Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan.
Department of Pharmacy, Tokyo Women's Medical University, Tokyo, Japan.
Childs Nerv Syst. 2021 May;37(5):1649-1657. doi: 10.1007/s00381-020-04991-y. Epub 2021 Jan 6.
NSAIDs (nonsteroidal anti-inflammatory drugs) were administered to patients with ischemic onset-type moyamoya disease who experience headaches, but their therapeutic effect was very poor and resulted in a drop in quality of life (QOL). On the other hand, patients who were administered aspirin initially to prevent transient ischemic attacks (TIA) were observed to have a better QOL with the absence of headaches. Here, we report on patients with ischemic onset-type moyamoya disease experiencing headaches who received aspirin in order to verify its safety and effectiveness.
From October 2012 to July 2014, 35 patients (male: 19, female: 16 average age: 10.5 ± 3.9) with ischemic onset-type pediatric moyamoya disease and who were admitted or commuted to hospital and had surgical treatment were evaluated for background, moyamoya staging (Suzuki), presence/absence of TIA, and platelet aggregation activity by adenosine diphosphate (ADP)/collagen turbidity test. The patients were divided into four groups depending on the intensity of headache prior to being administered aspirin, and the Kruskal-Wallis test was carried out for platelet aggregation activity and moyamoya staging. Also, the 4 × 2 χ test was carried out for the presence/absence of TIA. Next, the items which were significant in these tests were used as independent variables to analyze the risk of headache onset, using logistic regression analysis.
One item with statistical significance was the platelet aggregation test(PAT) value (on collagen) (P < 0.0001). A logistic regression analysis was carried out, using this value as an independent variable and headache intensity-as a dependent variable. As a result, an increase in PAT value by 1 translated into 4.43 times higher risk of the onset of intractable headache, and the onset of intractable headaches was predicted at 58.8% with collagen. The risk of developing a headache decreased as a result of aspirin administration, and the decrease was dependent on the collagen-induced aggregation suppression effect of aspirin. Aspirin was administered in the range of 1.6~9.5 mg/kg/day, and the PAT value decreasing rate was 42.9% on average. One case alone experienced nasal bleeding, and all cases showed an improvement in the intractable headaches.
In patients with ischemic onset-type pediatric moyamoya disease who experience headaches, the platelet aggregation activity is accelerated, and aspirin administration is effective in alleviating headaches by inhibiting platelet activation, detected by the collagen PAT.
患有缺血性发作型烟雾病并伴有头痛的患者使用了非甾体抗炎药（NSAIDs），但疗效很差，导致生活质量（QOL）下降。另一方面，最初接受阿司匹林治疗以预防短暂性脑缺血发作（TIA）的患者头痛消失，生活质量更好。在这里，我们报告了患有缺血性发作型烟雾病并伴有头痛的患者接受阿司匹林治疗的安全性和有效性。
从 2012 年 10 月至 2014 年 7 月，我们对 35 名（男 19 名，女 16 名，平均年龄 10.5±3.9 岁）接受手术治疗的缺血性发作型儿科烟雾病患者进行了评估，这些患者因头痛入院或转院，并进行了烟雾病分期（铃木）、TIA 的存在/缺失以及通过二磷酸腺苷（ADP）/胶原浊度试验评估血小板聚集活性。根据服用阿司匹林前头痛的严重程度将患者分为四组，采用 Kruskal-Wallis 检验对血小板聚集活性和烟雾病分期进行检验。此外，还对 TIA 的存在与否进行了 4×2 χ 检验。接下来，将这些检验中具有统计学意义的项目作为自变量，使用逻辑回归分析来分析头痛发作的风险。
有一个具有统计学意义的项目是血小板聚集试验（PAT）值（在胶原上）（P<0.0001）。使用该值作为自变量，头痛强度作为因变量，进行逻辑回归分析。结果表明，PAT 值增加 1 会导致难治性头痛发作的风险增加 4.43 倍，胶原预测难治性头痛发作的风险为 58.8%。阿司匹林治疗后头痛的风险降低，这取决于阿司匹林对胶原诱导的血小板聚集的抑制作用。阿司匹林的用量范围为 1.6~9.5mg/kg/天，平均 PAT 值下降率为 42.9%。仅有 1 例出现鼻出血，所有病例的难治性头痛均有改善。
在患有缺血性发作型儿科烟雾病并伴有头痛的患者中，血小板聚集活性加快，阿司匹林通过抑制血小板激活来缓解头痛，这可通过胶原 PAT 检测到。
