加减川芎茶调散对频繁发作的偏头痛（风寒上扰证）患者CGRP及ET-1的影响

发布时间：2017-12-27 21:10

本文关键词：加减川芎茶调散对频繁发作的偏头痛（风寒上扰证）患者CGRP及ET-1的影响　出处：《成都中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的通过临床研究加减川芎茶调散对频繁发作的偏头痛(风寒上扰证)患者CGRP及ET-1的影响,为加减川芎茶调散防治偏头痛的临床疗效,提供客观的评价指标。方法病例均选自2015年6月至2016年1月就诊于成都中医药大学附属医院神经内科门诊辨证属风寒上扰证频繁发作的偏头痛患者。采用随机、对照、第三方盲的方法。研究共分2组,试验组与对照组比例为1：1,每组20例。对照组予以盐酸氟桂利嗪(西安杨森制药有限公司生产,规格每粒5mg)预防性用药,每次5-10 mg,每晚一次。偏头痛发作时可使用双氯芬酸钠双释放肠溶胶囊(戴芬,德国泰姆勒制药有限公司,规格每粒75mg)缓解治疗性用药,每次75mg,每日1-2次。试验组：盐酸氟桂利嗪+加减川芎茶调散,盐酸氟桂利嗪(西安杨森制药有限公司生产,规格每粒5mg)治疗,每次5-10mg,每晚一次。加减川芎茶调散,具体煎服方法详见3.2.1。疗程共4周。治疗前、后测定患者血清ET-1及CGRP含量,进行中医证候评分、偏头痛疗效评分、偏头痛发作次数、持续时间及疼痛程度评分,以作为有效性评价。治疗前、后分别行血、尿、粪常规、肝、肾功、心电图检查,用药期间观察生命体征,以作为安全性评价。随访期间进行中医证候评分、偏头痛疗效评分、偏头痛发作次数、持续时间及疼痛程度评分以判定疗效及复发情况。结果(1) CGRP及ET-1含量变化比较：①组内比较：治疗4周后试验组与对照组组内CGRP及ET-1含量较治疗前均降低,差异有统计学意义(P0.05)。②组间比较：治疗后两组CGRP含量均有下降,与对照组比较,试验组下降趋势更明显,差异无统计学意义(P0.05)；治疗后两组ET-1含量均有下降,与对照组比较,试验组下降更明显,差异有统计学意义(P0.05)。(2) CGRP及ET-1变化程度比较：①组内比较：治疗后试验组组内CGRP及ET-1含量较治疗前明显下降,差异有统计学意义(P0.05)；治疗后对照组组内CGRP及ET-1含量较治疗前下降不明显,差异无统计学意义(P0.05)。②组间比较：治疗后两组CGRP及ET-1含量均有下降,与对照组比较,试验组下降更明显,差异有统计学意义(P0.05)。(3)疗效评价：①组内比较：治疗4周后试验组与对照组中医证候评分、偏头痛疗效评分、偏头痛发作次数、持续时间及疼痛程度评分较治疗前均降低,差异有统计学意义(P0.05),即两组均有疗效。②组间比较：治疗4周后两组间中医证候评分、偏头痛疗效评分、偏头痛发作次数及持续时间评分比较均有降低,试验组降低更明显,差异有统计学意义(P0.05),偏头痛疼痛程度评分组间比较,差异无统计学意义(P0.05),但试验组偏头痛疼痛程度评分均值低于对照组,即试验组疗效优于对照组。③中医证候评分有效性分析,治疗4周后试验组总有效率90%,对照组总有效率60%,两组间有效率比较,差异有统计学意义(P0.05),即试验组疗效优于对照组。④偏头痛疗效评分有效性分析,治疗4周后试验组总有效率85%,对照组总有效率55%,两组间有效率比较,差异有统计学意义(P0.05),即试验组疗效优于对照组。(4)安全性评价：①试验组与对照组治疗后血常规、尿常规、粪常规、肝、肾功能、心电图等检查组间及组内比较,差异无统计学意义(P0.05)。②通过对用药前后体温、心率、呼吸、血压的安全性检验,两组间及组内比较,差异无统计学意义(P0.05)。③通过对两组间不良反应检验,两组间差异无统计学意义(P0.05)。(5)随访情况：①组内比较,治疗4周前与随访3月后中医证候评分及偏头痛疗效评分试验组组内比较差异有统计学意义(P0.05),即试验组有远期疗效；对照组组内比较差异无统计学意义(P0.05),即对照组远期疗效不明显。治疗4周前与随访3月后偏头痛发作次数、持续时间及疼痛程度评分试验组与对照组组内比较差异有统计学意义(P0.05),即两组均有远期疗效。②组间比较,随访3月后两组患者中医证候评分、偏头痛疗效评分、偏头痛发作次数及持续时间评分组间比较差异有统计学意义(P0.05),偏头痛疼痛程度评分组间比较,差异无统计学意义(P0.05),但试验组偏头痛疼痛程度评分均值低于对照组。随访3月后试验组中医证候评分、偏头痛疗效评分、偏头痛发作次数、持续时间及疼痛程度评分均值低于对照组,即试验组远期疗效优于对照组。综上所述,两组均有预防作用,与对照组比较,试验组能够有效地预防偏头痛的复发,降低复发率。结论(1)加减川芎茶调散能够安全有效地改善频繁发作的偏头痛(风寒上扰证)患者的症状。(2)推测加减川芎茶调散的配伍组分可能影响了CGRP及ET-1基因的表达,使CGRP及ET-1合成释放入血减少,削弱了两者舒缩血管效应,达到防治偏头痛的作用。(3)加减川芎茶调散在治疗偏头痛(风寒上扰证)患者的同时,可以有效地预防偏头痛的复发,结合现代医学偏头痛预防性用药,可以增强预防效果。
[Abstract]:Objective to study the effect of Chuanxiong Chai powder on CGRP and ET-1 in patients with frequent migraine (cold and wind disturbance), and provide an objective evaluation index for the treatment of migraine with Chuanxiong Chai powder. Methods all cases were selected from June 2015 to January 2016 in the outpatient department of Neurology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine. A randomized, controlled, third - party blind method was used. The study was divided into 2 groups. The proportion of the test group and the control group was 1:1, with 20 cases in each group. The control group was given flunarizine hydrochloride (Xi'an Janssen Pharmaceutical Ltd, specifications of each 5mg) preventive medication, every 5-10 mg, once a night. Migraine can be used when Diclofenac Sodium Dual Release Enteric-coated Capsules (Dai Fen, German Temmler Pharma, specifications of each 75mg) relief medication, 75mg each time, 1-2 times a day. Test group: flunarizine hydrochloride + Decoction of Chuanxiong chatiao San, flunarizine hydrochloride (Xi'an Janssen Pharmaceutical Ltd, specifications of each 5mg) treatment, 5-10mg each time, once every night. In addition and subtraction of Chuanxiong tea, the specific method of decocting clothing is detailed in 3.2.1. The course of treatment was 4 weeks. Before and after treatment, the serum ET-1 and CGRP levels were measured. TCM syndrome score, migraine efficacy score, migraine attack frequency, duration and pain score were taken as effective evaluation. Before and after treatment, blood, urine, fecal routine, liver, kidney work, electrocardiogram were examined, and life signs were observed during the drug use as a safety evaluation. During the follow-up period, TCM syndrome score, migraine efficacy score, migraine attack frequency, duration and pain score were used to determine the efficacy and recurrence. Results (1) the changes of CGRP and ET-1 contents were compared: (1) comparison between groups: after 4 weeks of treatment, the contents of CGRP and ET-1 in the experimental group and the control group were lower than those before treatment, the difference was statistically significant (P0.05). The comparison between groups: after treatment two groups CGRP decreased. Compared with the control group, the test group decreased more significantly, the difference was not statistically significant (P0.05); the two groups after treatment ET-1 decreased. Compared with the control group, the test group decreased more significantly, the difference was statistically significant (P0.05). (2) compare the degree of CGRP and ET-1 changes: comparison within group: after treatment of CGRP and ET-1 in the experimental group was significantly lower than that before treatment, the difference was statistically significant (P0.05); the control group after treatment in group CGRP and ET-1 content decreased significantly, the difference was not statistically significant (P0.05). (2) group comparison: after treatment, the content of CGRP and ET-1 decreased in two groups. Compared with the control group, the decrease of the test group was more obvious, the difference was statistically significant (P0.05). (3) efficacy evaluation: comparison within group: the treatment group with the control group after 4 weeks of TCM syndrome score, migraine score, migraine attack frequency, duration and degree of pain scores were decreased significantly compared with before treatment, the difference was statistically significant (P0.05), the two groups have the curative effect. The comparison between groups: after 4 weeks of treatment between the two groups of TCM syndrome score, migraine score, migraine attack frequency and duration scores were lower in experimental group decreased more significantly, the difference was statistically significant (P0.05), migraine pain scores were compared between groups, the difference was not statistically significant (P0.05), but the test migraine pain group mean scores were lower than the control group, the experimental group than the control group. (3) validity analysis of TCM syndrome score. After 4 weeks of treatment, the total effective rate of the experimental group was 90%, and the total effective rate of the control group was 60%. The difference between the two groups was statistically significant (P0.05), that is, the curative effect of the experimental group was better than that of the control group. (4) effective analysis of migraine efficacy score. After 4 weeks of treatment, the total effective rate of the experimental group was 85%, and the total effective rate of the control group was 55%. The difference between the two groups was statistically significant (P0.05), that is, the efficacy of the experimental group was better than that of the control group. (4) safety evaluation: (1) there was no significant difference in blood routine, urine routine, fecal routine, liver, renal function and electrocardiogram between the experimental group and the control group after treatment (P0.05). (2) there was no statistical difference between the two groups and the group (P0.05) through the test of the safety of the body temperature, heart rate, respiration and blood pressure before and after the drug use. (3) there was no statistical difference between the two groups through the test of adverse reactions between the two groups (P0.05). (5) follow up: comparison group, treatment 4 weeks ago after the March follow-up score and TCM syndrome score and the curative effect of migraine in test group had significant difference (P0.05), the experimental group has long-term effect; the control group there was no significant difference in the control group (P0.05), long term the effect is not obvious. The number of migraine attacks, duration and pain scores before and after treatment 4 weeks ago and after March were compared between the experimental group and the control group, the difference was statistically significant (P0.05), that is, the two groups had long-term curative effect. The comparison between groups, followed up after March two groups of TCM syndrome score, migraine score, migraine frequency and duration was statistically significant score difference between the two groups (P0.05), migraine pain scores were compared between groups, the difference was not statistically significant (P0.05), but the test group of migraine pain score is lower than the mean control group. Follow up in March, the TCM syndrome score, migraine efficacy score, migraine attack frequency, duration and pain score in the experimental group were lower than those in the control group, that is, the long-term effect of the experimental group is better than that of the control group. To sum up, the two groups have preventive effect. Compared with the control group, the experimental group can effectively prevent the recurrence of migraine and reduce the recurrence rate. Conclusion (1) the addition and subtraction of Chuanxiong tea dispersal can effectively improve the symptoms of frequent migraine (wind and cold disturbance). (2) it is presumed that the addition and subtraction of the compatibility components of Chuanxiong tea dispersal may affect the CGRP and ET-1 genes
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.7

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