偏头痛与脑小血管病MRI总负荷评分的相关性研究
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摘要
目的:分析偏头痛患者与脑小血管病(cSVD)MRI表现及总负荷评分的相关性。方法:将2016年10月-2018年9月在本院神经内科诊断为偏头痛的69例患者及年龄和性别与患者组相匹配的从未发生过各种类型偏头痛的体检者69例(对照组)纳入研究。所有患者行多模态MRI(常规T1WI、T2WI、FLAIR、DWI和SWI),对每例患者的血管源性脑腔隙、白质内高信号(WMH)、微出血(CMBs)及血管周围间隙扩大(EPVS)这四个典型cSVD征象的出现情况及程度进行分析,并采用四级量表法进行总负荷评分。采用卡方检验比较两组受试者中cSVD征象出现率的差异,采用Mann-Whitney U检验比较两组间cSVD总负荷评分的差异,并采用二元Logistic回归法分析二者间的关系。结果:患者组和对照组中严重WMH(57.97%vs.40.58%;χ~2=4.175,P=0.041)和CMBs(28.99%vs.13.04%;χ~2=5.283;P=0.022)的出现率及cSVD总负荷评分(Z=-2.949;P=0.020)的差异有统计学意义。cSVD总负荷评分对偏头痛的诊断敏感度为59.42%,特异度为62.32%。校正混杂因素后的二元多变量回归分析显示,cSVD总负荷是偏头痛的独立危险因素(优势比=1.399,95%置信区间为1.036～1.890;P=0.029)。结论:偏头痛与cSVD的MRI表现密切相关,cSVD总负荷是偏头痛的独立危险因素。
Objective:To analyze the distribution of MRI features of cerebral small vessel disease(cSVD)and total MRI burden of cSVD in patients with migraine.Methods:Sixty-nine patients with migraine from the neurology department headache clinic of our hospital from October 2016 to September 2018 were collected as the migraine group,and sixty-nine healthy subjects who have never been any kind of migraine were used as the control group at the same time.The presence of lacunes,white matter hyperintensities(WMH),cerebral microbleeds(CMBs),enlarged perivascular spaces(EPVS)were recorded in an ordinal score(range 0～4).The difference of features of cSVD was conducted using Chi-squared test,the difference of distribution of total MRI burden of cSVD was conducted using Mann-Whitney U-test and the correlation between migraine and total MRI burden of cSVD was conducted using binary multivariate regression.Results:There was no statistical difference in age or sex between the two groups.There were significant differences in the proportions of severe WMH(57.97% vs.40.58%;χ~2=4.175,P=0.041)and CMBs(28.99% vs.13.04%;χ~2=5.283,P=0.022)as well as total cSVD scores(Z=-2.949,P=0.020)between the patients group and the control group.For the diagnosis of migraine,sensitivity of the total cSVD score on MRI was 59.42%and the specificity was 62.32%.After adjustment for confounding factors,binary multivariate regression analysis revealed that the total MRI burden score of cSVD(odds ratio:1.399,95%confidence interval:1.036～1.890,P=0.029)was the independent risk factor for migraine.Conclusion:The total MRI burden of cSVD is closely associated with the migraine and can be the independent risk factor of migraine.
Objective:To analyze the distribution of MRI features of cerebral small vessel disease(cSVD)and total MRI burden of cSVD in patients with migraine.Methods:Sixty-nine patients with migraine from the neurology department headache clinic of our hospital from October 2016 to September 2018 were collected as the migraine group,and sixty-nine healthy subjects who have never been any kind of migraine were used as the control group at the same time.The presence of lacunes,white matter hyperintensities(WMH),cerebral microbleeds(CMBs),enlarged perivascular spaces(EPVS)were recorded in an ordinal score(range 0～4).The difference of features of cSVD was conducted using Chi-squared test,the difference of distribution of total MRI burden of cSVD was conducted using Mann-Whitney U-test and the correlation between migraine and total MRI burden of cSVD was conducted using binary multivariate regression.Results:There was no statistical difference in age or sex between the two groups.There were significant differences in the proportions of severe WMH(57.97% vs.40.58%;χ~2=4.175,P=0.041)and CMBs(28.99% vs.13.04%;χ~2=5.283,P=0.022)as well as total cSVD scores(Z=-2.949,P=0.020)between the patients group and the control group.For the diagnosis of migraine,sensitivity of the total cSVD score on MRI was 59.42%and the specificity was 62.32%.After adjustment for confounding factors,binary multivariate regression analysis revealed that the total MRI burden score of cSVD(odds ratio:1.399,95%confidence interval:1.036～1.890,P=0.029)was the independent risk factor for migraine.Conclusion:The total MRI burden of cSVD is closely associated with the migraine and can be the independent risk factor of migraine.
