拉莫三嗪治疗原发性三叉神经痛患者疗效及其对疼痛因子的影响
|
摘要
目的观察拉莫三嗪治疗原发性三叉神经痛(PTN)患者的疗效及其对血清疼痛因子的影响。方法收集2014年7月—2018年6月成都医学院第一附属医院神经内科治疗PTN患者118例,依照随机数字表法分为对照组(n=59)与拉莫三嗪组(n=59)。对照组以奥卡西平治疗,拉莫三嗪组以拉莫三嗪治疗,均治疗90 d。观察2组临床疗效,治疗前后疼痛评分(VAS)、焦虑评分(SAS)、抑郁评(SDS))及睡眠情况(PSQL)、健康状况评分,检测血清β-Ep、VIP、TNF-α、IL-1β等疼痛因子,观察记录不良反应。结果拉莫三嗪组总有效率高于对照组(89.83%vs. 69.49%,χ~2=7.468,P=0.006)。治疗后,拉莫三嗪组VAS、SAS、SDS、PSQL评分均低于对照组(t=18.178、17.825、17.522,P均=0.000),健康状况评分8项均高于对照组(t=10.113、13.917、13.038、12.837、15.226、13.446、13.012、13.057;P均=0.000)。拉莫三嗪组血清β-Ep水平高于对照组(t=7.073,P=0.000),VIP、TNF-α、IL-1β水平均低于对照组(t=17.937、11.066、11.536,P均=0.000)。拉莫三嗪组不良反应发生率低于对照组(5.08%vs.22.03%,χ~2=7.169,P=0.007)。结论拉莫三嗪治疗PTN可抑制疼痛因子生成,缓解或解除患者疼痛,疗效显著,安全可靠。
Objective To observe the efficacy of lamotrigine in the treatment of primary trigeminal neuralgia(PTN) and its effect on serum pain factors.Methods One hundred and eighteen patients with PTN treated by Department of Neurology, First Affiliated Hospital of Chengdu Medical College from July 2014 to June 2018 were randomly divided into control group(n=59) and lamotrigine group(n=59). The control group was treated with oxcarbazepine and the lamotrigine group was treated with lamotrigine for 90 days. The clinical efficacy, pain score(VAS), anxiety score(SAS), depression score(SDS), sleep status(PSQL), health status score, serum pain factors such as beta-Ep, VIP, TNF-α and IL-1-beta were observed before and after treatment, and adverse reactions were recorded. Results The total effective rate of lamotrigine group was higher than that of control group(89.83% vs. 69.49%, χ~2 = 7.468,P=0.006). After treatment, the scores of VAS, SAS, SDS and PSQL in lamotrigine group were lower than those in control group(t=18.178,t=17.825,t=17.522,P=0.000), and the health status scores were higher than those in control group(t=10.113,t=13.917,t=13.038,t=12.837,t=15.226,t=13.446, t=13.012,t=13.057;P=0.000). The serum levels of beta Ep in lamotrigine group were higher than those in control group(t=7.073,P=0.000). The levels of VIP, TNF-α and IL-1 beta in lamotrigine group were lower than those in control group(t=17.937,t=11.066,t=11.536,P=0.000). The incidence of adverse reactions in lamotrigine group was lower than that in control group(5.08% vs. 22.03%, χ~2 = 7.169,P=0.007). Conclusion Lamotrigine in the treatment of PTN can inhibit the production of pain factors, relieve or relieve pain in patients with significant efficacy, safety and reliability.
