偏头痛与脑小血管病总体负担的相关性  

Correlation between migraine and overall burden of cerebral small vessel disease

作　　者：陆强彬[1] 柏燕燕[1] 缪江芳 张慧萍[1] Lu Qiangshan;Bai Yanyan;Miao Jiangfang;Zhang Huiping(Department of Neurology,Jiangyin People’s Hospital,Wuxi 214400,China)

机构地区：[1]江阴市人民医院神经内科,无锡214400

出　　处：《国际脑血管病杂志》2022年第5期355-359,共5页International Journal of Cerebrovascular Diseases

基　　金：江苏大学临床医学专项项目(JLY20180186)。

摘　　要：目的探讨偏头痛与脑小血管病(cerebral small vessel disease,CSVD)总体负担的相关性。方法选取2021年1月至2021年10月在江阴市人民医院头痛门诊就诊的偏头痛患者作为病例组,既往无任何类型原发性头痛且年龄和性别相匹配的同期健康体检者作为对照组。通过多模式MRI检测各种CSVD表型,包括血管源性腔隙、脑白质高信号(white matter hyperintensities,WMHs)、脑微出血(cerebral microbleeds,CMBs)以及血管周围间隙扩大,并计算CSVD总体负担评分。比较病例组与对照组CSVD及其各种表型的检出率和CSVD总体负担。将存在CSVD的研究对象按照CSVD总体负担评分分为轻度组、中度组和重度组,应用有序多分类logistic回归模型确定CSVD总体负担的独立影响因素。结果共纳入109例偏头痛患者和100例健康对照者。病例组CSVD检出率(65.13%对46.00%;P=0.005)和CSVD总体负担重度患者的比例(24.77%对10.00%;P=0.005)均显著高于对照组。在具体CSVD表型方面,病例组WMHs(48.62%对33.00%;P=0.022)和CMBs(35.80%对19.00%;P=0.007)检出率显著高于对照组,而血管源性腔隙和中重度血管周围间隙扩大检出率差异无统计学意义。单变量分析显示,CSVD总体负担与年龄、偏头痛、高血压、基线舒张压、低密度脂蛋白胆固醇及糖化血红蛋白存在显著相关性(P均<0.05)。多变量logistic分析表明,年龄[优势比(odds ratio,OR)3.731,95%置信区间(confidence interval,CI)1.051~1.217;P=0.001]、偏头痛(OR 2.812,95%CI 1.045~5.124;P=0.012)、高血压(OR 2.112,95%CI 1.525~4.021;P=0.032)及低密度脂蛋白胆固醇水平(OR 2.512,95%CI 1.541~4.312;P=0.023)与CSVD总体负担独立相关。结论偏头痛患者的CSVD检出率高于普通人群,尤其是WMHs和CMBs。偏头痛与CSVD总体负担独立相关。Objective To investigate the correlation between migraine and overall burden of cerebral small vessel disease(CSVD).Methods Migraine patients who visited the headache clinic of Jiangyin People's Hospital from January 2021 to October 2021 were selected as the case group,and healthy people who had no previous primary headache of any type and matched age and sex in the same period were selected as the control group.Various CSVD phenotypes,including vasogenic lacuna,white matter hyperintensities(WMHs),cerebral microbleeds(CMBs)and enlarged perivascular space(EPVS)were detected by the multimodal MRI,and the overall burden score of CSVD was calculated.The detection rates of CSVD and its phenotypes and the overall burden of CSVD were compared between the case group and the control group.The subjects with CSVD were divided into mild group,moderate group and severe group according to the overall burden score of CSVD.The independent influencing factors of the overall burden of CSVD were identified by the ordinal multi-classification logistic regression model.Results A total of 109 migraine patients and 100 healthy controls were enrolled.The detection rate of CSVD(65.13%vs.46.00%;P=0.005)and the proportion of patients with severe CSVD overall burden(24.77%vs.10.00%;P=0.005)in the case group were significantly higher than those in the control group.In terms of specific CSVD phenotypes,the detection rates of WMHs(48.62%vs.33.00%;P=0.022)and CMBs(35.80%vs.19.00%;P=0.007)in the case group were significantly higher than those in the control group,while there were no significant differences in vasogenic lacuna and moderate to severe EPVS.Univariate analysis showed that the overall burden of CSVD was significantly associated with age,migraine,hypertension,baseline diastolic blood pressure,low-density lipoprotein cholesterol(LDL-C)and glycosylated hemoglobin(all P<0.05).Multivariate logistic analysis showed that age(odds ratio[OR]3.731,95%confidence interval[CI]1.051-1.217;P=0.001),migraine(OR 2.812,95%CI 1.045-5.124;P=0.012),hyper

关 键 词：脑小血管疾病 偏头痛 磁共振成像 危险因素 

分 类 号：R747.2[医药卫生—神经病学与精神病学] R743[医药卫生—临床医学]