引文
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[27]Zhao Z,Nelson AR,Betsholtz C,et al.Establishment and dysfunction of the blood-brain barrier[J].Cell,2015,163(5):1064-1078.
[28]Tietjen GE.Migraine as a systemic vasculopathy[J].Cephalalgia,2009,29(9):987-996.
[29]Arkink EB,Terwindt GM,de Craen AJ,et al.Infratentorial microbleeds:another sign of microangiopathy in migraine[J].Stroke,2015,46(7):1987-1999.
[30]Androulakis XM,Kodumuri N,Giamberardino LD,et al.Ischemic stroke subtypes and migraine with visual aura in the ARIC study[J].Neurology,2016,87(24):2527-2532.
[31]Machado MA,Matos AS,Goyanna F,et al.Dilatation of Virchow-Robin spaces in patients with migraine[J].Arq Neuropsiquiatr,2001,59(2a):206-209.
[32]贾艳露,刘春岭,李慧等.偏头痛血管周围间隙的磁共振特征分析[J].中华神经科杂志,2018,51(4):275-280.
[33]Husoy AK,Indergaard MK,Honningsvag LM,et al.Perivascular spaces and headache:apopulation-based imaging study(HUNTMRI)[J].Cephalalgia,2016,36(3):232-239.
[2]Kruit MC,van Buchem MA,Launer LJ,et al.Migraine is associated with an increased risk of deep white matter lesions,subclinical posterior circulation infarcts and brain iron accumulation:the population-based MRI CAMERA study[J].Cephalalgia,2010,30(2):129-136.
[3]Negm M,Housseini AM,Abdelfatah M,et al.Relation between migraine pattern and white matter hyperintensities in brain magnetic resonance imaging[J].Egypt J Neurol Psychiatr Neurosurg,2018,54:e24.https://doi.org/10.1186/s41983-018-0027-x.
[4]Schain AJ,Melo-Carrillo A,Strassman AM,et al.Cortical spreading depression closes paravascular space and impairs glymphatic flow:Implications for migraine headache[J].J Neurosci,2017,37(11):2904-2915.
[5]Pantoni L.Cerebral small vessel disease:from pathogenesis and clinical characteristics to therapeutic challenges[J].Lancet Neurol,2010,9(7):689-701.
[6]Wardlaw JM,Smith EE,Biessels GJ,et al.Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration[J].Lancet Neurol,2013,12(8):822-838.
[7]Benjamin P,Viessmann O,MacKinnon AD,et al.7Tesla MRI in cerebral small vessel disease[J].Int J Stroke,2015,10(5):659-664.
[8]Cheng AL,Batool S,McCreary CR,et al.Susceptibility-weighted imaging is more reliable than T2*-weighted gradient-recalled echo MRI for detecting microbleeds[J].Stroke,2013,44(10):2782-2786.
[9]Smith EE,Saposnik G,Biessels GJ,et al.Prevention of stroke in patients with silent cerebrovascular disease:a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association[J/OL].Stroke,2017,48(2):e44-e71.
[10]Fazekas F,Chawluk JB,Alavi A,et al.MR signal abnormalities at 1.5Tin Alzheimer's dementia and normal aging[J].AJR,1987,149(2):351-456.
[11]Gregoire SM,Chaudhary UJ,Brown MM,et al.The Microbleed Anatomical Rating Scale(MARS):reliability of a tool to map brain microbleeds[J].Neurology,2009,73(21):1759-1766.
