发作性和慢性偏头痛患者右侧丘脑γ-氨基丁酸及谷氨酸/谷氨酰胺水平的变化：一项质子磁共振波谱研究

Changes in gamma-aminobutyric acid and glutamate/glutamine levels in the right thalamus of patients with episodic and chronic migraine: A proton magnetic resonance spectroscopy study.

作者信息

Zhang Xueyan, Wang Wei, Bai Xiaoyan, Zhang Yingkui, Yuan Ziyu, Tang Hefei, Zhang Xue, Li Zhiye, Zhang Peng, Hu Zhangxuan, Zhang Yaqing, Yu Xueying, Man Xue, Sui Binbin, Wang Yonggang

机构信息

Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

出版信息

Headache. 2023 Jan;63(1):104-113. doi: 10.1111/head.14449. Epub 2023 Jan 18.

DOI:10.1111/head.14449

PMID:36651572

Abstract

OBJECTIVE

To explore gamma-aminobutyric acid (GABA) and glutamate/glutamine (Glx) levels in the right thalamus of patients with episodic migraine (EM) and chronic migraine (CM) and their effects on the chronification of migraine.

BACKGROUND

Migraine affects approximately 1 billion people worldwide, with 2.5%-3% of people with EM progressing to CM each year. Magnetic resonance spectroscopy studies have revealed altered GABA and Glx levels in the thalamus of patients with migraine without aura, but these neurometabolic concentrations are underexplored in the thalamus of patients with CM.

METHODS

In this cross-sectional study, patients with EM and CM were recruited. Mescher-Garwood point resolved spectroscopy sequence was used to acquire neurotransmitter concentrations in the right thalamus of patients with EM and CM and matched healthy controls (HCs).

RESULTS

A total of 26 patients (EM, n = 11; CM, n = 15) and 16 age- and sex-matched HCs were included in the analysis. There were significantly lower GABA+/Water levels in the right thalamus of the CM group (mean ± standard deviation: 2.27 ± 0.4 [institutional units]) than that of the HC group (2.74 ± 0.4) (p = 0.026; mean difference [MD] = -0.5 [i.u.]), and lower Glx/Cr levels in the EM group (mean ± SD: 0.11 ± < 0.1) than in the HCs (0.13 ± < 0.1) and CM group (0.13 ± < 0.1) (p = 0.023, MD < -0.1, and p = 0.034, MD < -0.1, respectively). The GABA+/Glx ratio was lower in the CM group (mean ± SD: 0.38 ± 0.1) compared to the EM group (0.47 ± 0.1) (p = 0.024; MD = -0.1). The area under the curve for GABA+/Water levels in differentiating patients with CM from HCs was 0.83 (95% confidence interval 0.68, 0.98; p = 0.004). Correlation analyses within the migraine group revealed no significant correlation between metabolite concentration levels and headache characteristics after Bonferroni correction.

CONCLUSION

Reduced GABA+/Water levels and imbalance of excitation/inhibition in the right thalamus may contribute to migraine chronification.

摘要

目的

探讨发作性偏头痛（EM）和慢性偏头痛（CM）患者右侧丘脑的γ-氨基丁酸（GABA）以及谷氨酸/谷氨酰胺（Glx）水平，及其对偏头痛慢性化的影响。

背景

偏头痛影响着全球约10亿人，每年有2.5%-3%的EM患者进展为CM。磁共振波谱研究显示，无先兆偏头痛患者丘脑的GABA和Glx水平发生了改变，但CM患者丘脑中这些神经代谢物浓度尚未得到充分研究。

方法

在这项横断面研究中，招募了EM和CM患者。采用Mescher-Garwood点分辨波谱序列来获取EM和CM患者以及匹配的健康对照者（HCs）右侧丘脑的神经递质浓度。

结果

共有26例患者（EM，n = 11；CM，n = 15）和16例年龄及性别匹配的HCs纳入分析。CM组右侧丘脑的GABA+/水水平（均值±标准差：2.27±0.4[单位]）显著低于HC组（2.74±0.4）（p = 0.026；平均差值[MD]= -0.5[单位]），EM组的Glx/Cr水平（均值±标准差：0.11±<0.1）低于HC组（0.13±<0.1）和CM组（0.13±<0.1）（分别为p = 0.023，MD< -0.1，以及p = 0.034，MD< -0.1）。与EM组（0.47±0.1）相比，CM组的GABA+/Glx比值更低（均值±标准差：0.38±0.1）（p = 0.024；MD = -0.1）。区分CM患者与HCs的GABA+/水水平曲线下面积为0.83（95%置信区间0.68，0.98；p = 0.004）。偏头痛组内的相关性分析显示，经Bonferroni校正后，代谢物浓度水平与头痛特征之间无显著相关性。