目的 分析卵圆孔未闭(PFO)合并偏头痛(MA)患者的高危因素,建立并验证基于临床与检验指标的风险诊断模型。方法 回顾性研究解放军总医院第六医学中心2021-01-01至2024-12-31收治的PFO患者的临床资料。根据是否合并偏头痛进行分组,采集人口统计学特征及检验指标数据。运用LASSO回归实施特征筛选,将筛选变量引入多因素logistic回归分析,报告优势比(OR)及95%置信区间(CI)。通过受试者工作特征曲线下面积(AUC)评价判别性能,运用校准曲线与Brier评分评价校准性能,并实施10折交叉验证评价模型的稳定性。结果 共纳入346例患者,年龄18~65岁。单因素分析显示年龄、性别、WBC、γ-谷氨酰转肽酶(GGT)、血肌酐(SCr)、同型半胱氨酸(Hcy)、红细胞沉降率(ESR)及纤维蛋白原(FIB)与偏头痛结局相关,差异有统计学意义(P＜0.05)。多因素分析表明,HCY升高为独立危险因素(OR=1.341,95% CI:1.241~1.463,P＜0.001),ESR降低(OR=0.817,95% CI:0.764~0.867,P＜0.001)及51~65岁年龄段(OR=0.270,95% CI:0.113~0.626,P=0.003)为保护因素。所建模型具有优良的判别能力与校准度(AUC=0.914,95% CI:0.883~0.944),内部交叉验证结果一致。结论 HCY浓度升高是PFO患者发生偏头痛的高危影响因素,而较低ESR水平及51~65岁年龄区间为其保护因素;本筛选特征建立的多变量模型展现出良好的诊断效能,可为PFO患者偏头痛风险评估与个性化管理提供指导。
Abstract
Objective To investigate the high-risk factors of patients with patent foramen ovale (PFO) complicated with migraine(MA) , and to establish and validate a risk diagnostic model based on clinical and laboratory indicators. Methods A retrospective study was conducted on the clinical data of PFO patients admitted to the Sixth Medical Center of Chinese PLA General Hospital from January 1 2021, to December 31 2024. The patients were stratified into groups based on the presence or absence of migraine, and demographic characteristics along with laboratory parameter data were collected. LASSO regression was utilized for feature selection, with selected variables subsequently incorporated into multivariable logistic regression analysis. Odds ratios (OR) and 95% confidence intervals (CI) were reported. Discriminative performance was evaluated by the area under the receiver operating characteristic curve (AUC), calibration performance was assessed through calibration curves and Brier scores, and 10-fold cross-validation was implemented to evaluate the stability of the model. Results A total of 346 patients aged 18-65 years were included. In univariable analyses, age, sex, WBC, gammaglutamyl transferase (GGT), serum creatinine (SCr), homocysteine (HCY), erythrocyte sedimentation rate (ESR), and fibrinogen (FIB) were associated with the outcome of migraine (P＜0.05). Multivariable analysis identified elevated HCY as an independent risk factor (OR=1.341, 95% CI:1.241-1.463, P＜0.001), while lower ESR (OR=0.817, 95% CI: 0.764-0.867, P＜0.001) and age 51-65 years (OR=0.270, 95% CI: 0.113-0.626, P=0.003) were protective factors. The constructed model demonstrated excellent discrimination and calibration (AUC=0.914, 95% CI: 0.883-0.944), with consistent performance on internal cross-validation. Conclusions Elevated homocysteine (HCY) concentration is a high-risk factor for migraine in patients with PFO, while a lower ESR level and the age range of 51-65 years are protective factors. The multivariable model established based on the screened features exhibits good predictive efficacy and can provide guidance for the risk assessment and personalized management of PFO patients with migraine.
关键词
卵圆孔未闭 /
偏头痛 /
同型半胱氨酸 /
红细胞沉降率 /
logistic回归
Key words
patent foramen ovale /
migraine /
homocysteine /
erythrocyte sedimentation rate /
logistic regression
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 邱 林, 朱 航, 马 为, 等. 卵圆孔未闭相关疾病研究2023年度进展[J]. 中国介入心脏病学杂志,2024,32 (1): 9-13.
[2] 张玉顺, 蒋世良, 朱鲜阳. 卵圆孔未闭相关卒中预防中国专家指南[J]. 心脏杂志,2021,33 (1):1-10.
[3] 张玉顺, 于生元, 董 钊, 等. 卵圆孔未闭相关非卒中性疾病防治中国专家共识[J]. 心脏杂志,2024,36 (2):125-134.
[4] Headache Classifification Committee of the International Headache Society (IHS) The international classifificationof headache disorders, 3rd edition[J].Cephalalgia, 2018, 38(1): 1-211.
