柴胡桂枝干姜汤加减治疗偏头痛伴焦虑状态的临床疗效观察及对血清VEGF、5-HT的影响

Clinical Effect of Modified Chaihu Guizhi Ganjiang Decoction(柴胡桂枝干姜汤)on Migraine with Anxiety and Its Effects on Serum VEGF and 5-HT Levels

目的:以疏肝健脾立法,对伴发焦虑的肝郁脾虚型偏头痛患者予中药柴胡桂枝干姜汤加减干预治疗,观察疗效及血清血管内皮生长因子(VEGF)、5-羟色胺(5-HT)的变化。方法:选取2019年7月—2021年4月符合诊断标准的82例肝郁脾虚型偏头痛伴焦虑患者,按照随机数字表法分为两组,各41例。观察组予柴胡桂枝干姜汤加减和西药盐酸帕罗西汀片联合治疗,对照组予盐酸帕罗西汀片治疗,两组均用药4周后评定疗效。记录偏头痛发作频率、发作总时间,并进行治疗前后焦虑自评量表(SAS)和汉密尔顿焦虑量表(HAMA)评分;同时运用酶联免疫吸附法(ELISA)测定血清VEGF及5-HT的含量。结果:观察组和对照组的总有效率分别为84.2%(32/38)、52.8%(19/36),组间差异明显(P<0.01)。观察组偏头痛发作频率、发作时间较对照组均有不同程度的减少和缩短(P<0.05,P<0.01)。两组患者治疗后SAS评分、HAMA评分、血清VEGF含量均较治疗前显著降低(P<0.01),血清5-HT较治疗前显著增高(P<0.01);观察组上述各项指标变化均显著于对照组(P<0.05)。两组均无明显不良反应发生。结论:针对肝郁脾虚型偏头痛伴焦虑患者,运用柴胡桂枝干姜汤辨证加减联合西药盐酸帕罗西汀片可获得显著疗效,且无明显不良反应,降低VEGF水平,升高5-HT含量是其部分作用机制。

Objective:To observe the curative effect of Modified Chaihu Guizhi Ganjiang Decoction in treatment of migraine patients with liver depression and spleen deficiency accompanied by anxiety and effects on serum vascular endothelial growth factor(VEGF)and 5-hydroxytryptamine(5-HT)levels.Methods:82 patients of migraine with anxiety of liver depression and spleen deficiency from July 2019 to April 2021 were randomly divided into two groups with each 41 cases.The observation group was treated with Modified Chaihu Guizhi Ganjiang Decoction and Paroxetine hydrochloride tablets,while the control group was treated with Paroxetine hydrochloride tablets alone,they were treated for 4 weeks,then curative effct was evaluated.The seizure frequency and total attack time of migraine were recorded,Seif-Rating Anxiety Scale(SAS)and Hamilton Anxiety Scale(HAMA)were recorded before and after treatment.At the same time,the contents of VEGF and 5-HT in serum were determined by ELISA.Results:The total effective rates of the observation group and the control group were 84.21%(32/38)and 52.78%(19/36),respectively(P<0.01).The attack frequency and migraine attack time in the observation group were fewer and shorter than those in the control group(P<0.05,P<0.01).After treatment,SAS score,HAMA score and serum VEGF level in both groups were significantly lower than those before treatment(P<0.01).While serum 5-HT was significantly higher than that before treatment(P<0.01).The changes of the above indexes in the observation group were more significant than those in the control group(P<0.05).There were no obvious adverse reactions in both groups.Conclusion:For the patients of migraine with anxiety state of liver depression and spleen deficiency,Chaihu Guizhi Ganjiang Decoction combined with Paroxetine hydrochloride tablets can obtain significant curative effect,and there is no obvious adverse reaction,reducing serum VEGF and raising 5-HT levels were part of the mechanism.