysfunction.Conclusions Migraine patients with different CM syndrome types induced different degenerations in white matter.Migraine patients with PTS and BSS complicated white matter lesions have serious cognitive impairment.At the same time,white matter damage and long course are risk factors for cognitive impairment.

关 键 词：偏头痛 不同中医证型 脑白质异常 认知功能损害 

分 类 号：R277.7[医药卫生—中医学]