腺苷钴胺联合巴氯芬治疗三叉神经痛患者的临床疗效及对炎性因子及氧化应激反应的影响
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摘要
目的探讨腺苷钴胺联合巴氯芬治疗三叉神经痛(TN)的临床价值。方法选取2016年4月至2017年4月收治的TN患者98例为研究对象,以随机数字表法分为对照组49例,观察组49例,对照组给予巴氯芬治疗,观察组在对照组基础上加用腺苷钴胺治疗,观察两组治疗效果,治疗前、治疗4w后炎性因子、氧化应激反应指标变化,用药期间不良反应发生情况。结果观察组治疗总有效率为91.84%,同对照组75.51%对比明显较高(P<0.05);两组治疗前炎性因子水平差异无统计学意义(P>0.05),治疗后均有下降,观察组治疗4w后血清白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及白介素-1β(IL-1β)水平与对照组对比下降明显(P<0.05);观察组治疗4w后血清谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)及丙二醛(MDA)水平与对照组对比差异明显(P<0.05);观察组用药期间不良反应发生率为14.29%,同对照组10.20%对比,差异无统计学意义(P>0.05)。结论腺苷钴胺联合巴氯芬治疗三叉神经痛,疗效显著,可有效减轻患者炎症反应及氧化应激反应,且安全性高,值得临床应用。
Objective To investigate the clinical value of adenosylcobalamin combined with baclofen in the treatment of trigeminal neuralgia(TN). Method 98 patients with TN treated in Apr 2016 to Apr 2017 were selected as the subjects, the random digital table was divided into 49 patients in the control group, the other patients in the observation group, the control group were treated with baclofen, the observation group were treated with adenosylcobalamin on the basis of the control group. Observe the treatment effect, the changes of inflammatory factors and oxidative stress indexes before and 4 weeks after treatment,the occurrence of adverse reactions during medication of two groups. Results In the observation group, the total effective rate was 91.84%, compared with the control group(75.51%), significantly higher(P<0.05); There was no significant difference in the levels of inflammatory factors between the two groups before treatment(P>0.05), and all of them decreased after treatment, the levels of serum interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β) in the observation group compared with the control group after 4 weeks of treatment, decreased obviously(P<0.05); The levels of serum glutathione peroxidase(GSH-Px), superoxide dismutase(SOD), malondialdehyde(MDA) in the observation group compared with the control group after 4 weeks of treatment, difference obviouslyt(P<0.05); The incidence of adverse reactions in the observation group during medication was 14.29%, compared with 10.20% in the control group, the difference was not statistically significant(P>0.05). Conclusion Adenosylcobalamin combined with baclofenn is effective in the treatment of TN, it can effectively reduce the inflammatory reaction and oxidative stress, and it is highly safe, worthy of clinical application.
Objective To investigate the clinical value of adenosylcobalamin combined with baclofen in the treatment of trigeminal neuralgia(TN). Method 98 patients with TN treated in Apr 2016 to Apr 2017 were selected as the subjects, the random digital table was divided into 49 patients in the control group, the other patients in the observation group, the control group were treated with baclofen, the observation group were treated with adenosylcobalamin on the basis of the control group. Observe the treatment effect, the changes of inflammatory factors and oxidative stress indexes before and 4 weeks after treatment,the occurrence of adverse reactions during medication of two groups. Results In the observation group, the total effective rate was 91.84%, compared with the control group(75.51%), significantly higher(P<0.05); There was no significant difference in the levels of inflammatory factors between the two groups before treatment(P>0.05), and all of them decreased after treatment, the levels of serum interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β) in the observation group compared with the control group after 4 weeks of treatment, decreased obviously(P<0.05); The levels of serum glutathione peroxidase(GSH-Px), superoxide dismutase(SOD), malondialdehyde(MDA) in the observation group compared with the control group after 4 weeks of treatment, difference obviouslyt(P<0.05); The incidence of adverse reactions in the observation group during medication was 14.29%, compared with 10.20% in the control group, the difference was not statistically significant(P>0.05). Conclusion Adenosylcobalamin combined with baclofenn is effective in the treatment of TN, it can effectively reduce the inflammatory reaction and oxidative stress, and it is highly safe, worthy of clinical application.