[12]Doubal FN,MacLullich AM,Ferguson KJ,et al.Enlarged perivascular spaces on MRI are a feature of cerebral small vessel disease[J].Stroke,2010,41(3):450-454.
[13]Staals J,Makin SD,Doubal FN,et al.Stroke subtype,vascular risk factors,and total MRI brain small-vessel disease burden[J].Neurology,2014,83(14):1228-1234.
[14]Poels MM,Vernooij MW,Ikram MA,et al.Prevalence and risk factors of cerebral microbleeds:an update of the Rotterdam scan study[J].Stroke,2010,41(10Suppl):S103-S106.
[15]Yu S,Liu R,Zhao G,et al.The prevalence and burden of primary headaches in China:apopulation-based door-to-door survey[J].Headache,2012,52(4):582-591.
[16]于生元,陈小燕.偏头痛发生机制的神经影像学研究进展[J].2014,25(1):1-4.
[17]Seneviratne U,Chong W,Billimoria PH.Brain white matter hyperintensities in migraine:clinical and radiological correlates[J].Clin Neurol Neurosurg,2013,115(7):1040-1043.
[18]Kruit MC,van Buchem MA,Hofman PA,et al.Migraine as a risk factor for subclinical brain lesions[J].JAMA,2004,291(4):427-434.
[19]Toghae M,Rahimian E,Abdollahi M,et al.The prevalence of magnetic resonance imaging hyperintensity in migraine patients and its association with migraine headache characteristics and cardiovascular risk factors[J].Oman Med J,2015,30(3):203-207.
[20]Zhang Q,Datta R,Detre JA,et al.White matter lesion burden in migraine with aura may be associated with reduced cerebral blood flow[J].Cephalalgia,2017,37(6):517-524.
[21]Rossato G,Adami A,Thijs VN,et al.Cerebral distribution of white matter lesions in migraine with aura patients[J].Cephalalgia,2010,30(7):855-859.
[22]Le Pira F,Reggio E,Quattrocchi G,et al.Executive dysfunctions in migraine with and without aura:what is the role of white matter lesions[J].Headache,2014,54(1):125-130.
[23]Agostoni E,Rigamonti A.Migraine and small vessel diseases[J].Neurol Sci,2012,33(Suppl 1):S51-S54.
[24]Lawrence AJ,Patel B,Morris RG,et al.Mechanisms of cognitive impairment in cerebral small vessel disease:multimodal MRI results from the St George's cognition and neuroimaging in stroke(SCANS)study[J/OL].PLoS One,2013,8(4):e61014.
[25]Cordonnier C,van der Flier WM.Brain microbleeds and Alzheimer's disease:innocent observation or key player[J].Brain,2011,134(2):335-344.
[26]Valdes Hernandez M,Allerhand M,Glatz A,et al.Do white matter hyperintensities mediate the association between brain iron deposition and cognitive abilities in older people[J].Eur J Neurol,2016,23(7):1202-1209.
[27]Zhao Z,Nelson AR,Betsholtz C,et al.Establishment and dysfunction of the blood-brain barrier[J].Cell,2015,163(5):1064-1078.
[28]Tietjen GE.Migraine as a systemic vasculopathy[J].Cephalalgia,2009,29(9):987-996.
[29]Arkink EB,Terwindt GM,de Craen AJ,et al.Infratentorial microbleeds:another sign of microangiopathy in migraine[J].Stroke,2015,46(7):1987-1999.
[30]Androulakis XM,Kodumuri N,Giamberardino LD,et al.Ischemic stroke subtypes and migraine with visual aura in the ARIC study[J].Neurology,2016,87(24):2527-2532.
[31]Machado MA,Matos AS,Goyanna F,et al.Dilatation of Virchow-Robin spaces in patients with migraine[J].Arq Neuropsiquiatr,2001,59(2a):206-209.
[32]贾艳露,刘春岭,李慧等.偏头痛血管周围间隙的磁共振特征分析[J].中华神经科杂志,2018,51(4):275-280.
[33]Husoy AK,Indergaard MK,Honningsvag LM,et al.Perivascular spaces and headache:apopulation-based imaging study(HUNTMRI)[J].Cephalalgia,2016,36(3):232-239.