背景:磁共振波谱(MRS)研究表明,γ-氨基丁酸(GABA)和谷氨酸/谷氨酰胺(Glx)水平之间的不平衡是偏头痛发展的潜在原因。然而,新的每日持续性头痛(NDPH)患者GABA和Glx水平的变化尚不清楚.本研究旨在使用MEGA-PRESS序列研究NDPH患者导水管周围灰质(PAG)和齿状核(DN)中GABA和Glx水平的变化。
方法:纳入21名NDPH患者和22名年龄和性别匹配的健康对照(HCs),并进行了3.0TMRI检查,使用MEGA-PRESS序列分析PAG和DN的GABA和Glx水平。还分析了这些神经递质水平与临床特征之间的相关性。
结果:GABA+/水没有显著差异,GABA+/Cr,Glx/水,两组间PAG和DN的Glx/Cr水平(均p>0.05)。与轻度NDPH患者相比,DN中重度NDPH患者的Glx/水(p=0.034)和Glx/Cr(p=0.012)水平较低。在NDPH患者中,发现PAG(r=-0.471,p=0.031,n=21)和DN(r=-0.501,p=0.021,n=21)中较高的Glx/Cr水平(r=-0.483,p=0.026,n=21)与较低的视觉模拟评分相关。此外,DN患者GABA+/Cr水平与广泛性焦虑症-7评分呈正相关(r=0.519,p=0.039,n=16).
结论:这项研究的结果表明,PAG和DN中的GABA和Glx水平可能不是NDPH发展的主要原因。某些临床量表与神经递质水平之间的相关性可能来自NDPH相关症状。
BACKGROUND: Magnetic resonance spectroscopy (MRS) studies have indicated that the imbalance between gamma-aminobutyric acid (GABA) and glutamate/
glutamine (Glx) levels was the potential cause of migraine development. However, the changes in the GABA and Glx levels in patients with New daily persistent headache (NDPH) remain unclear. This study aimed to investigate the changes in GABA and Glx levels in the periaqueductal gray (PAG) and dentate nucleus (DN) in patients with NDPH using the MEGA-PRESS sequence.
METHODS: Twenty-one NDPH patients and 22 age- and sex-matched healthy controls (HCs) were included and underwent a 3.0T MRI examination, using the MEGA-PRESS sequence to analyze GABA and Glx levels of PAG and DN. The correlations between these neurotransmitter levels and clinical characteristics were also analyzed.
RESULTS: There were no significant differences in the GABA+/Water, GABA+/Cr, Glx/Water, and Glx/Cr levels in both PAG and DN between the two groups (all p > 0.05). Moderate-severe NDPH patients had lower levels of Glx/Water (p = 0.034) and Glx/Cr (p = 0.012) in DN than minimal-mild NDPH patients. In patients with NDPH, higher Glx/Water levels in the PAG (r=-0.471, p = 0.031, n = 21) and DN (r=-0.501, p = 0.021, n = 21) and higher Glx/Cr levels in DN (r=-0.483, p = 0.026, n = 21) were found to be correlated with lower Visual Analogue Scale scores. Additionally, a positive correlation was observed between the GABA+/Cr levels in the DN and the Generalized Anxiety Disorder-7 scores (r = 0.519, p = 0.039, n = 16).
CONCLUSIONS: The results of this study indicated that the GABA and Glx levels in the PAG and DN may not be the primary contributor to the development of NDPH. The correlations between certain clinical scales and the neurotransmitter levels may be derived from the NDPH related symptoms.