引文
[1]中华医学会神经外科学分会功能神经外科学组,中国医师协会神经外科医师,分会功能神经外科专家委员会等.三叉神经痛诊疗中国专家共识[J].中华外科杂志,2015,53(9):657-664.
[2]刘鸣,谢鹏.神经内科学.第2版[M].北京:人民卫生出版社,2014:247-248.
[3]Sathasivam H P,Ismail S,Ahmad A R,et al.Trigeminal neuralgia:a retrospective multicentre study of 320 Asian patients[J].Oral Surg Oral Med Oral Pathol Oral Radiol,2016,123(1):51-57.
[4]Liao C.Underlying mechanism of trigeminal neuralgia:central?peripheral?or both?[J].World Neurosurgery,2016,90:694-695.
[5]Geneidi E A S,Ali H I,Ghany W A A,et al.Trigeminal pain:potential role of MRI[J].Esrnm,2016,47(4):1549-1555.
[6]Spisák T,Pozsgay Z,Aranyi C,et al.Central sensitizationrelated changes of effective and functional connectivity in the rat inflammatory trigeminal pain model[J].Neuroscience,2017,344:133-147.
[7]Cruccu G,Finnerup N B,Jensen T S,et al.Trigeminal neuralgia:New classification and diagnostic grading for practice and research[J].Neurology,2016,87(2):220-228.
[8]Yuan M,Zhou H,Xiao Z,et al.Efficacy and safety of gabapentin vs.carbamazepine in the treatment of trigeminal neuralgia:A Metaanalysis[J].Pain Practice,2016,16(8):1083-1091.
[9]Qin Z,Xie S,Mao Z,et al.Comparative efficacy and acceptability of antiepileptic drugs for classical trigeminal neuralgia:a Bayesian network meta-analysis protocol[J].BMJ Open,2018,8(1):e017392.
[10]Yang F,Lin Q,Dong L,et al.Efficacy of 8 different drug treatments for patients with trigeminal neuralgia:A network meta-analysis[J].Clin J Pain,2018,34(7):685-690.
[11]Makins C,Pickering A V,Mariani C,et al.Mutagenesis of a conserved glutamate reveals the contribution of electrostatic energy to adenosylcobalamin co-C bond homolysis in ornithine4,5-aminomutase and methylmalonyl-CoA mutase[J].Biochemistry,2013,52(5):878-888.
[12]Jost M,Born D A,Cracan V,et al.Structural basis for substrate specificity in adenosylcobalamin-dependent isobutyryl-CoAmutase and related acyl-CoA mutases[J].J Biol Chem,2015,290(45):26882-26898.
[13]Zhang Y P,Song C Y,Yuan Y,et al.Diabetic neuropathic pain development in type 2 diabetic mouse model and the prophylactic and therapeutic effects of coenzyme Q10[J].Neurobiol Dis,2013,58(10):169-178.
[14]Ranjithkumar R,Prathab Balaji S,Balaji B,et al.Standardized aqueous tribulus terristris(nerunjil)extract attenuates hyperalgesia in experimentally induced diabetic neuropathic pain model:role of oxidative stress and inflammatory mediators[J].Phytother Res,2013,27(11):1646-1657.
[15]Amin B,Hajhashemi V,Abnous K,et al.Ceftriaxone,a beta-lactam Antibiotic,modulates apoptosis pathways and oxidative stress in a rat Model of neuropathic pain[J].Biomed Res Int,2014,2014(5):937568.
[16]Shatillo A,Koroleva K,Giniatullina R,et al.Cortical spreading depression induces oxidative stress in the trigeminal nociceptive system[J].Neuroscience,2013,253(17):341-349.
[17]Teodoro F C,Tronco Júnior M F,Zampronio A R,et al.Peripheral substance P and neurokinin-1 receptors have a role in inflammatory and neuropathic orofacial pain models[J].Neuropeptides,2013,47(3):199-206.
[18]Lyons D N,Kniffin T C,Zhang L,et al.Trigeminal inflammatory compression(TIC)injury induces Chronic facial pain and susceptibility to anxiety-related behaviors[J].Neuroscience,2015,295:126-138.
[19]Leclercq D,Thiebaut J B,Héran F.Trigeminal neuralgia[J].Diagn Interv Imaging,2013,94(10):993-1001.
[20]Silbert B I,Silbert P L.Under-recognized:inflammatory trigeminal neuropathy[J].Oral Surg Oral Med Oral Pathol Oral Radiol,2013,116(5):659-660.
