甲氧氯普胺联合弱激光照射星状神经节治疗偏头痛的临床疗效

Study on Clinical Effect of Joint Application of Methoxyclopamine and Superlaser Irradiation of Stellate Ganglion on Migraine

目的探讨甲氧氯普胺联合弱激光(low level laser)照射星状神经节治疗偏头痛的临床疗效,及其对血清中基质金属蛋白酶9(matrix metalloproteinase-9,MMP-9)和肿瘤坏死因子-α(tumor necrosis factor,TNF-α)的影响。方法 2013年1月至2016年1月偏头痛患者108例。采用随机数字表法分为激光组和对照组,每组患者54例。对照组给予甲氧氯普胺治疗,激光组采用甲氧氯普胺联合弱激光照射星状神经节治疗。采用头痛视觉模拟评分法(visual analogue scale,VAS),观察患者头痛症状改善情况。比较两组患者的临床疗效、症状改善情况,同时测量了患者治疗前后的血流动力学指标和血清中MMP-9和TNF-α变化,记录并发症的发生率。结果 108例患者治疗后,激光组患者偏头痛发作次数、偏头痛每次发作持续时间以及VAS评分均显著低于对照组(P <0. 05);治疗有效率激光组(92. 6%)显著高于对照组(70. 4%)(P <0. 05);激光组患者红细胞聚集指数、血小板黏附率、血浆粘度、纤维蛋白原、红细胞沉降率(erythrocyte sedimentation rate,ESR)以及经颅多普勒收缩期血流速度(Transcranial doppler systolic blood flow rate,TCDVp)等血流动力学指标均显著低于对照组(P <0. 05);两组患者治疗后血清中MMP-9和TNF-α水平与治疗前比较显著降低(P <0. 05),且激光组水平显著低于对照组(P <0. 05)。治疗后激光组患者偏头痛、头痛头昏及神经功能异常等并发症的状况显著低于对照组(P <0. 05)。结论甲氧氯普胺联合弱激光照射星状神经节治疗可有效改善患者的血流动力学特征,通过降低血清中MMP-9和TNF-α水平,进而减少由于5-羟色胺和肾上腺素过度释放引起的脑血管收缩,且治疗后并发症发生率较低,对偏头痛的治疗具有显著疗效。

Objective To explore the clinical effect of combined application of methoxyclopamine and low level laser irradiation of stellate ganglion in treating migraine and its effect on serum levels of MMP-9 and TNF-α.Methods Totally 108 selected patients with migraine treated from Jan 2013 to Jan 2016 were equally divided into 2 groups : the control group and laser group. The patients in the control group were treated with methoxyclopamine and those in the laser group with methoxyclopamine plus low level laser irradiation of stellate ganglion. The clinical indicators of migraine, treatment effective rates, hemodynamic indicators, serum levels of MMP-9 and TNF-a and complications were observed.Results After the treatment, the number of migraine attack, duration of migraine attacks and headache VAS score in the laser group were significantly lower than those in the control group( P < 0. 05). The treatment effective rate in the treatment group was 92. 6%,higher than that in the control group( P < 0. 05).Moreover, the hemodynamic indexes in the laser group such as the erythrocyte aggregation index, platelet adhesion rate, plasma viscosity, fibrinogen, ESR and TCDVp were all significantly lower than those in the control group(P <0. 05). For both groups, the levels of MMP-9 and TNF-a reduced significantly(P <0. 05) after the treatment. At last,the occurrence of complications in the treatment group was significant lower than that in the control group( P < 0. 05).Conclusions Combined application of methoxyclopamine and low level laser irradiation of stellate ganglion will effectively improve patients’ hemodynamic characteristics, and decrease cerebral vasoconstriction caused by excessive release of serotonin and adrenaline via reducing levels of MMP-9 and TNF-a. It is hence effective in treating migraine.