杨娟;赵娜;齐清华;

• 1:郑州大学第一附属医院

摘要(Abstract)：

目的应用经食管超声心动图(transesophageal echocardiograghy,TEE)联合右心声学造影评估卵圆孔未闭(patent foramen ovale,PFO)伴房间隔膨出瘤(atrial septal aneurysm,ASA)与先兆偏头痛(migraine with aura,MA)的关系。方法回顾性分析郑州大学第一附属医院2018-01—2021-05接受经食道超声心动图联合右心声学造影的988例患者的检查图像及临床资料。超声检查前,采用经过验证的头痛问卷,由两位神经科医生根据国际头痛标准诊断是否有先兆偏头痛,由超声医生在不知患者是否有偏头痛的前提下进行超声心动图检查,进行RLS分级,对无FPO和ASA组、PFO组、ASA组和PFO伴ASA组进行偏头痛及先兆偏头痛的单因素分析,并对有无先兆偏头痛患者的RLS分级进行比较。结果孤立的PFO占15.38%,孤立的ASA占3.04%,PFO合并ASA占7.29%。偏头痛发生率19.03%,MA发生率8.20%。与无PFO和ASA组比较,PFO伴ASA组无先兆偏头痛(OR=2.324,95%CI:1.225～4.41,P=0.008)及有先兆偏头痛(OR=5.533,95%CI:3.031～10.1,P<0.001)患病率显著增高。偏头痛患者中,PFO伴ASA组有先兆发生的患病率显著增高(OR=2.381,95%CI:1.095～5.176)。在RLS分级中,2级和3级分流在MA及MA—患者之间差异有统计学意义(χ2=7.912,P=0.005);PFO伴ASA组2级和3级分流显著高于PFO组(χ2=7.023,P=0.008)。结论 PFO合并ASA与MA显著相关,且出现右向左分流的程度增高,PFO引起的偏头痛研究应集中于这种特殊的心房异常。

关键词(KeyWords)： 偏头痛;右心声学造影;经食管;卵圆孔未闭;房间隔膨出瘤

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 杨娟;赵娜;齐清华;

