Table_3_Evaluating the relationship between right-to-left shunt and white matter hyperintensities in migraine patients: A systematic review and meta-analysis.docx

IntroductionWhite matter hyperintensities (WMHs) have been observed with greater frequency in patients with migraine and are thought to be associated with impaired cognition and function. The relationship between WMHs and right-to-left shunt (RLS) in migraine patients is unknown. We performed a systematic review to determine if there is an association between RLS and WMHs in patients with migraine.
MethodsA systematic search of the literature was performed in PubMed and Embase using a suitable keyword search strategy from inception up to 16th June 2021. All studies that included patients with migraine and studied RLS and WMHs were included.
ResultsA total of 8 non-randomized observational studies comprising 1125 patients with migraine were included; 576 had an RLS, compared to 549 patients with no RLS. The mean age of the study populations ranged from 28.4 to 43 years, while the average duration from migraine diagnosis ranged from 5.1 to 19 years. The proportion of female to male patients was consistently higher in all studies (60.0–94.4%). Amongst migraine patients with RLS, 338 patients (58.7%) had WMHs. In contrast, 256 (46.6%) of migraine patients without RLS had WMHs. RLS was significantly associated with the presence of WMHs in migraine patients (OR: 1.56, 95% CI: 1.05–2.34, p = 0.03).
ConclusionIn migraine patients, RLS was significantly associated with the presence of WMHs. Longitudinal studies are warranted to establish RLS as a risk factor for WMHs in patients with migraine, and to establish the significance of these changes.

引言：脑白质高信号（White matter hyperintensities, WMHs）在偏头痛患者中的检出频率更高，目前认为其与认知及功能受损相关。偏头痛患者中脑白质高信号与右向左分流（Right-to-left shunt, RLS）的关联尚不明确。本研究通过系统综述，旨在明确偏头痛患者中右向左分流与脑白质高信号是否存在关联。

方法：本研究于2021年6月16日前，采用合适的关键词检索策略，在PubMed及Embase数据库中开展文献系统检索。纳入所有纳入偏头痛患者且探讨右向左分流与脑白质高信号关联的研究。

结果：共纳入8项非随机观察性研究，涉及1125例偏头痛患者，其中576例合并右向左分流，549例未合并右向左分流。研究人群的平均年龄范围为28.4岁至43岁，偏头痛确诊后的平均病程范围为5.1年至19年。所有研究中女性患者占比均显著高于男性（60.0%~94.4%）。在合并右向左分流的偏头痛患者中，338例（58.7%）存在脑白质高信号；与之相比，未合并右向左分流的偏头痛患者中256例（46.6%）存在脑白质高信号。右向左分流与偏头痛患者脑白质高信号的存在显著相关（比值比OR=1.56，95%置信区间CI：1.05~2.34，p=0.03）。

结论：偏头痛患者中，右向左分流与脑白质高信号的存在显著相关。未来需开展纵向研究，以明确右向左分流是否为偏头痛患者脑白质高信号的危险因素，并阐明上述改变的临床意义。