BoNT-A联合文拉法辛治疗慢性偏头痛共病焦虑抑郁的疗效分析  

AN ANALYSIS OF THE EFFICACY OF BoNT-A COMBINED WITH VENLAFAXINE IN TREATING CHRONIC MIGRAINE COMORBID ANXIETY AND DEPRESSION

作　　者：李蒙 任占秀[1] 郝家涛 李宝荣 赵远 何秋[1] LI Meng;REN Zhan-Xiu;HAO Jia-Tao;LI Bao-Rong;ZHAO Yuan;HE Qiu(Department of Neurology,The People' s Hospital of Liaoning Province,Shenyang,110016,China;Graduate School of Dalian Medical University,Dalian,116000,China;General Department,Affiliated Zhongshan Hospitalof Fudan University,Shanghai,200032,China;Xi' an Jiaotong University Health Science Center,Xi'an,710000,China)

机构地区：[1]辽宁省人民医院神经内科,沈阳110016 [2]大连医科大学研究生院,大连116000 [3]复旦大学附属中山医院全科,上海200032 [4]西安交通大学医学部,西安710000

出　　处：《中国疼痛医学杂志》2019年第8期581-586,共6页Chinese Journal of Pain Medicine

基　　金：沈阳市科技计划项目(计划文号：沈科发〔2017〕40号.项目编号：17-230-9-26)

摘　　要：目的:探究A型肉毒毒素(botulinum toxin type-A,BoNT-A)及其联合文拉法辛治疗慢性偏头痛(chronic migraine,CM)共病焦虑抑郁病人的头痛及焦虑抑郁的改善情况。方法:依据慢性偏头痛诊断标准及焦虑自评量表(self-rating anxiety scale,SAS)和抑郁自评量表(self-rating depression scale,SDS)的评价标准,筛选慢性偏头痛共病焦虑或(和)抑郁状态的病人并排序。依照随机数字表法,将病人分为3 组:单用文拉法辛组(A组)、单用A 型肉毒毒素注射组(B组)、文拉法辛联合A 型肉毒毒素注射组(C组)。采用视觉模拟评分(visual analogue scale,VAS)、每月头痛天数、头痛发作期治疗次数、头痛影响测定-6(headache impact test-6,HIT-6)、偏头痛残疾程度评估问卷(the migrainedisability assessment questionnaire,MIDAS)、SAS及SDS量表评估病人治疗前及接受治疗12 周时的病情。结果:A组经治疗焦虑抑郁状态及部分头痛状况(每月头痛天数、每月头痛发作治疗次数和MIDAS)明显改善(P<0.05),而VAS及MIDAS评分未见差异;B组经治疗病人在头痛状况及焦虑抑郁状态方面都有显著改善(P<0.05);C组经治疗后头痛状况及焦虑抑郁状态也都有显著改善(P<0.05)。并且其改善量在VAS、每月头痛天数及头痛对病人生活影响方面显示出了“1+1>2”的趋势,BoNT-A 与文拉法辛联合治疗效果明显优于分别单独使用的效果(P<0.05)。结论:慢性偏头痛共病焦虑抑郁病人,单用A型肉毒毒素注射治疗后不仅可改善头痛情况,还可明显改善焦虑抑郁状态;且联合文拉法辛后治疗效果明显优于分别单独使用的效果。Objective:To investigate the improvement effects on headache,anxiety and depression after botulinum toxin type A (BoNT-A) injection combined with venlafaxine in the patients of chronic migraine comorbided with anxiety and depression.Methods:According to the criteria of chronic migraine and self-rating anxiety scale (SAS) and self-rating depression scale (SDS),patients with chronic migraine comorbided anxiety or (and) depression status were selected.According to the random number table method, patients were divided into 3 groups:venlafaxine group (group A),BoNT-A injection group (group B),venlafaxine and BoNT-A injection group (group C).Visual analog scale (VAS),number of headache days per month,times of headache treatment episodes per month,headache impact test-6 (HIT-6),migraine disability assessment questionnaire (MIDAS),SAS and SDS scales were used to evaluate the patient' s condition before treatment and at 12 weeks of treatment.Results:In group A,the anxiety and depression and some headaches status (number of headache days per month,times of headache treatment episodes per month and HIT- 6) were significantly improved (P < 0.05).There was no difference in VAS and MIDAS scores,The patients in group B were significantly improved in headache,anxiety and depression status (P < 0.05),The headache, anxiety and depression status of group C were also significantly improved (P < 0.05),and the improvement showed a trend of "1 + 1 > 2" in terms of VAS,Number of headache days per month,Times of headache treatment episodes per month and the impact of headache on patients' lives.Combined with BoNT-A and venlafaxine, the treatment effect is significantly better than that treated either independently.(P < 0.05).Conculsion: In patients with chronic migraine comorbided anxiety and depression,the treatment of BoNT-A can improve not only headaches but also the state of anxiety and depression significantly.Combined with oral venlafaxine,the effect is significantly better than that treated with either independently.

关 键 词：慢性偏头痛 焦虑 抑郁 A型肉毒毒素 联合治疗 

分 类 号：R747.2[医药卫生—神经病学与精神病学]