| Background Tension-type headache(TTH)is the most prevalent primary headache.Chronic TTH(CTTH),as the most serious form of TTH,is refractory,with a high socio-economic burden.Insomnia is the most common disorder in sleep disorder and can make patients feel discomfortable at daytime.Chronic insomnia(CI)may lead to absenteeism,truancy,increase risk of mental illness and cardiovascular disease.The physiopathologic mechanism of these two diseases is unclear.We found the two diseases have many demographic and clinical similarities such as more frequent in females,chronic episode,sleep disorder,mood disorders and so on.Patients with CTTH also have the decline of sleep tine and sleep efficiency.Patients with CI also have headache just like tension type headache.So,we assumed that the two diseases may have a similar physiopathologic mechanism.Objective To explore the changes of cognitive function,sleep quality,depression mood and blood parameters of neuroendocrine-cytokine in the patients with CTTH and CI,and to investigate the association among them.Methods The patients with CTTH and CI were studied with health controls.Montreal Cognitive Assessment,China-Beijing(Mo CA-C)was used to evaluate general cognitive function in all subjects.Then a modified Nine-Boxes Maze Test protocol was used to examine the spatial working memory(SWM),object working memory(OWM),spatial reference memory(SRM)and object reference memory(ORM).The Pittsburgh Sleep Quality Index(PSQI),Hamilton Depression Rating Scale-17 Items(HAMD-17)and sleep quality,depression state respectively.The serum concentrations of corticotrophin-releasing hormone(CRH),thyrotrophin-releasing hormone(TRH),gonadotropin releasing hormone(Gn RH),adenocorticotropic hormone(ACTH),thyroid stimulating hormone(TSH),cortisol,total triiodothyronine(TT3),total thyroxine(TT4),interleukin-1?(IL-1?)and tumor necrosis factor-?(TNF-?)were detected.Compare the different of these factors among the three groups,and evaluate the correlation between hormones,cytokines and cognitive performance,sleep quality,depression mood,headache intensity and headache duration.Results1.Cognitive function,sleep quality,depression mood: Compared to the normal control group,the CTTH and CI patients had poorer performance of visuospatial/executive function,CTTH patients also had poor performance of attention,while CI patients had poorer performance of memory and abstract ability.Patients with CTTH and CI had higher errors of ORM(H=11.560,P=0.003)and SWM(H=6.586,P=0.037),the poor quality of sleep and depression mood.The CTTH patients also had poorer performance of SRM(F=3.862,P=0.024),and the score of HAMD-17(H=54.057,P<0.001)and PSQI(H=59.805,P<0.001)were lower than CI patients.2.Compare the neuroendocrine hormones and cytokines: The level of CRH(H=40.782,P<0.001),ACTH(H=10.178,P=0.006),cortisol(H=67.118,P<0.001),TRH(H=57.907,P<0.001),TT3(H=53.469,P<0.001),TT4(H=67.982,P<0.001),Gn RH(H=72.861,P<0.001),IL-1?(H=65.973,P<0.001)and TNF-?(H=22.663,P<0.001)have difference among the three groups.The level of CRH,IL-1?and TNF-? was higher in CTTH and CI than controls,but there is no difference between CTTH and CI.The level of cortisol,TRH,Gn RH in CTTH was higher than controls but lower than CI.The level of ACTH in CTTH was higher than CI and controls,but no differences between CI and controls.The level of TT3 and TT4 was lower in CTTH but higher in CI compared to controls.The level of TSH has no difference among the theree groups.3.Correlations between hormonal levels and cognition,insomnia and depression:In CTTH patients: Partial's correlation analysis indicated that the ACTH(r =-0.441,P =0.002),Gn RH(r =-0.409,P =0.005)level was negatively and TT3(r =0.333,P = 0.024)level was positively correlated with the Mo CA-C score.Linear regression analysis only showed that the ACTH(? =-0.333,P =0.026)had negatively effect on the Mo CA-C score.The levels of TT3 was negatively correlated with the errors of SRM(r =-0.311,P =0.035)and SWM(r =-0.521,P <0.001).IL-1?(r =0.302,P =0.041)and TNF-?(r = 0.311,P =0.036)was positively correlated with the errors of SWM.No factors had correlation with ORM and OWM.Linear regression showed that the level of TSH had positively effect on OWM errors(? = 0.301,P=0.049),while the level of TT3 had negatively effect on SWM errors(? =-0.591,P<0.001).CRH was positively correlated with the duration of headache(r = 0.335,P =0.016),PSQI(r = 0.380,P = 0.006)and HAMD-17(r = 0.348,P = 0.012),TRH was negatively correlated with PSQI(r =-0.288,P = 0.040),the level of cortisol was positively correlated with HAMD-17(r = 0.413,P = 0.03).Linear regression showed that the level of CRH had positively effect on PSQI(?= 0.417,P = 0.012)and HAMD-17(?= 0.292,P = 0.044).The level of cortisol had positively effect on HAMD-17(?= 0.398,P = 0.005).PSQI and HAMD-17 had no effect on each other.In CI patients: the level of ACTH(r =-0.486,P=0.008)negatively and the level of IL-1?(r = 0.358,P =0.024),TNF-?(r = 0.348,P =0.021)positively correlated with the Mo CA-C score.Linear regression analysis only showed that the ACTH(?=-0.474,P=0.028)had negatively effect on the Mo CA-C score.The levels of CRH had significantly positive correlation with the errors of ORM(r = 0.441,P =0.004)and SRM(r = 0.610,P <0.001).The level of cortisol had significantly negative correlation with the errors of SWM(r =-0.354,P=0.025),and the level of TT3 had significantly positive correlation with the errors of OWM(r =0.430,P=0.006).Linear regression showed that the level of CRH had positively effect on ORM(?=0.555,P=0.025)and SRM(?=0.783,P<0.001)errors,the level of TT3 had positively effect on OWM(?=0.412,P=0.048)errors.CRH(r = 0.615,P <0.001)had significantly positive correlation with PSQ,ACTH(r =-0.377,P =0.011)and IL-1?(r =-0.536,P<0.001)had significantly negative correlation with PSQI.Linear regression didn't find any factors had effect on PSQI.ACTH(r = 0.394,P =0.007),cortisol(r = 0.558,P<0.001),TRH(r = 0.462,P =0.001),TSH(r = 0.358,P =0.016)and Gn RH(r = 0.616,P<0.001)had significantly positive correlation with HAMD-17,Gn RH(?=0.566,P=0.021)and IL-1?(?=0.963,P=0.040)had positively effect on HAMD-17.PSQI and HAMD-17 had no effect on each other like CTTH.Conclusion These results showed that patients with CTTH and CI had the similar changes in clinic features and neuroendocrine hormones,cytokines.ACTH had the same correlation and effect on Mo CA-C in these two diseases.These suggested that CTTH and CI may had some similar physiopathologic mechanisms. |
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