二甲双胍在神经病理性疼痛中的作用研究

发布时间：2018-04-03 11:18

  本文选题：神经病理性疼痛　切入点：二甲双胍　出处：《江苏大学》2016年硕士论文

【摘要】：神经病理性疼痛(NP)是一种由躯体感觉系统的损害或疾病所导致的疼痛。因其特有的发病机制和难治性,使其成为临床中的治疗难点。加巴喷丁和曲马多是目前临床治疗NP的常规用药,但仅有1/4的患者达到50%的疼痛缓解。有研究称二甲双胍作为腺苷酸活化蛋白激酶(AMPK)激活剂,可通过抑制相关信号通路而减轻疼痛症状。当前二甲双胍用于治疗NP的临床研究较少,本研究从治疗的角度出发联合用药,为二甲双胍能否安全用于临床治疗NP提供研究数据。【目的】1、观察二甲双胍对不同年龄段患者NP的治疗作用及对抑郁焦虑的影响。2、观察各组不良反应及炎性因子的变化,评价二甲双胍治疗NP的临床应用的安全性和可能的作用机制。【方法】1、选取2013年9月~2015年7月至江苏大学附属医院诊断为NP且符合纳入与排除标准的患者168例,运用随机区组设计原则将NP患者分为三个年龄区段:A区(n=48,18~40岁)、B区(n=54,41~60岁)和C区(n=66,60岁以上)。2、将三个年龄区段再分为两个亚组。Ⅰ组:按我院常规疗法给予加巴喷丁胶囊口服,每日3次,每次300mg;盐酸曲马多缓释片口服,每日2次,每次100mg。Ⅱ组:在Ⅰ组用药基础上加服盐酸二甲双胍缓释片,每日2次,每次500mg。两组疗程均为期6个月。3、记录和分析患者治疗前(T0)、治疗后3个月(T1)、治疗后6个月(T2)的视觉模拟法(VAS)评分、抑郁焦虑评分、血清中高敏C反应蛋白(HS-CPR)水平、血清肿瘤坏死因子-α(TNF-α)水平、肝肾功能指标及用药后不良反应。【结果】1、在T0时点,Ⅰ组和Ⅱ组的各区段VAS评分无明显差异(P0.05);在T1、T2时点,同Ⅰ组相比,Ⅱ组VAS评分下降明显且随治疗时间的延长,VAS评分不断下降(P0.05),且年龄区段越年轻,VAS评分下降越明显(P0.05)。Ⅰ组和Ⅱ组治疗方法与时间在VAS评分上有交互作用(P0.05);VAS评分的组间比较,差异有统计学意义(P0.05);VAS评分时间间比较,差异有统计学意义(P0.05)。2、在T2时点,疼痛缓解度(PAR)比较中,Ⅰ组和Ⅱ组的总有效率无差异(P0.05),但Ⅱ组的总显效率高于Ⅰ组(P0.05)。3、在T0时点,区段越年轻,抑郁焦虑评分越低(P0.05);经治疗后,各区组抑郁焦虑评分均有缓解(P0.05);同年龄区段内比较,Ⅱ组抑郁焦虑评分下降较Ⅰ组显著(P0.05)。Ⅰ组和Ⅱ组抑郁焦虑评分在时间间比较,差异有统计学意义(P0.05)。4、Ⅰ组和Ⅱ组的VAS评分和抑郁焦虑评分间在三个时点呈正相关(P0.05)。5、在T0时点,Ⅰ组和Ⅱ组血清中HS-CRP水平变化同年龄成正比(P0.05);在T2时点,HS-CRP和肿瘤坏死因子-α(TNF-α)较T0时点有所下降(P0.05);同年龄区段中Ⅱ组HS-CPR和TNF-α水平较Ⅰ组降低明显(P0.05)。6、Ⅰ组和Ⅱ组的HS-CRP和VAS评分间在T0及T2时点呈正相关(P0.05)。7、Ⅱ组的谷草转氨酶、谷丙转氨酶、血尿素氮、肌酐、空腹血糖、维生素B12在三个时点均无明显变化(P0.05)。8、治疗后,Ⅰ组和Ⅱ组患者胃肠道不适、头晕、嗜睡及共济失调症状发生率比较,差异无统计学意义(P0.05)。【结论】1、与加巴喷丁和曲马多治疗组相比,二甲双胍联合这两种药物治疗具有更好的镇痛效果,不良反应并未见增加。2、疼痛程度、抑郁焦虑程度、炎性因子水平三者间呈正相关。3、治疗效果受到年龄因素影响即年龄越轻,治疗效果越好。
[Abstract]:Neuropathic pain (NP) is a kind of the somatosensory system damage or disease caused by pain. Because of its unique mechanism and refractory, make it become difficult to treat in clinic. Gabapentin and tramadol is routine medication for the treatment of NP at present, but only 1/4 patients reached 50% pain relief. There are studies that metformin protein kinase (AMPK) activation of adenylate as activator, can relieve pain by inhibiting the signaling pathway. The metformin in the treatment of NP in clinical research less, this study starting from the angle of combination therapy, is safe for clinical treatment of NP metformin can provide research data. [Objective] 1, treatment to observe the effect of metformin on patients of different age NP and effect on depression and anxiety of.2, observe the adverse reaction and inflammatory factors, evaluation of the two metformin treatment N P clinical safety and possible mechanism. [Methods] 1, September 2013 ~2015 year in July to the Affiliated Hospital of Jiangsu University diagnosed NP and 168 patients met the inclusion and exclusion criteria, using randomized block design principles of the NP patients were divided into three sections: A age (n=48,18~40 years), B (n=54,41~60 years old) and C (n=66,60 years old).2, three age sections divided into two subgroups. Group I: give oral gabapentin according to conventional therapy in our hospital, 3 times daily, 300mg each time; Tramadol Hydrochloride Sustained Release Tablets oral, 2 times a day, each time 100mg. II Group: in group 1, on the basis of the drug take Metformin Hydrochloride Sustained Release Tablets, 2 times a day, each time 500mg. two groups were treated for 6 months.3, recorded and analyzed before treatment (T0), 3 months after treatment (T1), 6 months after treatment (T2) and the visual analog scale (VAS) score, depression score, serum high 鏁廋鍙嶅簲铔嬬櫧(HS-CPR)姘村钩,琛，

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