[2]刘鸣,谢鹏.神经内科学.第2版[M].北京:人民卫生出版社,2014:247-248.
[3]Sathasivam H P,Ismail S,Ahmad A R,et al.Trigeminal neuralgia:a retrospective multicentre study of 320 Asian patients[J].Oral Surg Oral Med Oral Pathol Oral Radiol,2016,123(1):51-57.
[4]Liao C.Underlying mechanism of trigeminal neuralgia:central?peripheral?or both?[J].World Neurosurgery,2016,90:694-695.
[5]Geneidi E A S,Ali H I,Ghany W A A,et al.Trigeminal pain:potential role of MRI[J].Esrnm,2016,47(4):1549-1555.
[6]Spisák T,Pozsgay Z,Aranyi C,et al.Central sensitizationrelated changes of effective and functional connectivity in the rat inflammatory trigeminal pain model[J].Neuroscience,2017,344:133-147.
[7]Cruccu G,Finnerup N B,Jensen T S,et al.Trigeminal neuralgia:New classification and diagnostic grading for practice and research[J].Neurology,2016,87(2):220-228.
[8]Yuan M,Zhou H,Xiao Z,et al.Efficacy and safety of gabapentin vs.carbamazepine in the treatment of trigeminal neuralgia:A Metaanalysis[J].Pain Practice,2016,16(8):1083-1091.
[9]Qin Z,Xie S,Mao Z,et al.Comparative efficacy and acceptability of antiepileptic drugs for classical trigeminal neuralgia:a Bayesian network meta-analysis protocol[J].BMJ Open,2018,8(1):e017392.
[10]Yang F,Lin Q,Dong L,et al.Efficacy of 8 different drug treatments for patients with trigeminal neuralgia:A network meta-analysis[J].Clin J Pain,2018,34(7):685-690.
[11]Makins C,Pickering A V,Mariani C,et al.Mutagenesis of a conserved glutamate reveals the contribution of electrostatic energy to adenosylcobalamin co-C bond homolysis in ornithine4,5-aminomutase and methylmalonyl-CoA mutase[J].Biochemistry,2013,52(5):878-888.
[12]Jost M,Born D A,Cracan V,et al.Structural basis for substrate specificity in adenosylcobalamin-dependent isobutyryl-CoAmutase and related acyl-CoA mutases[J].J Biol Chem,2015,290(45):26882-26898.
[13]Zhang Y P,Song C Y,Yuan Y,et al.Diabetic neuropathic pain development in type 2 diabetic mouse model and the prophylactic and therapeutic effects of coenzyme Q10[J].Neurobiol Dis,2013,58(10):169-178.
[14]Ranjithkumar R,Prathab Balaji S,Balaji B,et al.Standardized aqueous tribulus terristris(nerunjil)extract attenuates hyperalgesia in experimentally induced diabetic neuropathic pain model:role of oxidative stress and inflammatory mediators[J].Phytother Res,2013,27(11):1646-1657.
[15]Amin B,Hajhashemi V,Abnous K,et al.Ceftriaxone,a beta-lactam Antibiotic,modulates apoptosis pathways and oxidative stress in a rat Model of neuropathic pain[J].Biomed Res Int,2014,2014(5):937568.
[16]Shatillo A,Koroleva K,Giniatullina R,et al.Cortical spreading depression induces oxidative stress in the trigeminal nociceptive system[J].Neuroscience,2013,253(17):341-349.
[17]Teodoro F C,Tronco Júnior M F,Zampronio A R,et al.Peripheral substance P and neurokinin-1 receptors have a role in inflammatory and neuropathic orofacial pain models[J].Neuropeptides,2013,47(3):199-206.
[18]Lyons D N,Kniffin T C,Zhang L,et al.Trigeminal inflammatory compression(TIC)injury induces Chronic facial pain and susceptibility to anxiety-related behaviors[J].Neuroscience,2015,295:126-138.
[19]Leclercq D,Thiebaut J B,Héran F.Trigeminal neuralgia[J].Diagn Interv Imaging,2013,94(10):993-1001.
[20]Silbert B I,Silbert P L.Under-recognized:inflammatory trigeminal neuropathy[J].Oral Surg Oral Med Oral Pathol Oral Radiol,2013,116(5):659-660.
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