从反常栓塞到神经体液紊乱：PFO相关偏头痛病理生理机制的演进与整合

From Paranormal Embolism to Neurohumoral Dysregulation: The Evolution and Integration of the Pathophysiological Mechanisms of PFO-Related Migraine

摘要: 本文综述及分析了既往卵圆孔未闭(PFO)与偏头痛(MA)关系的研究，并探讨了PFO引起MA发病的作用，归纳了PFO的流行病学资料，并结合国内外大量大样本队列研究结果，发现PFO患者中可见MA症状，反之亦然，且两者密切相关。同时从动物模型、组织学层面揭示PFO参与偏头痛发生发展的机制：由于右至左分流致脑缺血，以及血清素等相关脑内神经介质的改变而造成的血–脑屏障功能异常，可能是PFO参与偏头痛发生发展的主要机制之一。本研究以先进成像技术评估PFO人群中MA的发生率，经多因素分析证实PFO是独立的MA危险因素之一，并且通过该动物模型探索PFO介入封闭后对MA的危害有可能是降低PFO分流，改善PFO导致神经血管功能紊乱所导致偏头痛的发生。总结目前的报道并结合自身实验研究，提出建议：未来有必要加大PFO诊治标准的规范、PFO封闭设备的改进及个体化治疗的应用前景，这对于更好地降低或预防MA的发生均具有重要的意义。

Abstract: This article reviews and analyzes previous studies on the relationship between patent foramen ovale (PFO) and migraine with aura (MA), and explores the role of PFO in the pathogenesis of MA. It summarizes the epidemiological data on PFO and, in light of numerous large-sample cohort studies both domestically and internationally, identifies that MA symptoms can be observed in PFO patients and vice versa, indicating a close correlation between the two. Furthermore, the mechanism by which PFO contributes to the development and progression of migraine is elucidated at the levels of animal models and histology: right-to-left shunting leading to cerebral ischemia, along with alterations in serotonin and related cerebral neurotransmitters resulting in blood-brain barrier dysfunction, may represent one of the primary mechanisms through which PFO participates in the pathogenesis of MA. Using advanced imaging techniques, this study assesses the incidence of MA in the PFO population. Multivariate analysis confirms that PFO is an independent risk factor for MA. Additionally, through animal models, it is suggested that interventional closure of PFO may reduce the risk of MA by decreasing PFO shunting and mitigating the neurovascular dysfunction associated with PFO. Based on a synthesis of current literature and our own experimental findings, the following recommendations are proposed: future efforts should focus on standardizing the diagnostic and therapeutic criteria for PFO, improving PFO closure devices, and advancing personalized treatment strategies. These measures are of great significance for reducing or preventing the occurrence of MA.