原发性头痛患者血清维生素D水平变化及相关性分析
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摘要
目的观察原发性头痛中偏头痛及紧张型头痛患者维生素D水平,并分析其与临床特点的相关性。方法选择2017年6月—2018年6月上海交通大学医学院附属仁济医院神经内科就诊的紧张型头痛患者150例、偏头痛患者277例作为研究对象,另选择同时期于体检中心健康体检者250例作为健康对照组。详细记录3组临床资料并测量血清25-(OH)D水平。比较3组受试者维生素D水平的差异,同时根据维生素D是否正常分亚组,分析其与紧张型头痛及偏头痛患者临床特点的相关性。结果紧张型头痛及偏头痛患者的维生素D水平均低于健康对照者(F=57.698,P<0.001),调整性别、年龄及季节后这种差异仍存在(P<0.05)。在紧张型头痛中,维生素D缺乏亚组较正常亚组头痛程度重(t=3.034,P=0.004),调整性别、年龄及季节后这种差异仍存在(P<0.05);在偏头痛中未发现头痛特点与维生素D缺乏有关(P>0.05),但正常亚组年龄较缺乏亚组高(t=3.827,P<0.001),接受维生素D检测的季节差异有统计学意义(χ~2=17.217,P<0.001)。经二元Logistic回归分析,在紧张型头痛中发现,校正性别及年龄后,头痛程度与维生素D的缺乏显著相关(OR=1.487,95%CI 1.153～1.918,P=0.002),接受检测的季节也与维生素D缺乏相关(OR=0.384,95%CI 0.168～0.876,P=0.023)。在偏头痛中发现,校正性别和年龄后,接受检测的季节与维生素D缺乏相关(OR=0.186,95%CI 0.082～0.424,P<0.001)。结论维生素D缺乏可能与原发性头痛相关,尤其紧张型头痛,维生素D缺乏可能与其疼痛程度有关。
Objective To observe the levels of vitamin D in migraine and tension headache patients with primary headache, and to analyze its correlation with clinical characteristics. Methods From June 2017 to June 2018, 150 patients with tension-type headache and 277 patients with migraine were selected as the study subjects, and 250 patients with physical examination at the same time were selected as the healthy control group in Renji Hospital Affiliated to Medical College of Shanghai Jiaotong University. Clinical data of three groups were recorded and serum 25(OH) D level was measured. The differences of vitamin D levels among the three groups were compared, and the relationship between vitamin D levels and clinical characteristics of tension headache and migraine patients was analyzed according to whether vitamin D was normal or not. Results Vitamin D levels in patients with tension-type headache and migraine were lower than those in healthy controls(F=57.698, P<0.001), and this difference remained after adjusting for gender, age, and season(P<0.05). In tension-type headache, the vitamin D deficiency subgroup was more severe than the normal subgroup(t=3.034, P=0.004), and the difference remained after adjusting for gender, age, and season(P<0.05); in migraine No headache was found to be associated with vitamin D deficiency(P>0.05), but the normal subgroup was older than the subgroup(t=3.827, P<0.001). The seasonal difference in vitamin D test was statistically significant(χ~2=17.217, P<0.001). After binary logistic regression analysis, it was found in tension-type headache that the degree of headache was significantly associated with vitamin D deficiency after adjusting for gender and age(OR=1.487, 95% CI 1.153 to 1.918,P=0.002), the season of testing Also associated with vitamin D deficiency(OR=0.384, 95% CI 0.168-0.876, P=0.023). In migraine, the age of the test was associated with vitamin D deficiency after adjusting for gender and age(OR=0.186, 95% CI 0.082 to 0.424, P<0.001). Conclusion Vitamin D deficiency may be associated with primary headache, especially tension headache. Vitamin D deficiency may be related to the degree of pain.
Objective To observe the levels of vitamin D in migraine and tension headache patients with primary headache, and to analyze its correlation with clinical characteristics. Methods From June 2017 to June 2018, 150 patients with tension-type headache and 277 patients with migraine were selected as the study subjects, and 250 patients with physical examination at the same time were selected as the healthy control group in Renji Hospital Affiliated to Medical College of Shanghai Jiaotong University. Clinical data of three groups were recorded and serum 25(OH) D level was measured. The differences of vitamin D levels among the three groups were compared, and the relationship between vitamin D levels and clinical characteristics of tension headache and migraine patients was analyzed according to whether vitamin D was normal or not. Results Vitamin D levels in patients with tension-type headache and migraine were lower than those in healthy controls(F=57.698, P<0.001), and this difference remained after adjusting for gender, age, and season(P<0.05). In tension-type headache, the vitamin D deficiency subgroup was more severe than the normal subgroup(t=3.034, P=0.004), and the difference remained after adjusting for gender, age, and season(P<0.05); in migraine No headache was found to be associated with vitamin D deficiency(P>0.05), but the normal subgroup was older than the subgroup(t=3.827, P<0.001). The seasonal difference in vitamin D test was statistically significant(χ~2=17.217, P<0.001). After binary logistic regression analysis, it was found in tension-type headache that the degree of headache was significantly associated with vitamin D deficiency after adjusting for gender and age(OR=1.487, 95% CI 1.153 to 1.918,P=0.002), the season of testing Also associated with vitamin D deficiency(OR=0.384, 95% CI 0.168-0.876, P=0.023). In migraine, the age of the test was associated with vitamin D deficiency after adjusting for gender and age(OR=0.186, 95% CI 0.082 to 0.424, P<0.001). Conclusion Vitamin D deficiency may be associated with primary headache, especially tension headache. Vitamin D deficiency may be related to the degree of pain.
