摘要
目的:探讨疏肝通窍汤辅助治疗气滞血瘀证原发性三叉神经痛(PTN)的近期和远期疗效及对血管活性肠肽(VIP),β-内啡肽(β-EP),白细胞介素-1β(IL^(-1)β)和肿瘤坏死因子-α(TNF-α)水平的影响。方法:将123例PTN患者随机按数字表法分为对照组60例和观察组63例。两组患者均采用射频热凝术,术后对照组口服颅痛宁颗粒,6 g/次,2次/d;观察组内服疏肝通窍汤,1剂/d。两组疗程均为12周,并进行48周随访。于术前、术后1,2,3,5,7 d各记录一次疼痛视觉模拟评分(VAS);进行治疗前后焦虑自评量表(SAS),抑郁自评量表(SDS),匹兹堡睡眠指数(PSQL),生活质量(LSI-B)和中医证候评分;检测治疗前后VIP,β-EP,IL^(-1)β和TNF-α水平;记录48周内的复发情况。结果:治疗后第1,2,3,5,7天两组患者VAS评分均较治疗前明显下降(P<0.01),观察组在第5,7天VAS评分低于对照组(P<0.01);经Ridit分析,治疗后观察组临床疗效优于对照组(P<0.05),观察组疼痛缓解度优于对照组(P<0.05);治疗后观察组SAS,SDS,PSQL和中医证候评分均低于对照组,LSI-B评分高于对照组(P<0.01);与健康对照组比较,治疗前两组患者VIP,IL^(-1)β和TNF-α水平均升高,β-EP水平明显下降(P<0.01),治疗后观察组VIP,IL^(-1)β和TNF-α水平低于对照组,β-EP水平较高于对照组(P<0.01);治疗后观察组VIP,IL^(-1)β仍高于健康对照组(P<0.01),TNF-α和β-EP与健康对照组比较,差异无统计学意义;观察组复发率为16.13%,低于对照组的31.67%(P<0.05)。结论:对于PTN射频热凝术后患者,采用疏肝通窍汤治疗,近期能减轻疼痛,改善症状,改善患者负性情绪,提高患者生活质量和临床疗效,远期能降低患者的复发率,其作用可能与减轻炎症损伤,调节β-EP和VIP等水平有关。
Objective： To discuss the short-term and long-term efficacy of Shugan Tongqiao decoction as an adjuvant therapy in treating primary trigeminal neuralgia（PTN） with Qi stagnation and blood stasis,and its effect on vasoactive intestinal peptide（VIP）,β-endorphin（β-EP）,interleukin-1β（IL-1β） and tumor necrosis factor-α（TNF-α）. Method： One hundred and twenty-three patients with PTN were randomly divided into control group（60 cases） and observation group（63 cases） by random number table. Both groups got radio frequency thermo-coagulation. After the operation,patients in control group took Lutongning granule,6 g/time,2 times/day;and patients in observation group took Shugan Tongqiao decoction,1 dose/day. The courses of treatment were 12 weeks. And the follow-up visit lasts for 48 weeks. Before the operation and at the first,second,third,fifth and seventh days after the operation,scores of the visual analogue scale（VAS） were recorded. And before and after treatment,scores of self-rating anxiety scale（SAS）,self-rating depression scale（SDS）,pittsburgh sleep quality index（PSQI）,life satisfaction index B（LSI B） and traditional Chinese medicine（TCM） syndrome were scored.Levels of vasoactive intestinal peptide（VIP）,β-endorphin（β-EP）,interleukin-1β（IL-1β） and tumor necrosis factor-α（TNF-α） were detected. And relapses within 48 hours were recorded. Result： At the first,second,third,fifth and seventh days after the treatment,both groups＇ VAS scores decreased compared with before the treatment（P〈0. 01）. At the 5thand 7thdays,VAS scores in observation group were lower than those in control group（P〈0. 01）. The comprehensive clinical effect in observation group was superior to that in control group according to the Ridit analysis（P〈0. 05）,pain relief in observation group was superior to that in control group（P〈0. 05）. After treatment,scores of SAS,SDS,PSQL and TCM syndrome were lower than those in control group,and score of LSI-B was higher than that in control group（P〈0. 01）. Compared with healthy group,before the treatment,levels of VIP,IL-1β and TNF-α increased,and level of β-endorphin decreased（P〈0. 01）. After the treatment,levels of VIP,IL-1β and TNF-α were lower than those in control group,and level of β-endorphin was higher than that in control group（P〈0. 01）. And levels of VIP and IL-1β in observation group was higher than those in healthy group（P〈0. 01）,with no statistically significant difference in levels of TNF-α and β-EP between the two groups. And recurrence rate in observation group was 16. 13%,which was lower than 31. 67% in control group（P〈0. 05）. Conclusion： Shugan Tongqiao decoction can relieve the patients＇ pain,ameliorate symptoms and negative emotion,improve the patients＇ quality of life and clnical efficacy,and reduce the recurrence rate after the radio frequency thermo-coagulation. Its effect may be correlated with reduction of inflammatory injury and regulation of levels of β-endorphin and VIP.
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2017年第1期190-194,共5页
Chinese Journal of Experimental Traditional Medical Formulae
基金
南阳市科技局医学基金项目(2014wy01205)
关键词
原发性三叉神经痛
气滞血瘀证
射频热凝术
疏肝通窍汤
炎症反应
血管活性肠肽
Β-内啡肽
primary trigeminal neuralgia
Qi-stagnation and blood stasis
radio frequency thermo coagulation
Shugan Tongqiao decoction
inflammatory response
vasoactive intestinal peptide
β-endorphin
作者简介
[通讯作者]姜开洋，主治医师，从事痛症的临床工作，Tel：13323690077，E—mail：keyangjiang@163．com
