托吡酯和丙戊酸钠预防偏头痛发作的对比研究  

Comparative study of Topiramate and Sodium Valproate as prophylactic therapy for migraine

作　　者：朱凯云 黄焰[1] 胡运新 

机构地区：[1]广东三九脑科医院神经内科中心,广州510510

出　　处：《临床神经病学杂志》2007年第4期271-273,共3页Journal of Clinical Neurology

摘　　要：目的对比研究托吡酯和丙戊酸钠预防偏头痛发作的疗效及安全性。方法采用前瞻性的方法,随机将偏头痛患者分为两组:(1)托吡酯组(74例),采用托吡酯,第1周每日25mg开始,每周日递增25mg,最高剂量增至每日100mg,分早晚两次口服;(2)丙戊酸钠组(72例),采用丙戊酸钠每日400mg,分早晚两次口服,最高剂量增至每日600mg。两组服药持续3个月。观察两组患者治疗前后的头痛发作频率、头痛发作天数和疼痛程度,并进行对比。头痛程度采用0～10分评分法,观察时间为13周,此期间患者记录头痛日记。结果发作频率:托吡酯组从每月7.01次减少至1.89次(P<0.001),丙戊酸钠组从每月6.87次减少至1.91次(P<0.001),两组之间差异无统计学意义(P>0.05);头痛发作天数:托吡酯组从7.28d减少至1.89d(P<0.001),丙戊酸钠组从7.09d减少至2.40d(P<0.001),两组差异无统计学意义(P>0.05);头痛程度:托吡酯组从8.05分减轻至2.02分(P<0.001),丙戊酸钠组从7.56分减轻至3.62分(P<0.001),两组之间差异有统计学意义(P<0.05)。托吡酯最常见的不良反应为肢体麻木、头晕、乏力和食欲减退,丙戊酸钠的不良反应为恶心、呕吐、血白细胞降低、转氨酶升高。结论托吡酯和丙戊酸钠均能有效预防偏头痛发作,但在减轻头痛程度方面,托吡酯比丙戊酸钠效果更好。Objective To assess the efficacy, safety, and tolerability of Topiramate （TPM） and Sodium Valproate （SV） as prophylactic therapy for migraine. Methods Prospectively, total of 146 patients with episodic migraine were randomly divided into two groups： TPM group （74 cases） and SV group （72 cases）. TPM was titrated by 25 mg per week for 2 -4 weeks and the highest dose was 100 mg/d. SV was given at 200 mg twice daily during initial titration of therapy and the highest dose was 600 mg/d. The therapies lasted for 13 weeks, meanwhile the migrain frequency, days and the severity of headache were recorded in headache diaries. The severity of headache was rated on a 0 - 10 rating scale. Results Mean frequency of headache attack decreased from 7.01 to 1.89 times per month （P 〈 0. 001 ） in TPM group and 6.87 to 1.91 times per month （ P 〈 0. 001 ） in SV group, respectively. Mean days of headache occurrence decreased from 7.28 to 1.89 d （P 〈 0. 001 ） in TPM group and 7.09 to 2.40 d in SV group （ P 〈 0. 001 ）. No significant differences existed in ,mean frequency and days of headache between two groups. Mean severity decreased from 8.05 to 2.02 （ P 〈 0. 001 ） in TPM group and from 7.56 to 3.62 （ P 〈 0. 001 ） in SV group. There was a significant difference between two groups （6.03 ± 3.84 VS 3.96 ± 3.22, P 〈 0. 05 ）. The most common side effects of TPM were acroparesthesias, dizziness, fatigue and anorexia and the side effects of SV were nausea, vomit, decline of white blood cells and light increase of transaminase. Conclusions Both TPM and SV prophylaxis therapy for episodic migraine yield significant reduction in migraine frequency, days and severity. TPM is better in reduction of headache severity.

关 键 词：托吡酯 丙戊酸钠 偏头痛 

分 类 号：R747.2[医药卫生—神经病学与精神病学]