中国偏头痛患者右向左分流阳性率及分流类型——一项全国多中心研究 Prevalence and Extent of Right-to-left Shunt in Chinese Patients with Migraine in a National Multicenter Study

背景 偏头痛与右向左分流（right-to-left shunt，RLS）的关系尚有争议。本研究旨在明确中国偏头痛 患者右向左分流的阳性率、分流类型以及分流量大小，分析偏头痛与右向左分流的关系。 方法 该研究为多中心-病例对照研究（北美临床研究注册号NCT0242569)。由中国9家分中心共同完 成，连续纳入2015年6月-2016年8月就诊于分中心且符合据第三版国际头痛疾病分类-β测试版（The International Classification of Headache Disorders 3rd Edition Beta Version，ICHD-3β）诊断偏头痛的患 者（18～65周岁），为偏头痛组。偏头痛组共纳入931例（女性695例），其中先兆偏头痛240例（女性174 例），无先兆偏头痛691例（女性521例）。健康对照组共282例。 结果 先兆偏头痛组RLS阳性率和大量分流比例高于无先兆偏头痛组（63.7% vs 39.9%，P＜0.001； 32.1% vs 16.5%，P＜0.001），两组中量和小量分流比例无差异（P =0.141；P =0.061）。无先兆偏头痛 组RLS阳性率和大量分流比例高于对照组（39.9% vs 29.4%，P＜0.001；16.5% vs 6.4%，P＜0.001）， 两组间中量和小量分流的比例无差异。 结论 偏头痛患者（包括有先兆和无先兆偏头痛患者），右向左分流阳性率高于正常对照组，且以大 量右向左分流为主，中至小量右向左分流及分流的类型与对照组相比无差异。右向左分流，特别是大 量的右向左分流，可能与偏头痛有关。 Abstract: Background The association between Right-to-left shunt (RLS) and migraine was still controversial. The aim of this study was to investigate the prevalence, grade and volume of RLS in Chinese patients with migraine and to evaluate the relationship between RLS and migraine. Methods It was a multi-center case-control study with North America Clinical Study Registration No. NCT02425696, and underwent jointly by 9 sunb-centers in China. The patients, aged between 18 years old to 65 years old, who received consultation services in sub-centers and were diagnosed as migraine according to The International Classification of Headache Disorders 3rd Edition Beta Version (ICHD-3 β) during June 2015 to August 2016, were consecutively enrolled into migraine group. There were 931 patients in migraine group, among which, there were 695 cases of female. There were 240 cases of migraine with aura and 691 cases of migraine without aura. There were 282 healthy adults in control group. Results The prevalence of RLS were 63.7% and 39.9% in the migraine with aura group (MA+) and migraine without aura group (MA-), respectively, which were significantly higher than that of healthy group (29.4%, P