Objective To observe the efficacy of lamotrigine in the treatment of primary trigeminal neuralgia(PTN) and its effect on serum pain factors.Methods One hundred and eighteen patients with PTN treated by Department of Neurology, First Affiliated Hospital of Chengdu Medical College from July 2014 to June 2018 were randomly divided into control group(n=59) and lamotrigine group(n=59). The control group was treated with oxcarbazepine and the lamotrigine group was treated with lamotrigine for 90 days. The clinical efficacy, pain score(VAS), anxiety score(SAS), depression score(SDS), sleep status(PSQL), health status score, serum pain factors such as beta-Ep, VIP, TNF-α and IL-1-beta were observed before and after treatment, and adverse reactions were recorded. Results The total effective rate of lamotrigine group was higher than that of control group(89.83% vs. 69.49%, χ~2 = 7.468,P=0.006). After treatment, the scores of VAS, SAS, SDS and PSQL in lamotrigine group were lower than those in control group(t=18.178,t=17.825,t=17.522,P=0.000), and the health status scores were higher than those in control group(t=10.113,t=13.917,t=13.038,t=12.837,t=15.226,t=13.446, t=13.012,t=13.057;P=0.000). The serum levels of beta Ep in lamotrigine group were higher than those in control group(t=7.073,P=0.000). The levels of VIP, TNF-α and IL-1 beta in lamotrigine group were lower than those in control group(t=17.937,t=11.066,t=11.536,P=0.000). The incidence of adverse reactions in lamotrigine group was lower than that in control group(5.08% vs. 22.03%, χ~2 = 7.169,P=0.007). Conclusion Lamotrigine in the treatment of PTN can inhibit the production of pain factors, relieve or relieve pain in patients with significant efficacy, safety and reliability.
引文
[1] Chen JN, Yu WH, Du HG, et al. Prospective Comparison of Redo Microvascular Decompression and Percutaneous Balloon Compression as Primary Surgery for Recurrent Trigeminal Neuralgia[J].J Korean Neurosurg Soc, 2018, 61(6):747-752.DOI: 10.3340/jkns.2017.0196.
[2] Perloff MD, Chung JS. Urgent care peripheral nerve blocks for refractory trigeminal neuralgia[J]. Am J Emerg Med, 2018, 36(11): 2058-2060. DOI: 10.1016/j.ajem.2018.08.019. Epub 2018 Aug 8.
[3] 刘洋, 康继宇, 孟超, 等. 神经毁损止痛治疗的研究进展[J]. 疑难病杂志, 2016, 15(5): 538-541,545. DOI: 10.39690/j.issn.1671-6450.2016.05.029.
[4] 中华医学会神经外科学分会功能神经外科学组. 三叉神经痛诊疗中国专家共识[J]. 中华外科杂志, 2015, 53 (9): 657-658.DOI: 10.3760/cma.j.issn.0529-5815.2015.09.005.
[5] Zung WK. 焦虑自评量表(SAS)[J]. 心理咨询师, 2012, 16(5): 34-35. DOI:10.3760∕cma.j.issn.0206-11616.2012.05.014.
[6] Morris JL, Rohay J, Chasens ER. Sex Differences in the Psychometric Properties of the Pittsburgh Sleep Quality Index[J]. J Womens Health (Larchmt), 2018, 27(3):278-282.DOI: 10.1089/jwh.2017.6447.
[7] Papou A, Hussain S, McWilliams D, et al.Responsiveness of SF-36 Health Survey and Patient Generated Index in people with chronic knee pain commenced on oral analgesia: analysis of data from a randomised controlled clinical trial[J]. Qual Life Res, 2017, 26(3): 761-766.DOI: 10.1007/s11136-016-1484-2.
[8] 严广斌. 视觉模拟评分法[J/OL]. 中华关节外科杂志:电子版, 2014, 8(2): 34. DOI:10.3760∕cma.j.issn.0236-1256.2014.02.003.
[9] Peter Y, Chen. Trigeminal Neuralgia[M]. Germany: Springer International Publishing,2018:499-516.
[10] Sharma R, Phalak M, Katiyar V, et al. Microvascular decompression versus stereotactic radiosurgery as primary treatment modality for trigeminal neuralgia: A systematic review and meta-analysis of prospective comparative trials[J]. Neurol India, 2018, 66(3): 688-694. DOI: 10.4103/0028-3886.232342.
