联合应用异烟肼对顽固性神经痛治疗效果的初步研究  

A Pilot Study of Combination Therapy with Isoniazid:in Management of Intractable Neuropathic Pain

作　　者：丰岩清[1] 国宁[1] 刘俊秀[1] 黄帆[1] 陈曦[1] 赖蓉[1] 

机构地区：[1]中山大学附属第一医院神经科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2011年第3期355-358,共4页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划项目(2004B33801006)

摘　　要：【目的】评估联合应用异烟肼(INH)治疗在难治性神经病理性疼痛(NP)治疗中的价值。【方法】采用前瞻性、联合用药的自身对照研究,36例患有难治性NP的病人入组,这些病人对卡马西平和加巴喷丁联合治疗无效,给以异烟肼8mg/kg联合治疗,观察期8周,检测其疗效和副作用。治疗前后采用采用视觉模拟量表(VAS)、睡眠干扰评分和病人总体印象改变表(PGIC)进行疗效评定。【结果】经过8周治疗后,VAS评分较加用异烟肼前有明显下降(配对t检验P<0.01),VAS评分由治疗前的61.76下降至32.94,下降幅度达46.7%。痛觉过敏明显减少,23例病人(63.9%)PGIC改善。另外,病人的平均睡眠分数也有明显改善。【结论】联合应用异烟肼可能是一种对治疗NP潜在有效的治疗方法,尤其对难治性NP可能有效。INH的作用机制不明,其疗效仍需要在大样本的RCT研究中进一步确定。[Objectives] To assess the efficacy of combination therapy with isoniazid for the treatment of intractable neuropathic pain.[Methods] This was a prospective,open-label,add-on study in 36 consecutive patients who suffered from intractable neuropathic pain.All patients had insufficient pain relief after previous treatment with carbamazepine and gabapentin.They were given combination therapy with 8 mg/kg isoniazid and followed for a minimum of 8 weeks,and monitored for efficacy and side effects.Pain relief was recorded using the visual analogue scale（VAS） from the screening week compared to the 8th treatment week.Secondary measures included sleep interference scores and patient global impression of change（PGIC）.[Results] There was a significant decrease in the mean VAS score following 8 weeks of treatment（paired t test;P 〈0.001） compared with baseline.The mean VAS score dropped from 61.76 at the end of the screening phase to 32.94 at the end of the trial,for a mean reduction of 46.7%.After 8 weeks of treatment,there was a significant reduction in allodynia,and a total of 23 subjects（63.9%） reported an improvement in PGIC.In addition,there was a significant improvements in mean sleep score from 5.41 to 3.19.[Conclusion]The results from this study provide a new possibility for treating neuropathic pain,and show that combination therapy with isoniazid has potent analgesic properties,and therefore,may be useful in the management of intractable neuropathic pain.These results will need to be confirmed in large,double-blind,placebo-controlled,randomized clinical trials.

关 键 词：神经病理性疼痛 难治性/治疗 异烟肼 

分 类 号：R745[医药卫生—神经病学与精神病学]