经皮神经电刺激联合氟桂利嗪治疗偏头痛的临床研究

Clinical study of transcutaneous electrical nerve stimulation and Flunarizine in treatment of migraine

目的观察经皮神经电刺激(transcutaneous electrical nerve stimulation,TENS)治疗偏头痛的临床疗效及其对颅内脑血流速、血浆降钙素基因相关肽(calcitonin gene-related peptide,CGRP)、血栓素B2(thromboxane B2,TXB2)和6-酮-前列素F1a(6-keto-prostaglandin FIa,6-K-PGF1a)水平的影响,探讨其可能的作用机制。方法无先兆偏头痛患者,随机分为TENS加氟桂利嗪组(A组,n=24)和单用氟桂利嗪组(B组,n=26)及健康对照组(C组)。分别观察治疗后临床症状的改善率、颅内脑血流速度的改变及血浆中CGRP、TXB2、6-K-PGF1a水平的变化。结果A组疗效(91.67%)优于B组(61.54%),P<0.05;与治疗前比,血流速均明显减慢(A组P<0.001,B组P<0.01),血浆CGRP、TXB2水平得以降低(P<0.001),而6-K-PGF1a水平得以升高(A组P<0.001,B组P<0.05);与B组比,A组血流速减慢更明显(P<0.05),血浆中CGRP(P<0.001)、TXB2(P<0.05)水平降低更加明显,而6-K-PGF1a的水平则升高更明显(P<0.05);两组治疗期间无明显不良反应。结论TENS联合氟桂利嗪治疗偏头痛临床疗效优于单用氟桂利嗪治疗,安全无不良反应。作用机制可能与解除血管痉挛,降低血浆CGRP、TXB2水平和升高6-K-PGF1a水平有关。

Objective To observe the clinical effects of transcutaneous electrical nerve stimulation （TENS） and its influence on the blood flow velocities, the levels of plasma calcitonin gene-related peptide（CGRP）, plasma thromboxane 132 （TXB2）, 6-keto-prostaglandin FIa （6-K-PGFla）in patients with migraine, and to explore its therapeutic mechanism. Methods The patients with migraine without aura were divided randomly into two groups： A group （ n = 24）, treated with TENS and Flunarizine; B group （ n = 26）, treated with Flunarizine alone. The efficacies were evaluated after treatment. TCD and levels of plasma CGRP,TXB2 ,6-K-PGFla were detected before and after treatment. Results In comparison of clinical effects after treatment between two groups, it was significantly higher in A group than in B group（91.67 % vs. 61.54 % ） （ P 〈 0. 05 ）. The blood flow velocities decreased obviously （A group P 〈 0. 001, B group P 〈 0.01 ） and the levels of plasma TXB2, CGRP decreased obviously （P 〈 0.001 ） while the levels of plasma 6-K-PGF1 a increased obviously （A group P 〈 0.01, B group P〈 0.05） after treatment; Moreover, the blood flow velocities（P 〈 0.05） and the levels of plasma CGRP（P〈0.001） ,TXB2（P〈0.05）was lower in A group than those in B group, the level of plasma 6-K-PGFla was higher in A group than that in B group after treatment. No obvious adverse reaction was observed during treatment in both groups. Conclusion The effect of TENS and Flunarizine is better than that of Flunarizine alone in treatment of migraine. This therapy is safe with no obvious adverse reaction. The therapeutic mechanism may be related to relieve the cerebral vascular spasm, reduce the levels of plasma CGRP, TXB2 and increase the level of 6-K-PGF1a in plasma.