右向左分流与光敏性之间的关联：一项基于社区的横断面研究。
Connection between right-to-left shunt and photosensitivity: a community-based cross-sectional study.
作者信息
Dong Bosi, Ji Shuming, Li Yajiao, Li Hua, Yang Ruiqi, Yang Na, Liu Zhu, Zhu Chenxing, Wang Hui, Tang Yusha, Peng Anjiao, Chen Lei
机构信息
Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China.
出版信息
Front Neurol. 2023 Apr 27;14:1177879. doi: 10.3389/fneur.2023.1177879. eCollection 2023.
BACKGROUND
Hypersensitivity to light is a common symptom associated with dysfunction of the occipital region. Earlier studies also suggested that clinically significant right-to-left shunt (RLS) could increase occipital cortical excitability associated with the occurrence of migraine. The aim of this study was to investigate the relationship between RLS and photosensitivity.
METHODS
This cross-sectional observational study included the residents aged 18-55 years living in the Mianzhu community between November 2021 and October 2022. Photosensitivity was evaluated using the Photosensitivity Assessment Questionnaire along with baseline clinical data through face-to-face interviews. After the interviews, contrast-transthoracic echocardiography (cTTE) was performed to detect RLS. Inverse probability weighting (IPW) was used to reduce selection bias. Photosensitivity score was compared between individuals with and without significant RLS using multivariable linear regression based on IPW.
RESULTS
A total of 829 participants containing 759 healthy controls and 70 migraineurs were finally included in the analysis. Multivariable linear regression analysis showed that migraine (β = 0.422; 95% CI: 0.086-0.759; = 0.014) and clinically significant RLS (β = 1.115; 95% CI: 0.760-1.470; < 0.001) were related to higher photosensitivity score. Subgroup analysis revealed that clinically significant RLS had a positive effect on hypersensitivity to light in the healthy population (β = 0.763; 95% CI: 0.332-1.195; < 0.001) or migraineurs (β = 1.459; 95% CI: 0.271-2.647; = 0.010). There was also a significant interaction between RLS and migraine for the association with photophobia ( = 0.009).
CONCLUSION
RLS is associated with photosensitivity independently and might exacerbate photophobia in migraineurs. Future studies with RLS closure are needed to validate the findings.
TRIAL REGISTRATION
This study was registered at the Chinese Clinical Trial Register, , ID: ChiCTR1900024623, URL: https://www.chictr.org.cn/showproj.html?proj=40590.
背景
对光过敏是与枕叶功能障碍相关的常见症状。早期研究还表明，具有临床意义的右向左分流（RLS）可能会增加与偏头痛发生相关的枕叶皮质兴奋性。本研究的目的是探讨RLS与光过敏之间的关系。
方法
这项横断面观察性研究纳入了2021年11月至2022年10月居住在绵竹社区的18 - 55岁居民。通过面对面访谈，使用光过敏评估问卷以及基线临床数据来评估光过敏情况。访谈后，进行经胸对比超声心动图（cTTE）以检测RLS。采用逆概率加权（IPW）来减少选择偏倚。基于IPW，使用多变量线性回归比较有和没有显著RLS的个体之间的光过敏评分。
结果
最终共有829名参与者纳入分析，其中包括759名健康对照者和70名偏头痛患者。多变量线性回归分析显示，偏头痛（β = 0.422；95%CI：0.086 - 0.759；P = 0.014）和具有临床意义的RLS（β = 1.115；95%CI：0.760 - 1.470；P < 0.001）与较高的光过敏评分相关。亚组分析显示，具有临床意义的RLS对健康人群（β = 0.763；95%CI：0.332 - 1.195；P < 0.001）或偏头痛患者（β = 1.459；95%CI：0.271 - 2.647；P = 0.010）的光过敏有正向影响。RLS与偏头痛在与畏光的关联方面也存在显著交互作用（P = 0.009）。
结论
RLS与光过敏独立相关，并且可能会加重偏头痛患者的畏光症状。需要进行关于RLS封堵的未来研究来验证这些发现。
试验注册
本研究在中国临床试验注册中心注册，注册号：ChiCTR1900024623，网址：https://www.chictr.org.cn/showproj.html?proj=40590 。
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