川芎茶调散加减配合针刺治疗偏头痛急性发作期(风痰阻络证)及对神经血管源性活性介质的影响  

Effect of Addition and Subtraction Therapy of Chuanxiong Chatiaosan Combined with Acupuncture on Acute Migraine Attack with Syndrome of Wind Phlegm Blocking Collaterals and Neurovascular Active Medium

作　　者：李聪[1] 胡纪可[1] 郭耀光[1] 宋剑英[1] LI Cong;HU Ji-ke;GUO Yao-guang;SONG Jian-ying(The Affiliated Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 610072,China)

机构地区：[1]成都中医药大学附属医院,成都610072

出　　处：《中国实验方剂学杂志》2020年第24期122-127,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：四川省中医药管理局科学技术研究专项(2018LC017)。

摘　　要：目的:观察川芎茶调散加减配合针刺治疗偏头痛急性发作期(风痰阻络证)的疗效及对神经血管源性活性介质的影响。方法:将134例符合要求的患者按随机数字表法分成对照组和观察组67例。研究期间对照组脱落、失访2例,剔除2例,完成63例;观察脱落、失访3例,完成64例。两组患者基础治疗,口服布洛芬缓释片,1片/次,2次/d;和佐米曲普坦片,2.5 mg/次,1次/d,症状缓解后停用。对照组给予针刺治疗,1次/d,口服正天丸,6 g/次,2次/d。观察组针刺治疗同对照组,并给予川芎茶调散加减内服,1剂/d。两组疗程均为连续治疗10 d。分别于治疗前、治疗后1 d(2,4,12,24 h)和治疗后2~10 d,各评价1次疼痛视觉模拟评分(VAS);进行治疗前后头痛持续时间和程度、伴随症状、头痛发作次数、风痰阻络证和偏头痛特异性生活质量量表(MSQ)评分;检测治疗前后一氧化氮(NO),内皮素1(ET-1),降钙素基因相关肽(CGRP),5-羟色胺(5-HT)和β内啡肽(β-EP)水平。结果:观察组临床疗效优于对照组(Z=2.115,P<0.05);治疗后2,4 h两组患者的VAS评分逐渐下降,组间VAS评分差异无统计学意义;治疗后12,24 h两组患者的VAS评分均较前一时间点升高(P<0.01),观察组在治疗后12,24 h的VAS评分均低于对照组(P<0.01);两组疼痛起效时间、治疗后2 h的疼痛有效率和治疗后3 d的疼痛消失率组间差异无统计学意义;观察组疼痛缓解时间短于对照组(P<0.01);观察组头痛程度、头痛持续时间、头痛发作次数和伴随症状评分均低于对照组,MSQ量表各因子评分和MSQ总分均高于对照组(P<0.01);对照组和观察组在治疗后24 h后疼痛复发率分别为36.51%(23/63)和18.75%(12/64),观察组疼痛复发率低于对照组(P<0.05);观察组治疗后5和10 d的疼痛消失率分别为70.31%(45/64)和90.63%(58/64),分别高于对照组的52.38%(33/63)和76.19%(48/63)(P<0.05);观察组NO,β-EP,5-HT水平均高于对照组(P<0.01),CGRP和ET-1水平均低�Objective:To observe the efficacy of addition and subtraction therapy of Chuanxiong Chatiaosan combined with acupuncture for acute migraine attack with syndrome of wind phlegm blocking collaterals and to investigate its effect on neurovascular active medium.Method:One hundred and thirty-four patients were randomly divided into control group(67 cases)and observation group(67 cases)by random number table.During the treatment,63 patients completed the study in control group(loss to follow-up in 2 cases,and elimination in 2 cases).64 patients completed the study in observation group(loss to follow-up in 3 cases).Patients in both groups got ibuprofen sustained release tablets,1 tablet/time,2 times/day,Zolmitriptan tablets,2.5 mg/time,1 time/day,which were stopped when symptoms got relieved.Patients in control group got acupuncture treatment,1 time/day,and Zhengtian pills by oral administration,6 g/time,2 times/day.Based on the treatment of acupuncture in control group,patients in observation group additionally received addition and subtraction therapy of Chuanxiong Chatiaosan,1 dose/day,with a treatment course of 10 days in both groups.Before treatment,at the first day(2,4,12,24 h)and second to tenth day after the treatment,scores of pain visual analoguescale(VAS)were graded;before and after treatment,scores of duration and degree of headache,concomitant symptoms,number of headache attacks,syndrome of wind phlegm blocking collaterals,migraine specific quality of life scale(MSQ)were graded.Levels of nitric oxide(NO),endothelin-1(ET-1),calcitonin gene-related peptide(CGRP),5-hydroxytryptamine(5-HT),andβendorphin(β-EP)were detected before and after treatment.Result:The clinical efficacy in observation group was better than that in control group(Z=2.115,P<0.05).At the second and fourth hour after treatment,VAS scores were decreased in both groups,but there was no statistically significant difference between two groups.At the 12th and 24th hour after treatment,VAS scores were increased as compared with those at the previ

关 键 词：偏头痛 急性发作期 风痰阻络证 川芎茶调散 针刺 生活质量 神经血管源性活性介质 

分 类 号：R289[医药卫生—方剂学] R245[医药卫生—中药学]