引文
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[5] 张爱飞,冯正平.维生素D免疫调节的研究进展[J].中国骨质疏松杂志,2019,25 (4):564-569.DOI:10.3969 /j.issn.1006-7108.2019.04.028.
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[11] Gocmen AY,Celikbilek A,Zararsiz G,et al.Serum levels of vitamin D,vitamin D-binding protein and vitamin D receptor in migraine patients from central Anatolia region[J].Int J Clin Pract,2014,68(10):1272-1277.DOI:10.1111/ijcp.12456.
[12] Song TJ,Chu MK,Sohn JH,et al.Effect of Vitamin D Deficiency on the Frequency of Headaches in Migraine[J].J Clin Neurol,2018,14 (3):366-373.DOI:10.3988/jcn.2018.14.3.366.
[13] Zandifar A,Masjedi SS,Banihashemi M,et al.Vitamin D status in migraine patients:a case-control study[J].Biomed Res Int,2014,2014:514782.DOI:10.1155/2014/514782.
[14] 陈超,刘志超,祝永刚,等.维生素D的最新研究进展[J].中国骨质疏松杂志,2018,24(10):1390-1395.DOI:10.3969 /j.issn.1006-7108.2018.10.024.
[15] Charles A.The pathophysiology of migraine:implications for clinical management[J].The Lancet Neurology,2018,17 (2):174-182.DOI:10.1016/s1474-4422(17)30435-0.
[16] Prakash S,Rathore C,Makwana P,et al.Vitamin D Deficiency in Patients With Chronic Tension-Type Headache:A Case-Control Study[J].Headache,2017,57(7):1096-1108.DOI:10.1111/head.13096.
[17] Donmez A,Orun E,Sonmez FM.Vitamin D status in children with headache:A case-control study[J].Clin Nutr ESPEN,2018,23:222-227.DOI:10.1016/j.clnesp.2017.09.010.
[18] 孙永欣,姚刚,于挺敏,等.紧张型头痛机制研究进展[J].中国医药导报,2019,16(3):37-40.DOI:CNKI:SUN:YYCY.0.2019-03-009.
[19] 王长贵.维生素D不足与非特异性骨骼肌肉痛的关系及其治疗措施分析[J].临床合理用药,2018,11(4):171-172.DOI:10.15887/j.cnki.13-1389/r.2018.11.113.
[20] Do TP,Heldarskard GF,Kolding LT,et al.Myofascial trigger points in migraine and tension-type headache[J].J Headache Pain,2018,19(1):84.DOI:10.1186/s10194-018-0913-8.
[21] 张瑞杰,郝小生,梁建民,等.维生素D与偏头痛[J].中风与神经疾病杂志,2018,35(2):187-189.DOI:1003-2754( 2018) 02-0187-03.
[22] Mpandzou G,Ait Ben Haddou E,Regragui W,et al.Vitamin D deficiency and its role in neurological conditions:A review[J].Rev Neurol (Paris),2016,172(2):109-122.DOI:10.1016/j.neurol.2015.11.005.
[23] Knutsen KV,Madar AA,Brekke M,et al.Effect of vitamin D on musculoskeletal pain and headache:A randomized,double-blind,placebo-controlled trial among adult ethnic minorities in Norway[J].Pain,2014,155(12):2591-2598.DOI:10.1016/j.pain.2014.09.024.
[2] Prakash S,Mehta NC,Dabhi AS,et al.The prevalence of headache may be related with the latitude:a possible role of Vitamin D insufficiency [J].J Headache Pain,2010,11(4):301-307.DOI:10.1007/s10194-010-0223-2.
[3] 白瑜,冯自立.维生素D受体(VDR)对中枢神经系统功能作用的研究进展[J].生命科学,2018,30 (7):716-722.DOI:10.13376/j.cbls/2018084.
