文拉法辛辅助治疗三叉神经痛的疗效及其与降钙素基因相关肽的关系

Effectiveness of venlafaxine as an adjunctive therapeusis in treatment of trigeminal neuralgia and its relationship with calcitonin gene-related peptide

目的观察文拉法辛辅助治疗三叉神经痛(TN)的疗效,探讨降钙素基因相关肽(CGRP)在文拉法辛治疗机制中的意义。方法 60例TN患者随机分为两组,联合组(n=30)接受文拉法辛(75 mg/d)、卡马西平治疗,对照组(n=30)仅接受卡马西平治疗;分别于治疗前、治疗后4周末,评定视觉模拟评分(VAS)、17项汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA),并测定血浆CGRP水平。结果治疗4周末,两组患者VAS、HAMD-17、HAMA评分均较治疗前下降(P<0.05);联合组VAS、HAMA减分率高于对照组(P<0.05)。治疗4周末,两组患者血浆CGRP均较治疗前下降(P<0.05),联合组血浆CGRP下降率高于对照组(P<0.05)。联合组VAS减分率与CGRP下降率正相关。结论文拉法辛辅助治疗可更为有效地改善TN患者的疼痛及焦虑症状,降低CGRP可能是文拉法辛实现治疗作用的机制之一。

Objective To evaluate the effectiveness Trigeminal Neuralgia （TN） and explore the relationship of venlafaxine as an adjunctive treatment in patients with between calcitonin gene -related peptide （CGRP） and venlafaxine. Methods Sixty patients with TN were randomized into study group （30 cases） treated with venlafaxine and carbamazepine and control group （30 cases） treated with carbamazepine monotherapy for 4 weeks. They were assessed with Visual Analogue Scale （ VAS）, 17 - item Hamilton Depression Rating Scale （ HAMD - 17 ）, Hamilton Anxiety Scale （HAMA）. Serum level of CGRP was measured at baseline and the end of the treatment. Results Compared with baseline, scores of VAS, HAMD - 17 and HAMA in two groups decreased significantly at the endpoint. The reduction rate of scores of VAS and HAMA in study group were significantly higher than those in control group. At the end of the treatment, the serum level of CGRP in two groups was significantly lower than those at baseline. The reduction of CGRP in study group was significantly higher than that in control group. The reduction rate of VAS was positively related with the reduction rate of CGRP. Conclusion Adjunctive treatment with venlafaxine can relieve the pain and anxiety symptoms of patients with TN. Decreasing CGRP may be one of the underlying mechanisms in its efficiency to TN.