兒童頭痛與長期血管疾病的危險因子有關


  【24drs.com】April 20, 2010 — 根據發表於4月號兒童與青少年醫學誌的研究結果顯示,嚴重或再發性頭痛或偏頭痛與許多長期血管疾病危險因子有關。
  
  來自馬里蘭班賽斯達國家精神健康的Karin B. Nelson醫師寫到,兒童再發性頭痛的臨床重要性及其與共病和生物關連性,即使在NHANES(國家健康與營養普查)次分類的困難,或是更寬鬆地說,兒童頭痛是個更重要的疾病。我們檢驗頭痛與血管或發炎生物標記,包括CRP(C反應蛋白)、同半胱胺酸、葉酸、脂肪、尿酸濃度、血小板數目與這些指標在兒童的關連性。其他已確認與頭痛關連性以及/或是血管的危險因子包括年齡、性別、種族、貧窮收入比值(PIR)(代理社會地位)、BMI(身體質量指數)。
  
  這項研究的目的在於透過NHANES資料庫(一個國家代表性健康普查),來確定兒童頭痛疾病以及心血管與腦血管疾病危險因子之間的關係。
  
  在1999年到2004年之間,共有11,770位NHANES參與者,參與者的年齡介於4~19歲,研究者研究頭痛與BMI、CRP、同半胱胺酸濃度;血清與紅血球葉酸濃度;維生素B12;甲基丙二酸;總膽固醇、高密度脂蛋白(HDL)、以及非HDL膽固醇濃度;三酸甘油脂濃度;尿酸濃度與血小板數目。
  
  相較於沒有頭痛的兒童,有頭痛問題的兒童,其平均BMI、CRP、同半胱胺酸濃度較高,且他們的血清與紅血球葉酸濃度較低。更多有頭痛的兒童,他們這些因子的風險處於最高的四分位數,且有3種以上這些因子的風險也是最高的。
  
  研究作者們寫到,罹患嚴重、再發頭痛或是偏頭痛的兒童與青少年,聚集了許多長期血管疾病重要的危險因子。未來的研究,以及篩檢有頭痛的兒童可能讓我們改進預防性處理模式。
  
  這項研究的限制包括那些使用NHANES作為資料來源的先天限制。
  
  研究作者們的結論是,無症狀血管疾病的風險可以早一點被確認,且嚴重性隨著危險因子數目增加。這樣的年輕人可能是未來研究、篩檢與後續追蹤、以及預防長期血管疾病,甚至之後造成心血管疾病與中風一個適當的標的。
  
  國家精神健康機構、國家神經疾病、中風機構內研究計畫贊助這項研究。試驗作者表示沒有相關資金上的往來。

Pediatric Headache Linked to Risk Factors for Long-Term Vascular Morbidity

By Laurie Barclay, MD
Medscape Medical News

April 20, 2010 — Severe or recurrent headache or migraine in children and adolescents is linked to several important risk factors for long-term vascular morbidity, according to the results of a study reported in the April issue of the Archives of Pediatrics & Adolescent Medicine.

"The clinical significance of recurrent headaches in childhood and their association with comorbidities and biologic correlates suggest that, despite difficulties in their subclassification in NHANES [National Health and Nutrition Survey] and more broadly, pediatric headache is an important disorder," write Karin B. Nelson, MD, from the National Institute of Mental Health in Bethesda, Maryland, and colleagues. "We examined the association between headaches and vascular or inflammatory biomarkers including CRP [C-reactive protein], homocysteine, folate, lipid, and uric acid levels and platelet counts and their interrelationships in children. Other well-established correlates of headaches and/or vascular biomarkers including age, sex, ethnicity, poverty income ratio (PIR) (proxy for social class), and BMI [body mass index] were also included."

The goal of this study was to determine the association of childhood headache disorders with markers of cardiovascular and cerebrovascular disease risk, using data from NHANES, a nationally representative health survey.

In a population of 11,770 NHANES participants from 1999 through 2004 who were 4 to 19 years old, the investigators looked at the relationship of headache with BMI; CRP; homocysteine levels; serum and red blood cell folate levels; vitamin B12; methylmalonic acid levels; total cholesterol, high-density lipoprotein (HDL) cholesterol, and non-HDL cholesterol levels; triglyceride levels; uric acid levels; and platelet count.

Compared with children without headaches, children with headaches had higher mean BMI, CRP levels, and homocysteine levels, and they also had lower serum and red blood cell folate levels. More children with headaches were in the highest quintile of risk for these factors, as well as in the highest quintile of risk of having at least 3 or more of these factors.

"Several important risk factors for long-term vascular morbidity cluster in children and adolescents with severe or recurrent headache or migraine," the study authors write. "Further study and screening of children with headaches may permit improved preventive management."

Limitations of this study include those inherent in using NHANES as a data source.

"Risk of asymptomatic vascular disease can be identified early, and severity rises with increasing number of risk factors," the study authors conclude. "Such young people may be an appropriate target for further study and for screening, follow-up, and efforts to prevent long-term vascular pathology and resulting cardiovascular disease and stroke."

The National Institute of Mental Health and National Institute of Neurological Disorders and Stroke intramural research programs supported this study. The study authors have disclosed no relevant financial relationships.

Arch Pediatr Adolesc Med. 2010;164:358-362.

    
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