[5] 中国医师协会神经内科医师分会,中国研究型医院学会头痛与感觉障碍专业委员会.中国偏头痛诊治指南(2022版)[J]. 中国疼痛医学杂志,2022,28 (12):881-898.
[6] Takagi H, Umemoto T. A meta analys is of case-control studies of the association of migraine and patent foramenovale[J]. J Cardiol, 2016, 67(6): 493-503.
[7] Fu H J, Zhao L B, Xue J J, et al. Elevated serum homocysteine (hcy) levels may contribute to the pathogenesisof cerebral infarction[J]. J Mol Neurosci, 2015, 56(3): 553-561.
[8] Tran S K, Ngo T H, Nguyen P H, et al. Hyperhomocysteinemia in patients with newly diagnosed primary hypert-ension in can tho city, vietnam[J]. Healthcare, 2023, 11(2): 234.
[9] Wei H J, He J, Li X, et al. Hydroge-n sulfide ameliorates homocysteine in duced mitochondrial autophagy disord-er in HT22 cells[J]. Neurochem J, 2024, 18(1): 181-187.
[10] 李可欣, 吕 静, 于 冰, 等. 老年衰弱新兴标志物的研究进展及展望[J]. 中国全科医学,2021,24 (36):4580-4586.
[11] Chai G, Mao Y, Gong J, et al. Homocysteine interferes with Ndufa1 leading to mitochondrial dysfunction throu-gh repression of the NAD+/Sirt1 pathway in the brain: a possible link between hyperhomocysteinemia and neur-odegeneration[J].Cell Death Dis,2025,16(1): 499.
[12] Tang Y S, Sun H Q, Plummer C, et al. Association between patent foramen ovale and migraine: evidence from a resting-state fMRI study[J].Brain Imaging Behav, 2024,18(4): 720-729.
[13] Cannata F, Stankowski K, Donia D, et al. Percutaneous suture-based patentforamen ovale closure: A state-of-the- art review[J]. Trends Cardiovasc Med,2024, 34(6): 404-413.
[14] Javadian P, Heydarzadeh R, Vafa R G,et al. Effectiveness of PFO Closure inpreventing cerebrovascular events: a 13-year retrospective cohort study[J].Catheter Cardiovasc Interv,2025,106(4): 2321-2326.
[15] Luo C, Zha A H, Luo R Y, et al. Pr-oBDNF contributed to patrolling mon-ocyte infiltration and renal damage in systemic lupus erythematosus[J]. Clin Immunol, 2024, 259: 109880.
[16] 刘 慧, 张 伟.透刺法治疗偏头痛的研究进展[J]. 中国中医药现代远程教育,2023,21 (10):91-94.
[17] Kalkman D N, Couturier E G M, El Bouziani A, et al. Migraine and cardiovascular disease: what cardiologists should know[J].Eur Heart J, 2023,44(30):2815-2828.
[18] 杨士鋆.山东省农村老年人慢性病与心理困扰关系的路径分析:持续性疼痛和睡眠质量的中介作用[D].济南:山东大学,2022.
[19] 郭灶耿, 黄俊尹, 孟瑞伟, 等. 深圳市≥40岁社区居民高同型半胱氨酸的患病情况及其与脑卒中患病风险的相关性[J]. 中华健康管理学杂志,2021,15 (1):37-43.
[20] Sathasivam S, Sathasivam S. Patent foramen ovale and migraine: what is the relationship between the two?[J]. J Cardiol,2013,61(4): 256-259.
[21] Takizawa T, Ayata C, Chen S P. The-rapeutic implications of cortical sprea-ding depression models in migraine[J].Prog Brain Res, 2020, 255: 29-67.
[22] Wilmshurst P, Nightingale S. The role of cardiac and pulmonary pathology in migraine:a hypothesis[J]. Headache,2006, 46: 429-434.
[23] Hou S Q,Zhan Z,Fan J N, et al.Association of in situ thrombus within thepatent foramen ovale and patients with migraine:a prospective cohortstudy[J].Heliyon, 2024, 10(11): e32105.
[24] Radico F, Foglietta M, Di Fulvio M, et al. The ‘dreaded pfo’: Anatomicala-nd functional features of high risk for stroke[J]. Eur Heart J, 2021,23(Suppl E): E189-E193.
[25] Gu Y T, Jiang F L, Yuan X M, et al.A novel automated Multicycle magnetic solid phase extraction coupled to LC-MS/MS to study the disorders of six functional B vitamins in patients with gastroenterology and hyperhomo-cysteinemia[J]. J Pharm Biomed Anal,2024, 241: 115989.
[26] Shu J L, Sun X P, Li J, et al. Serumhomocysteine levels and their association with clinical characteristics of inflammatory arthritis[J]. Clin Rheumatol,2020, 39(11): 3295-3302.
PDF(1664 KB)