[11] Zhao Y, Zhang X, Yao J, et al. Microvascular Decompression for Trigeminal Neuralgia Due to Venous Compression Alone[J]. J Craniofac Surg, 2018, 29(1): 178-181. DOI: 10.1097/SCS.0000000000004174.
[12] Sharma R, Katiyar V, Gurjar H. Letter: Primary Modality for Medically Refractory Trigeminal Neuralgia: Microvascular Decompression or Gamma Knife Therapy [J]. Oper Neurosurg (Hagerstown), 2018, 14(2): E31-E32.DOI: 10.1093/ons/opx243.
[13] Zakrzewska JM, Palmer J, Morisset V, et al. Safety and efficacy of a Nav1.7 selective sodium channel blocker in patients with trigeminal neuralgia: a double-blind, placebo-controlled, randomised withdrawal phase 2a trial[J]. Lancet Neurol, 2017, 16(4): 291-300. DOI: 10.1016/S1474-4422(17)30005-4.
[14] 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. DOI: 10.1136/bmjopen-2017-017392.
[15] Di Stefano G, Truini A, Cruccu G. Current and Innovative Pharmacological Options to Treat Typical and Atypical Trigeminal Neuralgia[J]. Drugs, 2018, 78(14): 1433-1442. DOI: 10.1007/s40265-018-0964-9.
[16] 张月琴,张敏,田艳萍.拉莫三嗪群体药代动力学研究现状及影响因素[J].临床和实验医学杂志,2014,13(1):79-80,封3. DOI:10.3969/j.issn.1671-4695.2014.01.031.
[17] 周圣军, 杨剑宏, 黄悦士. 拉莫三嗪与奥卡西平对原发性三叉神经痛患者疼痛和睡眠质量的影响[J]. 中国临床药理学杂志, 2016, 32(9):803-805. DOI:10.13699/j.cnki.1001-6821.2016.09.012.
[18] Guo QH, Tong QH, Lu N, et al. Proteomic Analysis of the Hippocampus in Mouse Models of Trigeminal Neuralgia and Inescapable Shock-Induced Depression[J]. Neurosci Bull, 2018, 34(1): 74-84.DOI: 10.1007/s12264-017-0131-4.
[19] Heddini U, Johannesson U, Gr nbladh A, et al. A118G polymorphism in the μ-opioid receptor gene and levels of β-endorphin are associated with provoked vestibulodynia and pressure pain sensitivity[J]. Scand J Pain, 2014, 5(1): 10-16. DOI: 10.1016/j.sjpain.2013.10.004.
[20] Paungmali A, Joseph LH, Punturee K, et al. Immediate Effects of Core Stabilization Exercise on β-Endorphin and Cortisol Levels Among Patients With Chronic Nonspecific Low Back Pain: A Randomized Crossover Design[J]. J Manipulative Physiol Ther, 2018, 41(3): 181-188. DOI: 10.1016/j.jmpt.2018.01.002.
[21] Gazerani P, Cairns BE. New insight in migraine pathogenesis: Vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase-activating polypeptide (PACAP) in the circulation after sumatriptan[J]. Scand J Pain, 2013, 4(4): 208-210. DOI: 10.1016/j.sjpain.2013.07.001.
[22] 王瑞珂, 张琴琴. TNF-α通过p38丝裂原活化蛋白激酶信号通路对小胶质细胞HMGB1表达的调控作用[J]. 中南大学学报: 医学版, 2015, 40(9): 967-972. DOI:10.11817/j.issn.1672-7347.2015.09.004.
[23] Liu Y, Liu W, Wang X, et al. Dexmedetomidine Relieves Acute Inflammatory Visceral Pain in Rats through the ERK Pathway, Toll-Like Receptor Signaling, and TRPV1 Channel[J]. J Mol Neurosci, 2018, 66(2): 279-290. DOI: 10.1007/s12031-018-1172-5.
