A型肉毒毒素治疗三叉神经痛的效果及相关因子表达意义

THE EFFECT OF BOTULINUM TOXIN TYPE A IN PATIENTS WITH TRIGEMINAL NEURALGIA AND THE EXPRESSION OF RELATED INFLAMMATORY FACTORS

目的:探讨A型肉毒毒素治疗三叉神经痛的剂量-效果关系及相关炎性因子的表达意义。方法:选取2016年1月至2017年1月至胜利油田中心医院神经内科就诊的三叉神经痛病人82例,采用随机、双盲的方法,总观察时间4周,根据治疗剂量分为4组。观察各组病人疼痛程度、生活质量及不良反应,并采用ELISA法检测各组病人炎性因子表达水平变化。结果:与基线视觉模拟评分(visual analogue scale,VAS)相比,采用A型肉毒毒素治疗后,四组的VAS均有较明显的下降(P<0.05)。与12.5U组比较,其余三组各时间点VAS评分差异显著(P<0.05)。至4周观察期终点可以发现25U组、50U组、75U组VAS评分变化趋势基本一致,均优于12.5U组。四组各时间点TNF-α、IL-6均与VAS评分相关。25U组、50U组、75U组病人生活质量评分基本一致,均优于12.5U组。整个研究过程各组均未出现全身不良反应。结论:A型肉毒毒素对于三叉神经痛具有治疗效果,25U的剂量即可达到治疗要求,其镇痛作用机制可能与TNF-A、IL-6等炎性因子水平下调有关。

Objective:To investigate the dose-dependent effect of botulinum toxin type A in patients with trigeminal neuralgia,and the expression of related inflammatory factors.Methods:Eighty-two patients with trigeminal neuralgia from January,2016 to January,2017 in department of neurology of Shengli Oilfield Central Hospital were selected by randomized,double-blind method.All patients were divided into 4 groups by doses of botulinum toxin type A(12.5U,25U,50U,75U).The botulinum toxin type A was diluted by 0.9%NaCl.The pain degree,life quality and adverse reactions were observed,and related inflammatory factors were detected by ELISA.Results:Compared with baseline scores,the VAS of 4 groups decreased obviously,and there were differences in VAS in 4 groups of each time points(P<0.05).There were differences in VAS in other 3 groups of each time points excluded 12.5U group(P<0.05).The variation trends of 25U,50U,75U groups were unanimity,whose VAS scores were better than that of 12.5U group observed in VAS.There were relationships between TNF-α,IL-6 and VAS respectively by Pearson relation analysis.Life quality scores of all groups increased obviously,those of 25U,50U,75U groups were better than that of 12.5U group.No systemic adverse reactions occurred,slight adverse reactions were observed in all groups.Conclusion:Botulinum toxin type A were confirmed effective in the treatment of trigeminal neuralgia,the dose of 25U could meet the treatment requirement and could be used for clinic reference.The mechanism may be related to the decreased TNF-α,IL-6.