郑州大学第一附属医院，河南 郑州 450052
【摘要】 目的 应用经食管超声心动图（transesophageal echocardiograghy，TEE）联合右心声学造影评估卵圆孔未闭（patent foramen ovale，PFO）伴房间隔膨出瘤（atrial septal aneurysm，ASA）与先兆偏头痛（migraine with aura，MA）的关系。方法 回顾性分析郑州大学第一附属医院 2018-01—2021-05 接受经食道超声心动图联合右心声学造影的 988 例患者的检查图像及临床资料。超声检查前，采用经过验证的头痛问卷，由两位神经科医生根据国际头痛标准诊断是否有先兆偏头痛，由超声医生在不知患者是否有偏头痛的前提下进行超声心动图检查，进行 RLS 分级，对无 FPO 和ASA 组、PFO 组、ASA 组和PFO 伴ASA 组进行偏头痛及先兆偏头痛的单因素分析，并对有无先兆偏头痛患者的 RLS 分级进行比较。结果 孤立的PFO 占 15.38%，孤立的 ASA 占 3.04%，PFO 合并ASA 占 7.29%。偏头痛发生率 19.03%，MA 发生率 8.20 %。与无PFO 和ASA 组比较，PFO 伴ASA 组无先兆偏头痛（OR=2.324，95% CI：1.225~4.41，P=0.008）及有先兆偏头痛（OR=5.533，95% CI：3.031~10.1，P<0.001）患病率显著增高。偏头痛患者中，PFO 伴ASA 组有先兆发生的患病率显著增高（OR=2.381，95% CI：1.095~5.176）。在 RLS 分级中，2 级和 3 级分流在MA 及MA—患者之间差异有统计学意义（ χ2=7.912，P=0.005）；PFO 伴ASA 组 2 级和 3 级分流显著高于PFO 组（ χ2=7.023，P= 0.008）。结论 PFO 合并ASA 与MA 显著相关，且出现右向左分流的程度增高，PFO 引起的偏头痛研究应集中于这种特殊的心房异常。
【中图分类号】 R747.2；R445.1 【文献标识码】 A 【文章编号】 1673-5110 （2021） 24-2160-08 DOI：10.12083/SYSJ.2021.24.007
YANG Juan，ZHAO Na，QI Qinghua
The First Affiliated Hospital of Zhengzhou University，Zhengzhou 450052，China
【Abstract】 Objective To evaluate the relationship between patent foramen ovale（PFO）with atrial septal aneurysm（ASA）and migraine with aura（MA）by transesophageal echocardiography（TEE）combined with con⁃ trast echocardiography. Methods The examination images and clinical data of 988 patients who underwent tran- sesophageal echocardiography combined with right heart sonography in the First Affiliated Hospital of Zhengzhou University from January 2018 to May 2021 were analyzed retrospectively. Before the ultrasonic examination，the pa⁃ tients were treated with a validated headache questionnaire，and diagnosed by two neurologists to determine whether there was migraine aura according to the international headache standards. The ultrasonic doctor examined the pa⁃ tient by echocardiography without knowing whether the patient had migraine and RLS classification was conducted. Single factor analysis of migraine with aura and migraine without aura was performed in non FPO and ASA group，PFO group，ASA group and PFO with ASA group. RLS classification of migraine with aura group and migraine without aura group were compared. Results Isolated PFO accounted for 15.38% ，isolated ASA accounted for 3.04%，and PFO combined ASA accounted，for 7.29%. The incidence of migraine was 19.03%，and the incidence of MA was 8.20%. Compared with the without PFO and ASA，the prevalence of migraine without aura（OR=2.324， 95% CI：1.225-4.41，P=0.008）and migraine with aura（OR=5.533，95% CI：3.031-10.1，P<0.001）in PFO with ASA group were significantly higher. Among migraine patients，the prevalence of aura in PFO with ASA group was significantly higher（OR=2.381，95% CI：1.095-5.176）. In RLS grading，grade 2 and grade 3 shunts were statisti⁃ cally different between MA and non-MA patients（χ2=7.912，P=0.005）. The grade 2 and 3 shunts of PFO with ASA were significantly higher than those of patients with PFO alone（ χ2=7.023，P=0.008）. Conclusion PFO combined with ASA is significantly correlated with MA，and the degree of right to left shunt is increased. The study of mi⁃ graine caused by PFO should focus on this special atrial abnormality.
【Key words】 Migraine；Right heart contrast echocardiography；Transesophageal；Patent foramen ovale；Atrial septal aneurysm