[24] Marwaha L, Bansal Y, Singh R, et al. Niflumic acid, a TRPV1 channel modulator, ameliorates stavudine-induced neuropathic pain[J]. Inflammopharmacology, 2016, 24(6): 319-334. DOI: 10.1007/s10787-016-0285-0.
[25] Khuankaew C, Apaijai N, Sawaddiruk P, et al. Effect of coenzyme Q10 on mitochondrial respiratory proteins in trigeminal neuralgia[J]. Free Radic Res, 2018, 52(4): 415-425. DOI: 10.1080/10715762.2018.1438608.
[26] 陈建平, 李航, 张宇. IL-1β在神经病理性痛大鼠脊髓背角神经元NMDA受体活化中的作用[J]. 中华麻醉学杂志, 2016, 36(11): 1366-1370. DOI:10.3760∕cma.j.issn.0254-1416.2016.11.022.
[2] Perloff MD, Chung JS. Urgent care peripheral nerve blocks for refractory trigeminal neuralgia[J]. Am J Emerg Med, 2018, 36(11): 2058-2060. DOI: 10.1016/j.ajem.2018.08.019. Epub 2018 Aug 8.
[3] 刘洋, 康继宇, 孟超, 等. 神经毁损止痛治疗的研究进展[J]. 疑难病杂志, 2016, 15(5): 538-541,545. DOI: 10.39690/j.issn.1671-6450.2016.05.029.
[4] 中华医学会神经外科学分会功能神经外科学组. 三叉神经痛诊疗中国专家共识[J]. 中华外科杂志, 2015, 53 (9): 657-658.DOI: 10.3760/cma.j.issn.0529-5815.2015.09.005.
[5] Zung WK. 焦虑自评量表(SAS)[J]. 心理咨询师, 2012, 16(5): 34-35. DOI:10.3760∕cma.j.issn.0206-11616.2012.05.014.
[6] Morris JL, Rohay J, Chasens ER. Sex Differences in the Psychometric Properties of the Pittsburgh Sleep Quality Index[J]. J Womens Health (Larchmt), 2018, 27(3):278-282.DOI: 10.1089/jwh.2017.6447.
[7] Papou A, Hussain S, McWilliams D, et al.Responsiveness of SF-36 Health Survey and Patient Generated Index in people with chronic knee pain commenced on oral analgesia: analysis of data from a randomised controlled clinical trial[J]. Qual Life Res, 2017, 26(3): 761-766.DOI: 10.1007/s11136-016-1484-2.
[8] 严广斌. 视觉模拟评分法[J/OL]. 中华关节外科杂志:电子版, 2014, 8(2): 34. DOI:10.3760∕cma.j.issn.0236-1256.2014.02.003.
[9] Peter Y, Chen. Trigeminal Neuralgia[M]. Germany: Springer International Publishing,2018:499-516.
[10] Sharma R, Phalak M, Katiyar V, et al. Microvascular decompression versus stereotactic radiosurgery as primary treatment modality for trigeminal neuralgia: A systematic review and meta-analysis of prospective comparative trials[J]. Neurol India, 2018, 66(3): 688-694. DOI: 10.4103/0028-3886.232342.
[11] Zhao Y, Zhang X, Yao J, et al. Microvascular Decompression for Trigeminal Neuralgia Due to Venous Compression Alone[J]. J Craniofac Surg, 2018, 29(1): 178-181. DOI: 10.1097/SCS.0000000000004174.
[12] Sharma R, Katiyar V, Gurjar H. Letter: Primary Modality for Medically Refractory Trigeminal Neuralgia: Microvascular Decompression or Gamma Knife Therapy [J]. Oper Neurosurg (Hagerstown), 2018, 14(2): E31-E32.DOI: 10.1093/ons/opx243.
[13] Zakrzewska JM, Palmer J, Morisset V, et al. Safety and efficacy of a Nav1.7 selective sodium channel blocker in patients with trigeminal neuralgia: a double-blind, placebo-controlled, randomised withdrawal phase 2a trial[J]. Lancet Neurol, 2017, 16(4): 291-300. DOI: 10.1016/S1474-4422(17)30005-4.
