The Expression Levels Of P Selectin In The Serum Of Migraine Patients With Right To Left Shunt

Background:Migraine is one of clinical common primary nerve vascular disease,the pain is usually unilateral or bilateral pulse like moderate to severe pain,often accompanied by nausea,vomiting,photophobia,phonophobia symptoms,a small number of cases before the onset of visual,sensory,hemiplegia,brainstem symptoms Aura.The global incidence of migraine is between 5%and 10%,the incidence of statistics in China is about 9.3%.The onset of migraine is related to psychological factors,physical and chemical environmental factors and changes of hormone levels in the body.In adults,the prevalence of women and men was 3:1.The onset time of migraine is usually between 10-30 years old,with the increase of age,the prevalence of migraine gradually increased to the peak of young people,and gradually decreased.Many migraine have obvious incentives,such as menstruation,eating chocolate,red wine,rich in nitrite in food and mental anxiety,sleep is not enough,there are a small number of patients did not find the exact cause of headache,frequent development of migraine patients psychological,life and work have a great impact.Patent foramen ovale(PFO)accounted for approximately 95%of all right to left shunt(RLS)disease.Patent foramen ovale in high concentrations of metabolites in special circumstances such as cough,diving,chest occupying the right atrium in the blood platelet aggregation,microemboli generated as five hydroxytryptamine(5-HT)etc.without pulmonary circulation metabolism directly into the central nervous system and cause a series of diseases such as migraine,cryptogenic stroke occurrence.Many studies show that the increased level of platelet activation and release reaction enhancement and common migraine occurs during development,platelet activation ability,platelet and leukocyte interactions with migraine are closely linked,P selectin in the serum,which is stable and easy to be determined,is an ideal and reliable molecular marker for platelet activation.P selectin promote platelet aggregation and release reaction reaction,and injury of endothelial cells,platelet activation can be exposed by subendothelial collagen stimulated further,so as to promote a series of factors such as 5-HT,TXA2 and Ca2+release,vasoconstriction diastolic function disorder caused from migraine.At present,many studies have confirmed that patent foramen ovale is closely associated with migraine,especially in the right to left to the right side of the foramen ovale and the relationship between the more closely.Abnormal platelet activation in patients with migraine,but has not yet been reported migraine with PFO level of platelet activation in patients with migraine,this study through the detection of patent foramen ovale P selectin expression level in serum,thus indicating platelet activation level,to further explore the pathogenesis between patent foramen ovale and right to left shunt and migraine.Methods:In this study,from September 2015 to October 2016 to complete the contrast enhanced transcranial Doppler in Liaoning province people’s Hospital Department of neurology outpatient and inpatient migraine(c-TCD)in 95 patients,aged between 18-55 years old,the female 59 cases,36 cases were male,the average age of 33.07 years.A total of 47 healthy control subjects,including female and male,aged years,with an average age of 31.9 years(range,19-50).All groups of migraine patients are required to meet the following conditions:age 15 to 60 years old,good permeability,TCD temporal window to exclude other diseases caused by excessive use of drugs such as headache,headache,tension headache,exclude the presence of C reactive protein level and abnormal systemic disease with the crowd,without taking any medicine in March the prevention and treatment of migraine and non steroidal anti-inflammatory drugs and other groups.All enrolled patients with migraine according to contrast enhanced Doppler whether there is a right to left shunt were divided into RLS group and non RLS group,and RLS group according to the different right to left shunt size for small RLS group,RLS group,RLS group of three sub groups.The peripheral venous blood of all the groups were extracted and the serum was analyzed.The expression of P selectin in the serum of all the patients was detected by enzyme-linked immunosorbent assay(ELISA).Statistical analysis software SPSS 19 was used to analyze the data.Results:The expression of P selectin levels were significantly higher than that of the healthy control group in the serum,P<0.01,the difference was significant;P selectin expression leves in serum in migraine combined with right to left shunt is higher than that of migraine without right to left shunt group,P<0.05,the difference was statistically significant;comparison between the medium to large number of RLS group and small shunt group and no shunt group,the levels of P selectin in serum were significantly different,P<0.05;the levels of P selectin in serum in the small RLS group of migraine patients had no significant difference between without RLS group,P>0.05.Conclusion:1.The expression levels of P selectin in migraine patients with right to left shunt was significantly elevated especially in patients with medium to large right to left shunt.2.Increased platelet activation may be one of the pathogenesis of migraine caused by patent foramen ovale.