發(fā)布時間：2018-03-31 08:26

  本文選題：偏頭痛　切入點：藥物過度使用性頭痛　出處：《中國人民解放軍醫(yī)學院》2014年博士論文

【摘要】：背景：偏頭痛是一種發(fā)作性疾病，并可轉(zhuǎn)換成慢性形式。引起偏頭痛慢性化最常見的原因是止痛藥物過度使用。伴有藥物過度使用性頭痛的慢性偏頭痛（CM-MOH）和無藥物過度使用頭痛的慢性偏頭痛（CMwoMOH）在病理生理和治療上都存在很大差別。新型神經(jīng)影像技術(shù)發(fā)現(xiàn)偏頭痛患者疼痛處理網(wǎng)絡(luò)相關(guān)區(qū)域存在功能和結(jié)構(gòu)的變化，在一定程度上揭示了偏頭痛的病理生理機制。 目的：本研究旨在探索發(fā)作性偏頭痛和慢性偏頭痛伴或不伴藥物濫用的臨床和全腦灰質(zhì)容積差別，從而尋找偏頭痛慢性化可能的生物學標志。 方法：共納入110名受試著，其中包括44名CM-MOH,16名CMwoMOH,18名EM患者以及32名健康對照（HCs）。收集頭痛基本信息，對偏頭痛失能評分，生活質(zhì)量評估，焦慮抑郁和認知功能進行評估。采用核磁共振基于體素的形態(tài)測量學（VBM）分析各個組別腦灰質(zhì)容積的差別。 結(jié)果： CM-MOH和CMwoMOH患者的偏頭痛失能評估分數(shù)（MIDAS）顯著高于EM患者。三組頭痛患者的漢密爾頓焦慮抑郁分數(shù)均顯著高于HCs。相對EM患者，CM-MOH患者抑郁分數(shù)更高，而CMwoMOH患者焦慮分數(shù)更高(p0.05)。采用蒙特利爾認知評估量表評價發(fā)現(xiàn)CM-MOH患者和CMwoMOH患者認知功能較EM患者和HCs減低(p0.05)。各組之間全腦灰質(zhì)體積(GMV)無明顯差別，全腦GMV和體重指數(shù)及男性性別正相關(guān)，與年齡，頭痛慢性化時間，，HAMD分數(shù)呈負相關(guān)。與健康對照組相比，各頭痛組顳中極局部GMV明顯減少，CM-MOH患者和CMwoMOH患者右側(cè)上下眶額回，右側(cè)顳下回、小腦Crus1GMV減少，EM患者右側(cè)顳下回、小腦Crus1GMV增加。此外，CM-MOH患者左側(cè)直回，左側(cè)中扣帶回，雙側(cè)島葉，右側(cè)羅蘭迪克島蓋，左側(cè)枕下回，雙側(cè)楔前回，右側(cè)距狀回GMV減少。EM患者和CMwoMOH患者右側(cè)額中回，羅蘭迪克島蓋，右側(cè)中央前回，左側(cè)中央后回，左上枕葉較HCs組GMV增加。CMwoMOH患者雙側(cè)尾狀核GMV較其他頭痛組和HCs組明顯增加。感興趣區(qū)分析顯示顳下回、顳極、前扣帶回、眶額皮層與慢性頭痛年數(shù)和/或頭痛頻率負相關(guān)，與頭痛總病程無相關(guān)性。 結(jié)論：伴有或不伴有藥物過度使用的慢性偏頭痛患者存在更多的情感障礙，認知障礙和更嚴重的失能。偏頭痛患者既有GMV減少也有GMV增加的腦區(qū)。偏頭痛慢性化主要和疼痛的內(nèi)側(cè)情感反應(yīng)系統(tǒng)灰質(zhì)減少有關(guān)，包括眶額皮層、前/中扣帶回，島葉以及影響認知、情感的相關(guān)灰質(zhì)區(qū)域包括顳下回、顳極、小腦Crus1。下行調(diào)節(jié)系統(tǒng)中的尾狀核在CMwoMOH患者中體積增大，對鑒別慢性偏頭痛和藥物過度使用頭痛有一定價值。羅蘭迪克島蓋只在CM-MOH患者中發(fā)現(xiàn)灰質(zhì)減少，提示該結(jié)構(gòu)可能參與MOH的發(fā)病機制。
[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.
【學位授予單位】：中國人民解放軍醫(yī)學院
【學位級別】：博士
【學位授予年份】：2014
【分類號】：R747.2

【共引文獻】

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本文編號：1689925