[14] 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. DOI: 10.1136/bmjopen-2017-017392.
[15] Di Stefano G, Truini A, Cruccu G. Current and Innovative Pharmacological Options to Treat Typical and Atypical Trigeminal Neuralgia[J]. Drugs, 2018, 78(14): 1433-1442. DOI: 10.1007/s40265-018-0964-9.
[16] 张月琴,张敏,田艳萍.拉莫三嗪群体药代动力学研究现状及影响因素[J].临床和实验医学杂志,2014,13(1):79-80,封3. DOI:10.3969/j.issn.1671-4695.2014.01.031.
[17] 周圣军, 杨剑宏, 黄悦士. 拉莫三嗪与奥卡西平对原发性三叉神经痛患者疼痛和睡眠质量的影响[J]. 中国临床药理学杂志, 2016, 32(9):803-805. DOI:10.13699/j.cnki.1001-6821.2016.09.012.
[18] Guo QH, Tong QH, Lu N, et al. Proteomic Analysis of the Hippocampus in Mouse Models of Trigeminal Neuralgia and Inescapable Shock-Induced Depression[J]. Neurosci Bull, 2018, 34(1): 74-84.DOI: 10.1007/s12264-017-0131-4.
[19] Heddini U, Johannesson U, Gr nbladh A, et al. A118G polymorphism in the μ-opioid receptor gene and levels of β-endorphin are associated with provoked vestibulodynia and pressure pain sensitivity[J]. Scand J Pain, 2014, 5(1): 10-16. DOI: 10.1016/j.sjpain.2013.10.004.
[20] Paungmali A, Joseph LH, Punturee K, et al. Immediate Effects of Core Stabilization Exercise on β-Endorphin and Cortisol Levels Among Patients With Chronic Nonspecific Low Back Pain: A Randomized Crossover Design[J]. J Manipulative Physiol Ther, 2018, 41(3): 181-188. DOI: 10.1016/j.jmpt.2018.01.002.
[21] Gazerani P, Cairns BE. New insight in migraine pathogenesis: Vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase-activating polypeptide (PACAP) in the circulation after sumatriptan[J]. Scand J Pain, 2013, 4(4): 208-210. DOI: 10.1016/j.sjpain.2013.07.001.
[22] 王瑞珂, 张琴琴. TNF-α通过p38丝裂原活化蛋白激酶信号通路对小胶质细胞HMGB1表达的调控作用[J]. 中南大学学报: 医学版, 2015, 40(9): 967-972. DOI:10.11817/j.issn.1672-7347.2015.09.004.
[23] Liu Y, Liu W, Wang X, et al. Dexmedetomidine Relieves Acute Inflammatory Visceral Pain in Rats through the ERK Pathway, Toll-Like Receptor Signaling, and TRPV1 Channel[J]. J Mol Neurosci, 2018, 66(2): 279-290. DOI: 10.1007/s12031-018-1172-5.
[24] Marwaha L, Bansal Y, Singh R, et al. Niflumic acid, a TRPV1 channel modulator, ameliorates stavudine-induced neuropathic pain[J]. Inflammopharmacology, 2016, 24(6): 319-334. DOI: 10.1007/s10787-016-0285-0.
[25] Khuankaew C, Apaijai N, Sawaddiruk P, et al. Effect of coenzyme Q10 on mitochondrial respiratory proteins in trigeminal neuralgia[J]. Free Radic Res, 2018, 52(4): 415-425. DOI: 10.1080/10715762.2018.1438608.
[26] 陈建平, 李航, 张宇. IL-1β在神经病理性痛大鼠脊髓背角神经元NMDA受体活化中的作用[J]. 中华麻醉学杂志, 2016, 36(11): 1366-1370. DOI:10.3760∕cma.j.issn.0254-1416.2016.11.022.