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目的 探究右向左分流及血液指标与偏头痛合并卵圆孔未闭(PFO)患者临床症状严重程度的相关性。方法 本研究前瞻性纳入189例偏头痛合并PFO患者及100名健康对照，经胸右心声学造影评估右向左分流程度，并依据视觉模拟量表评分分组。比较不同组患者头痛指标、血小板参数及5-羟色胺(5-HT)、环氧合酶-2(COX-2)水平，采用Spearman相关性分析及Jonckheere-Terpstra趋势检验、Logistic回归及受试者工作特征曲线分析分流程度与偏头痛严重程度的相关性及影响因素。结果 Spearman 相关检验及Jonckheere-Terpstra趋势检验显示，右向左分级与偏头痛严重程度评分显著相关(rs=0.885，P<0.001)，各项头痛指标随分流加重呈递增趋势(均P<0.001)。多因素Logistic回归分析表明，5-HT降低，血小板计数(PLT)、平均血小板体积(MPV)、COX-2升高是其独立危险因素。ROC曲线分析显示，5-HT、PLT、MPV、COX-2单项指标(AUC分别为0.79、0.91、0.76、0.78)及联合模型(AUC：0.96)均具有诊断价值；经DeLong检验，联合模型的AUC显著优于各单项指标(均P<0.001)，联合模型预测效能最佳(敏感度87.06%，特异性91.35%)。结论 PFO右向左分流程度加重与偏头痛临床症状及功能损害程度相关，5-HT、PLT、MPV、COX-2等指标变化与疾病严重程度显著关联，联合检测可提升诊断效能，为临床评估与治疗提供参考。
Abstract：Objective To investigate the correlation of right-to-left shunt and blood parameters with the severity of migraine in patients with patent foramen ovale (PFO). Methods We prospectively enrolled 189 patients with PFO-related migraine and 100 healthy controls. The degree of right-to-left shunt was assessed by transthoracic contrast echocardiography， and patients were grouped according to their scores on the Visual Analog Scale. We compared headache parameters， platelet indices， and serum levels of 5-hydroxytryptamine (5-HT) and cyclooxygenase-2 (COX-2) across patient groups. Spearman’s rank correlation and the Jonckheere-Terpstra trend test were applied to assess the relationship between shunt grade and migraine severity， followed by logistic regression and receiver operating characteristic curve analysis to identify influencing factors and evaluate predictive performance. Results Spearman correlation and Jonckheere-Terpstra trend tests showed that right-to-left shunt grade was significantly correlated with migraine severity score (rs=0.885， P<0.001)， and all headache indices increased progressively with worsening shunt severity (all P<0.001). Multivariable logistic regression analysis identified decreased 5-HT， along with elevated platelet count (PLT)， mean platelet volume (MPV)， and COX-2， as independent risk factors. The ROC curve analysis showed that the individual indicators of 5-HT， PLT， MPV， and COX-2 (with AUC values of 0.79， 0.91， 0.76， and 0.78， respectively) as well as the combined model (with AUC: 0.96) all had diagnostic value. DeLong’s test further showed that the combined model’s AUC was significantly superior to that of each single parameter (all P<0.001)， and the combined model exhibited the best predictive performance， with a sensitivity of 87.06% and a specificity of 91.35%. Conclusion The increased severity of right-to-left shunt in PFO is associated with the clinical symptoms and functional impairment of migraine. The change in 5-HT， PLT， MPV， COX-2 are significantly correlated with disease severity. Combined detection can enhance diagnostic efficacy and provide a reference for clinical evaluation and treatment.
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基本信息:
中图分类号:R541.1;R747.2
引用信息:
[1]邵丽萍,金朝龙,李军,等.卵圆孔未闭合并偏头痛与右向左分流及相关血液指标的关联研究[J].安徽医科大学学报().
基金信息:
安徽省卫生健康科研项目（编号：ANWJ2024Aa20173）
2026-08-10
2026-08-10
2026-08-10