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

林 攀， 黄志珍， 卢珍友， 何祥盛， 陈 星

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

林 攀1， 黄志珍1， 卢珍友1， 何祥盛1， 陈 星2

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，χ2=7.583)；病例组的大量分流率显著高于对照组(P=0.011，χ2=6.530)，但两组的小量分流率比较无统计学差异(P=0.273，χ2=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。

对比增强经颅多普勒超声； 偏头痛； 右向左分流

Abstract：ObjectiveTo investigate the prevalence of right-to-left shunt (RLS) in migraine patients and analyze the relationship between migraine and right to left shunt.Methods116 cases of migraine patients and 75 healthy volunteers as control group，using contrast enhanced transcranial Doppler (c-TCD) for diagnosis of RLS and grade，the positive rate of the two groups were statistically analyzed.ResultsIn the case group，the positive rate of RLS was 50.9% (59/116)，of which grade Ⅰ shunt accounted for 30.2% (n=35)，grade Ⅱ shunt accounted for 2.6% (n=3)，grade Ⅲ shunt accounted for 6.0% (n=7)，and grade Ⅳ shunt accounted for 12.1% (n=14). In the control group，the positive rate of RLS was 30.6% (23/75)，of which grade Ⅰ shunt accounted for 24.0% (n=18)，the grade Ⅱ shunt accounted for 1.3% (n=1)，grade Ⅲ shunt accounted for 0% (n=0)，and grade Ⅳ shunt accounted for 5.3% (n=4). Comparison of two groups of the total positive rate，the total positive rate of case group was higher than the control group，there was statistically significant difference (P=0.006，χ2=7.583). Large shunt rate in case group was significantly higher than the control group (P=0.011，χ2=6.530)，but the two groups of small shunt rate had no significant difference (P=0.273，χ2=1.199).ConclusionMigraine is related to right-to-left shunt，and the large shunt may be the cause of migraine，which should be paid more attention to.

Keywords： Contrast-enhanced transcranial Doppler； Migraine； Right-to-left shunt

偏头痛是临床常见的原发性头痛类型，主要表现为反复发作、一侧或双侧搏动性的剧烈头痛，疼痛多为偏侧，常伴有恶心、呕吐、畏光和畏声等症状。偏头痛除了疾病本身造成的疼痛不适、失能等损害，还可能导致认知障碍、脑白质病变甚至脑梗死等，且可与焦虑、抑郁共患，严重危害人类健康[1]。偏头痛的发病机制尚未明确，目前研究发现，右向左分流(right-to-left shunt，RLS)与偏头痛之间存在联系，RLS可能是偏头痛的病因之一。

本研究以中……