偏头痛慢性化的临床与脑灰质结构研究

发布时间：2018-03-31 08:26

本文选题：偏头痛　切入点：药物过度使用性头痛　出处：《中国人民解放军医学院》2014年博士论文

【摘要】：背景：偏头痛是一种发作性疾病，并可转换成慢性形式。引起偏头痛慢性化最常见的原因是止痛药物过度使用。伴有药物过度使用性头痛的慢性偏头痛（CM-MOH）和无药物过度使用头痛的慢性偏头痛（CMwoMOH）在病理生理和治疗上都存在很大差别。新型神经影像技术发现偏头痛患者疼痛处理网络相关区域存在功能和结构的变化，在一定程度上揭示了偏头痛的病理生理机制。目的：本研究旨在探索发作性偏头痛和慢性偏头痛伴或不伴药物滥用的临床和全脑灰质容积差别，从而寻找偏头痛慢性化可能的生物学标志。方法：共纳入110名受试着，其中包括44名CM-MOH,16名CMwoMOH,18名EM患者以及32名健康对照（HCs）。收集头痛基本信息，对偏头痛失能评分，生活质量评估，焦虑抑郁和认知功能进行评估。采用核磁共振基于体素的形态测量学（VBM）分析各个组别脑灰质容积的差别。结果： CM-MOH和CMwoMOH患者的偏头痛失能评估分数（MIDAS）显著高于EM患者。三组头痛患者的汉密尔顿焦虑抑郁分数均显著高于HCs。相对EM患者，CM-MOH患者抑郁分数更高，而CMwoMOH患者焦虑分数更高(p0.05)。采用蒙特利尔认知评估量表评价发现CM-MOH患者和CMwoMOH患者认知功能较EM患者和HCs减低(p0.05)。各组之间全脑灰质体积(GMV)无明显差别，全脑GMV和体重指数及男性性别正相关，与年龄，头痛慢性化时间，，HAMD分数呈负相关。与健康对照组相比，各头痛组颞中极局部GMV明显减少，CM-MOH患者和CMwoMOH患者右侧上下眶额回，右侧颞下回、小脑Crus1GMV减少，EM患者右侧颞下回、小脑Crus1GMV增加。此外，CM-MOH患者左侧直回，左侧中扣带回，双侧岛叶，右侧罗兰迪克岛盖，左侧枕下回，双侧楔前回，右侧距状回GMV减少。EM患者和CMwoMOH患者右侧额中回，罗兰迪克岛盖，右侧中央前回，左侧中央后回，左上枕叶较HCs组GMV增加。CMwoMOH患者双侧尾状核GMV较其他头痛组和HCs组明显增加。感兴趣区分析显示颞下回、颞极、前扣带回、眶额皮层与慢性头痛年数和/或头痛频率负相关，与头痛总病程无相关性。结论：伴有或不伴有药物过度使用的慢性偏头痛患者存在更多的情感障碍，认知障碍和更严重的失能。偏头痛患者既有GMV减少也有GMV增加的脑区。偏头痛慢性化主要和疼痛的内侧情感反应系统灰质减少有关，包括眶额皮层、前/中扣带回，岛叶以及影响认知、情感的相关灰质区域包括颞下回、颞极、小脑Crus1。下行调节系统中的尾状核在CMwoMOH患者中体积增大，对鉴别慢性偏头痛和药物过度使用头痛有一定价值。罗兰迪克岛盖只在CM-MOH患者中发现灰质减少，提示该结构可能参与MOH的发病机制。
[Abstract]:Background: migraine is a paroxysmal disease that can be converted into a chronic form.The most common cause of chronic migraine is overuse of painkillers.There are great differences in pathophysiology and treatment between chronic migraine (CM-MOH) with drug overuse headache and chronic migraine (CMwoMOH) without drug overuse headache.The new neuroimaging technique revealed the changes of function and structure in the pain management network of migraine patients, which to some extent revealed the pathophysiological mechanism of migraine.Objective: to explore the clinical and global gray matter volume differences between paroxysmal migraine and chronic migraine with or without drug abuse, and to explore the possible biological markers of chronic migraine.Methods: a total of 110 subjects were enrolled, including 44 patients with CM-MOHH, 16 patients with CMwoMOHH and 18 patients with EM and 32 healthy controls.Basic information was collected to assess migraine disability score, quality of life, anxiety and depression, and cognitive function.The difference of gray matter volume in different groups was analyzed by VBM-based morphometry based on voxel by nuclear magnetic resonance imaging (MRI).Results: migraine disability assessment scores in CM-MOH and CMwoMOH patients were significantly higher than those in EM patients.The scores of Hamilton anxiety and depression in all three groups were significantly higher than those of HCs.The depression scores in patients with CM-MOH were higher than those in patients with EM, and the scores of anxiety in patients with CMwoMOH were higher than those in patients with CM-MOH (P 0.05).The cognitive function of CM-MOH patients and CMwoMOH patients was lower than that of EM patients and HCs patients.There was no significant difference in the whole brain gray matter volume between the three groups. There was a positive correlation between global GMV and body mass index (BMI) and male sex, but a negative correlation was found with age, headache chronicity time and Hamd score.Compared with the healthy control group, the local GMV of middle temporal pole in all headache groups decreased significantly in CM-MOH patients and CMwoMOH patients, the right inferior temporal gyrus, right inferior temporal gyrus, and cerebellar Crus1GMV decreased the right infratemporal gyrus and increased cerebellar Crus1GMV in EM patients.In addition, CM-MOH patients had left straight gyrus, left middle cingulate gyrus, bilateral island lobe, right Lorandike island cover, left inferior occipital gyrus, bilateral anterior cuneate gyrus, right talar gyrus GMV decreased. EM patients and CMwoMOH patients had right middle frontal gyrus, Lorandike island cover, right frontal gyrus.In the right precentral gyrus, left posterior central gyrus, left superior occipital lobe, compared with HCs group, the GMV of bilateral caudate nucleus in patients with CMwoMOH was significantly higher than that in other headache groups and HCs groups.The analysis of region of interest showed that the inferior temporal gyrus, temporal pole, anterior cingulate gyrus and orbital frontal cortex were negatively correlated with the number of chronic headache years and / or headache frequency, but had no correlation with the total course of headache.Conclusion: chronic migraine patients with or without drug overuse have more affective disorders, cognitive disorders and more severe disability.Migraine patients have both reduced GMV and increased GMV areas of the brain.Chronic migraine is mainly associated with decreased gray matter in the medial emotional response system of pain, including orbital frontal cortex, anterior / middle cingulate gyrus, insular lobe, and cognitive effects. Affective related gray matter areas include the inferior temporal gyrus, the temporal pole, and the cerebellar Crus1.The caudate nucleus in the downlink regulatory system increases in size in patients with CMwoMOH and is valuable in differentiating chronic migraine from overuse headache.A decrease in gray matter was found only in patients with CM-MOH, suggesting that the structure may be involved in the pathogenesis of MOH.
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R747.2

【共引文献】