清热燥湿法辨证加减联合西药治疗偏头痛伴抑郁焦虑障碍患者疗效及对β-EP、COX-2的影响

Effect of Qingre Zaoshi Method Syndrome Differentiation and Subtraction Combined with Western Medicine on β-EP,COX-2 of Treating Migraine with Depression and Anxiety Disorder

目的:观察清热燥湿法联合西药治疗偏头痛伴抑郁焦虑障碍患者疗效及对β-内啡肽(β-EP)、环氧合酶-2(COX-2)的影响,为临床治疗提供参考。方法:选取我院2018年8月~2020年2月收治的偏头痛伴抑郁焦虑障碍患者120例,根据治疗方法分为两组,每组60例。对照组给予盐酸氟桂利嗪治疗,观察组给予清热头风方联合盐酸氟桂利嗪治疗。记录两组治疗前后偏头痛发作情况及负性情绪评分变化,检测两组治疗前后β-内啡肽(β-EP)、环氧合酶-2(COX-2)、白细胞介素-1β(IL-1β)及颅内动脉血流速度的变化,并统计两组不良反应率。结果:治疗后两组每周发作次数、发作时疼痛程度逐渐下降(P<0.05),每次发作持续时间逐渐缩短(P<0.05),进一步组间比较发现,观察组偏头痛发作情况优于对照组(P<0.05)。治疗后两组β-EP逐渐上升(P<0.05),COX-2、IL-1β逐渐下降(P<0.05),进一步组间比较发现,观察组β-EP优于对照组(P<0.05),COX-2、IL-1β低于对照组(P<0.05)。治疗后两组大脑中动脉(MCA)、大脑前动脉(ACA)、大脑后动脉(PCA)、椎动脉颅内段(VA)和基底动脉(BA)血流速度及汉密尔顿抑郁量表(HAMD)评分、汉密尔顿焦虑量表(HAMA)评分均逐渐下降(P<0.05),进一步组间比较发现,观察组颅内动脉血流速度及负性情绪评分均低于对照组(P<0.05)。观察组的不良反应率为10.00%,与对照组的8.33%比较,无统计学意义(P>0.05)。结论:清热燥湿法联合盐酸氟桂利嗪治疗偏头痛伴抑郁焦虑障碍可改善颅内动脉血流速度,减轻不良情绪,改善偏头痛的发作。

Objective: To observe the effect of applying Qingre Zaoshi Method combined with western medicine in the treatment of migraine with depression and anxiety disorder on β-endorphin(β-EP),cyclooxygenase-2(COX-2),and to provide reference for clinical treatment. Methods: 120 patients with migraine with depression and anxiety disorder were selected from our hospital from August 2018 to February 2020. According to the treatment method, there were 2 groups, 60 cases in each group. The controlled group was treated with Flunarizine Hydrochloride, and the observation group was treated with Qingre Toufeng Recipe combined with Flunarizine Hydrochloride. The changes of migraine attack and negative emotion score before and after treatment were recorded, and the changes of endorphin(β-EP),cyclooxygenase-2(COX-2),interleukin-1β(IL-1β) and intracranial artery blood flow velocity were detected before and after treatment in group 2,and the adverse reaction rate was counted in group 2. Results: The number of attacks per week and the degree of pain decreased gradually in the two groups after treatment(P < 0.05),and the duration of each attack was gradually shortened(P < 0.05). Further comparison between the two groups found that the migraine attack in the observation group was better than that in the controlled group(P < 0.05). The β-EP of the two groups increased gradually(P < 0.05) and the COX-2,IL-1β decreased gradually(P < 0.05). It was found that the β-EP,COX-2,IL-1β of the observation group was lower than that in the controlled group(P < 0.05). The middle cerebral artery(MCA),anterior cerebral artery(ACA),posterior cerebral artery(PCA),intracranial segment of vertebral artery(VA) and basilar artery(BA) blood flow velocity and hamilton depression scale(HAMD) score, hamilton anxiety scale(HAMA) score gradually decreased(P < 0.05). Further comparison between the two groups found that the intracranial artery blood flow velocity and negative emotion score in the observation group were lower than those in the controlled group(P < 0.05). Adverse reaction rate in the observation group was 10.00%,which was not statistically significant compared with 8.33% in the controlled group(P > 0.05). Compared with the controlled group(8.33%),the adverse reaction rate in the observation group was not significant(P > 0.05). Conclusion: The treatment of migraine with depression and anxiety disorder by Qingre Zaoshi Method combined with Flunarizine Hydrochloride can improve the blood flow velocity of intracranial artery, alleviate the bad mood and improve the attack of migraine.