参考文献(References)：

• [1] OLESEN J. The international Classification of Headache Disorders[J]. Headche,2008,5:691-693. DOI:10.1111/j.1526-4610.2008.01121.x.
• [2] GUO Y,SHI Y J,ZHU D,et al. Clopidogrel can be an effective complementary prophylactic for drug-refractory migraine with patent foramen ovale[J]. J Investig Med,2020,68(7):1-6.DOI:10.1136/jim-2020-001342.
• [3] PREETHAM K,YASUFUMI K,BRIAN H W,et al. The Connection Between Patent Foramen Ovale and Migraine[J]. Neuroimaging Clin N Am,2019,29(2):261-270. DOI:10.1016/j.nic.2019.01.006.
• [4] PRESSMAN A,JACOBSON A,EGUILOS R,et al. Prevalence of migraine in a diverse community-electronic methods for migraine ascertainment in a large integrated health plan[J]. Cephalalgia,2016,36:325-334. DOI:10.1177/0333102415590242.
• [5] ETMINAN M,TAKKOUCHE B,ISORNA F C,et al. Risk of ischaemic stroke in people with migraine:systematic review and meta-analysis of observational studies[J]. BMJ,2005,330:63-66. DOI:10.1136/bmj.38302.504063.8F.
• [6] SAEED S S,RAJAN R G,RASADUL K,et al.Patent Foramen Ovale in Cryptogenic Stroke and Migraine with Aura:Does Size Matter?[J].Cureus,2018,10(8):e3213. DOI:10.7759/cureus.3213.
• [7] VOS T,FLAXMAN A D,NAGHAVI M,et al.Yearslived with disabi lity(YLDs)for 1160 sequelae of 289 diseases and injuries 1990-2010:a systematic analysis for the global burden of disease study 2010[J]. Lancet,2012,380:2163-2196. DOI:10.1016/S0140-6736(12)61729-2.
• [8] ZHANG Y,KONG Q,CHEN J,et al. International classification of headache disorders 3rd edition beta-based field testing of vestibular migraine in China:demographic,clinical characteristics,audiometric findings and diagnosis statues[J]. Cephalalgia,2016,36:240-248. DOI:10.1177/0333102415587704.
• [9] WILMSHURST P,BRYSON P. Relationship between the clinical features of neurological decompression illness and its causes[J]. Clin Sci,2000,99(1):65-75. DOI:10.1042/cs0990065.
• [10] CHOI D Y,SHIN D H,CHO K H,et al. Migraine with aura:a predictor of patent foramen ovale in children and adolescents[J]. Cephalalgia,2013,33(7):463-468. DOI:10.1177/0333102413477740.
• [11] JIE C,LUYUN C,WANGWANG H,et al. A comparison of contrast transthoracic echocardiography and contrast transcranial Doppler in cryptogenic stroke patients with patent foramen ovale[J]. Brain Behav,2019,9(5):e01283. DOI:10.1002/brb3.1283.
• [12] WANG S B,LIU K D,YANG Y,et al. Prevalence and extent of right-to-left shunt on contrast-enhanced transcranial Doppler in Chinese patients with migraine in a multicentre case-control study[J]. Cephalalgia,2018,38(4):690-696. DOI:10.1177/0333102417708203.
• [13] MERRILL H S,YVONNE G. Role of Transesophageal Echocardiography in Patients with Ischemic Stroke[J]. Prog Cardiovasc Dis,2018,61(5/6):456-467. DOI:10.1016/j.pcad.2018.11.007.
• [14] BABIKIR K,AHMED A,MOHAMMED O,et al. Percutaneous Closure of Patent Foramen Ovale in Migraine A Meta-Analysis of Randomized Clinical Trials[J]. JACC Cardiovasc Interv,2018,11(8):816-818. DOI:0.1016/j.jcin.2018.01.232.
• [15] MERON K T,KHALID N,CHIOMA C N,et al. Patent Foramen Ovale:A Comprehensive Review[J]. Curr Probl Cardiol,2020,45(2):100392. DOI:10.1016/j.cpcardiol.2018.08.004.
• [16] BRAIN H W,NABIL N,YAKOV M,et al. Frequency of Patent Foramen Ovale and Migraine in Patients With Cryptogenic Stroke[J]. Stroke,2018,49(5):1123-1128. DOI:10.1161/STRO KEAHA.117.020160.
• [17] CHENG F,KUN H,CHANG X,et al. Contrast-enhanced transthoracic echocardiography applied in evaluation of pulmonary right-to-left shunt:A preliminary study[J]. Comput Med Imaging Graph,2018,68:55-60. DOI:10.1016/j.compmedimag.2018.04.007.
• [18] ANTONIO V. Patent Foramen Ovale:Pivotal Role of Transesophageal Echocardiography in the Indications for Closure,Assessment of Varying Anatomies and Post-Procedure Follow-up[J]. Ultrasound Med Biol,2019,45(8):1882-1895. DOI:10.1016/j.ultrasmedbio.2019.04.015.
• [19] ARMANDO P STEFANO G,ANNA A,et al. A Novel ATP1A2 Gene Variant Associated With Pure Sporadic Hemiplegic Migraine Improved After Patent Foramen Ovale Closure:A Case Report[J]. Front Neurol,2018,9:332. DOI:10.3389/fneur.2018.00332.
• [20] CLAUDIA A,MATTEO P,NICOLETTA B,et al. Right-to-left shunts and hormonal therapy influence cerebral vasomotor reactivity in patients with migraine with aura[J]. PLoS One,2019,14(8):e0220637. DOI:10.1371/journal.pone.0220637.
• [21] AARON J S,AGUSTIN M C,JENNIFER S,et al. CSD-Induced Arterial Dilatation and Plasma Protein Extravasation Are Unaffected by Fremanezumab:Implications for CGRP's Role in Migraine with Aura[J]. J Neurosci,2019,39(30):6001-6011. DOI:10.1523/JNEUROSCI.0232-19.2019.
• [22] MOHANTY S,MOHANTY P,RUTLEDGE J N,et al. Effect of catheter ablation and periprocedural anticoagulation regimen on the clinical course of migraine in atrialfibrillation patients with or without pre-existent migraine:results from a prospective study[J]. Circ Arrhythm Electrophysiol,2015,8(2):279-287. DOI:10.1161/CIRCEP.114.002285.
• [23] ROBERT J S,NAZIF T,L PRIVITERA L,et al.Retrospective review of thienopyridine therapy in migraineurs with patent foramen ovale[J].Neurology,2018,91(22):1002-1009. DOI:10.1212/WNL.0000000000006572.
• [24] ADAM M R,BARBARA T R,DENISE E C,et al. Ticagrelor for Refractory Migraine/Patent Foramen Ovale(TRACTOR):An open-label pilot study[J]. Neurology,2018,91(22):1010-1017. DOI:10.1212/WNL.0000000000006573.
• [25]郑泽华，郝雨雁，方玉婷，等.偏头痛与紧张型头痛前驱症状比较及预测能力[J].中国实用神经疾病杂志，2021,24(19):1657-1667.DOI:10.12083/SYSJ.2021.18.012.
• [26]张晓蕾，王运良.偏头痛的分子机制研究进展[J].中国实用神经疾病杂志，2018,21(15):1634-1639. DOI:10.12083/SYSJ.2018.15.377.
• [27] YAODE H,XIULI Y,CHEN Q,et al.Transcatheter Patent Foramen Ovale Closure Is Effective in Alleviating Migraine in a 5-Year Follow-Up[J]. Front Neurol,2019,10:1224.DOI:10.3389/fneur.2019.01224.
• [28] AYMAN E,KIROLOS B,AHMED S A,et al.Meta-analysis of randomized trials on percutaneous patent foramen ovale closure for prevention of migraine[J]. Acta Cardiol,2019,74(2):124-129. DOI:10.1080/00015385.2018.1475027.
• [29] MI J L,BOYONG P,SOOHYUN C,et al. Cerebrovascular reactivity as a determinant of deep white matter hyperintensities in migraine[J].Neurology,2019,92(4):342-350. DOI:10.1212/WNL.0000000000006822.
• [30] QIU H,YINGBIN Z,FENGZHI W,et al. Impact of right-to-left shunt and transcatheter closure on the clinical features of migraine[J].Int J Neurosci,2020,130(3):270-275. DOI:10.1080/00207454.2019.1672681.