偏头痛患者视网膜微血管改变的Meta分析

Meta-analysis of retinal microvascular changes in migraine patients

摘要:

目的：采用Meta分析方法探索偏头痛患者的视网膜微血管改变。

方法：检索美国国立医学图书馆PubMed、荷兰医学文摘Embase、Cochrane图书馆查找相关研究，检索时间为建库至2023-06。两名研究者独立筛选文献、提取资料，并采用NOS量表评价纳入研究质量，使用STATA15.0软件进行Meta分析和发表偏倚评价，对异质性较大的结果进行敏感性分析，采用漏斗图和Egger法评估文献的发表性偏倚。

结果：本次Meta分析共纳入12项文献，包括217例有先兆偏头痛(MA)患者(252眼)、283例无先兆偏头痛(MO)患者(388眼)和374名健康人员(479眼)，对黄斑中心凹无血管区(FAZ)、黄斑及视盘灌注密度等多个光学相干断层扫描血管成像(OCTA)指标进行比较分析。Meta分析结果显示：与健康对照组相比，MA患者FAZ面积和周长显著增大，除中心凹区域外，黄斑深层视网膜毛细血管丛(mDCP)的灌注密度均明显降低，视盘周围放射状毛细血管(RPC)的灌注密度在视盘内明显降低； MO的FAZ参数明显增大，除外位于mDCP旁中心凹的灌注密度外，黄斑浅层视网膜毛细血管丛(mSCP)、mDCP和RPC的灌注密度两者无差异。

结论：MA和MO患者均存在FAZ面积的扩大，其中MA患者mDCP灌注密度显著减少，偏头痛患者存在一定程度的视网膜缺血。

Abstract:

AIM: To explore retinal microvascular changes in migraine patients using meta-analysis.

METHODS: The National Library of Medicine PubMed, Embase, and Cochrane Library were searched to find relevant studies, and the search period was from the creation of database to June 2023. Two investigators independently screened the literatures, extracted data, and evaluated the quality of included studies using the NOS scale. STATA15.0 was used for Meta-analysis and publication bias evaluation, sensitivity analysis was performed for results with large heterogeneity, and the funnel plot and Egger were used to assess the publication bias of the literature.

RESULTS:A total of 12 studies, including 217 patients(252 eyes)with migraine with aura(MA), 283 patients(388 eyes)with migraine without aura(MO), and 374 healthy individuals(479 eyes), were included in this Meta-analysis. Several optical coherence tomography angiography(OCTA)indicators, including foveal avascular zone(FAZ)macular or optic disc perfusion density were compared and analyzed. The Meta-analysis results showed that compared with healthy controls, patients with MA had a significant increase in FAZ area and perimeter, a significant decrease in perfusion density of the macular deep capillary plexus(mDCP)except for the fovea, and a significant decrease in perfusion density of the radial peripapillary capillaries(RPC)around the optic disc; the FAZ parameters were significantly increased in MO, while the differences in perfusion density of the macular superficial capillary plexus(mSCP), mDCP and RPC were not statistically significant, except for the perfusion density in the parafovea mDCP.

CONCLUSIONS: Both MA and MO patients had an enlarged FAZ area, patients with MA had a significant decrease in mDCP perfusion density, and migraine patients had some degree of retinal ischemia.