[4] Holick MF.The vitamin D deficiency pandemic:Approaches for diagnosis,treatment and prevention[J].Rev Endocr Metab Disord,2017,18 (2):153-165.DOI:10.1007/s11154-017-9424-1.
[5] 张爱飞,冯正平.维生素D免疫调节的研究进展[J].中国骨质疏松杂志,2019,25 (4):564-569.DOI:10.3969 /j.issn.1006-7108.2019.04.028.
[6] Bouillon R.Extra-Skeletal Effects of Vitamin D[J].Front Horm Res,2018,50:72-88.DOI:10.1159/000486072.
[7] McCabe PS,Pye SR,Beth JM,et al.Low vitamin D and the risk of developing chronic widespread pain:results from the European male ageing study[J].BMC Musculoskelet Disord,2016,17(1):32.DOI:10.1186/s12891-016-0881-6.
[8] Bansal D,Boya CS,Vatte R,et al.High Prevalence of Hypovitaminosis D in Patients with Low Back Pain:Evidence from Meta-Analysis[J].Pain Physician,2018,21(4):389-399.
[9] Cernuda-Morollón E,Larrosa D,Ramón C,et al.Interictal increase of CGRP levels in peripheral blood as a biomarker for chronic migraine[J].Neurology,2013,81(14):1191-1196.DOI:10.1212/WNL.0b013e3182a6cb72.
[10] Feingold D,Brill S,Goor-Aryeh I,et al.Depression and anxiety among chronic pain patients receiving prescription opioids and medical marijuana[J].J Affect Disord,2017,218:1-7.DOI:10.1016/j.jad.2017.04.026.
[11] Gocmen AY,Celikbilek A,Zararsiz G,et al.Serum levels of vitamin D,vitamin D-binding protein and vitamin D receptor in migraine patients from central Anatolia region[J].Int J Clin Pract,2014,68(10):1272-1277.DOI:10.1111/ijcp.12456.
[12] Song TJ,Chu MK,Sohn JH,et al.Effect of Vitamin D Deficiency on the Frequency of Headaches in Migraine[J].J Clin Neurol,2018,14 (3):366-373.DOI:10.3988/jcn.2018.14.3.366.
[13] Zandifar A,Masjedi SS,Banihashemi M,et al.Vitamin D status in migraine patients:a case-control study[J].Biomed Res Int,2014,2014:514782.DOI:10.1155/2014/514782.
[14] 陈超,刘志超,祝永刚,等.维生素D的最新研究进展[J].中国骨质疏松杂志,2018,24(10):1390-1395.DOI:10.3969 /j.issn.1006-7108.2018.10.024.
[15] Charles A.The pathophysiology of migraine:implications for clinical management[J].The Lancet Neurology,2018,17 (2):174-182.DOI:10.1016/s1474-4422(17)30435-0.
[16] Prakash S,Rathore C,Makwana P,et al.Vitamin D Deficiency in Patients With Chronic Tension-Type Headache:A Case-Control Study[J].Headache,2017,57(7):1096-1108.DOI:10.1111/head.13096.
[17] Donmez A,Orun E,Sonmez FM.Vitamin D status in children with headache:A case-control study[J].Clin Nutr ESPEN,2018,23:222-227.DOI:10.1016/j.clnesp.2017.09.010.
[18] 孙永欣,姚刚,于挺敏,等.紧张型头痛机制研究进展[J].中国医药导报,2019,16(3):37-40.DOI:CNKI:SUN:YYCY.0.2019-03-009.
[19] 王长贵.维生素D不足与非特异性骨骼肌肉痛的关系及其治疗措施分析[J].临床合理用药,2018,11(4):171-172.DOI:10.15887/j.cnki.13-1389/r.2018.11.113.
[20] Do TP,Heldarskard GF,Kolding LT,et al.Myofascial trigger points in migraine and tension-type headache[J].J Headache Pain,2018,19(1):84.DOI:10.1186/s10194-018-0913-8.
[21] 张瑞杰,郝小生,梁建民,等.维生素D与偏头痛[J].中风与神经疾病杂志,2018,35(2):187-189.DOI:1003-2754( 2018) 02-0187-03.
[22] Mpandzou G,Ait Ben Haddou E,Regragui W,et al.Vitamin D deficiency and its role in neurological conditions:A review[J].Rev Neurol (Paris),2016,172(2):109-122.DOI:10.1016/j.neurol.2015.11.005.
[23] Knutsen KV,Madar AA,Brekke M,et al.Effect of vitamin D on musculoskeletal pain and headache:A randomized,double-blind,placebo-controlled trial among adult ethnic minorities in Norway[J].Pain,2014,155(12):2591-2598.DOI:10.1016/j.pain.2014.09.024.