Zhao Qiuxia, Liu Rong, Zhou Jun, Dong Zhizhi, Chen Yue
The First College of Clinical Medical Science, China Three Gorges University; Ultrasound Department of Yichang Central People's Hospital, Yichang, China.
Medicine (Baltimore). 2021 Jan 29;100(4):e24175. doi: 10.1097/MD.0000000000024175.
Right-to left shunt (RLS) is regarded as a risk factor resulting in migraine, but the relevance between the RLS and migraine remains controversial. This paper aims at investigating the prevalence and RLS grade of patent foramen ovale (PFO) in cases of migraine (including migraine with and without aura) and evaluate the relationship between PFO and migraine.
Synchronous test of contrast transthoracic echocardiography and contrast transcranial Doppler ultrasonography was performed in 251 cases of migraine, which contains 62 cases of migraine with aura (MA) and 189 cases without aura (MO) and 275 healthy adults. Among these cases, 25 cases with migraine and 14 healthy adults were evaluated through transesophageal echocardiography.
(1). The prevalence of permanent RLS, total RLS, and large RLS in migraine was 11.16%, 39.04%, and 17.13%, respectively, which was significantly higher than that of the controls (P = .042, <.001, and.001, respectively). (2). Permanent RLS was detected as 7.93% of the cases in MO, 20.96% in MA, and 6.18% in controls. Total RLS was detected as 35.98% of the cases in MO, 48.38% in MA, and 23.64% in controls. Large RLS was detected as 13.76% of the cases in MO, 27.41% in MA, and 7.27% in controls. Compared with controls, the positive rate of total RLS and large RLS in MO increased (P = .004 and.022, respectively), the that of permanent RLS, total RLS, and large RLS in MA also increased (P < .001 for each of the comparisons). The positive rate of permanent RLS and large RLS in MA was remarkably higher than that in MO (P = .005 and.013, respectively). (3) The presence of large-size PFO (≥2.0 mm) of migraine showed higher than that of the controls (P = .048).
PFO is associated with the migraine (especially with aura), when it is permanent RLS, large RLS, and large-size PFO (≥2.0 mm).
右向左分流（RLS）被认为是导致偏头痛的一个危险因素，但RLS与偏头痛之间的相关性仍存在争议。本文旨在调查偏头痛患者（包括有先兆和无先兆偏头痛）中卵圆孔未闭（PFO）的患病率及RLS分级，并评估PFO与偏头痛之间的关系。
对251例偏头痛患者（其中62例有先兆偏头痛（MA），189例无先兆偏头痛（MO））及275例健康成年人进行经胸超声心动图造影和经颅多普勒超声造影同步检查。其中，对25例偏头痛患者和14例健康成年人进行了经食管超声心动图检查。
（1）偏头痛患者中永久性RLS、总RLS和大量RLS的患病率分别为11.16%、39.04%和17.13%，显著高于对照组（P值分别为0.042、<0.001和0.001）。（2）MO组中永久性RLS检出率为7.93%，MA组为20.96%，对照组为6.18%。MO组中总RLS检出率为35.98%，MA组为48.38%，对照组为23.64%。MO组中大量RLS检出率为13.76%，MA组为27.41%，对照组为7.27%。与对照组相比，MO组中总RLS和大量RLS的阳性率升高（P值分别为0.004和0.022），MA组中永久性RLS、总RLS和大量RLS的阳性率也升高（各比较P值均<0.001）。MA组中永久性RLS和大量RLS的阳性率显著高于MO组（P值分别为0.005和0.013）。（3）偏头痛患者中大型PFO（≥2.0mm）的存在率高于对照组（P值为0.048）。
当PFO为永久性RLS、大量RLS及大型PFO（≥2.0mm）时，其与偏头痛（尤其是有先兆偏头痛）相关。
