奥卡西平与卡马西平分别联合巴氯芬治疗三叉神经痛的效果比较

Clinical efficacy of oxcarbazepine versus carbamazepine combined with baclofen in the treatment of trigeminal neuralgia

目的比较奥卡西平与卡马西平分别联合巴氯芬治疗三叉神经痛(TN)的效果。方法选取海阳市人民医院2019年5月至2021年5月收治的TN患者74例为研究对象,采用前瞻性研究方法,以随机对照研究方法,按照随机数字表法分为观察组、对照组各37例。观察组采用奥卡西平联合巴氯芬治疗,对照组采用卡马西平联合巴氯芬治疗,两组均连续治疗4周。比较两组临床疗效、不良反应及治疗前后视觉模拟评分法(VAS)评分、疼痛递质[P物质(SP)、5-羟色胺(5-HT)、β-内啡肽(β-EP)]水平、生活质量水平变化等。结果观察组总有效率为97.3%(36/37),明显优于对照组的83.8%(31/37)(χ^(2)=3.95,P<0.05)。治疗前,两组VAS评分、SP、5-HT、β-EP、五维健康量表(EQ-5D)各维度评分等差异均无统计学意义(均P>0.05);治疗后,两组VAS评分、SP、5-HT、EQ-5D各维度评分均低于治疗前,且观察组治疗后VAS评分、SP水平、5-HT水平均低于对照组[(3.1±0.8)分比(4.2±0.9)分,(240.1±34.1)ng/L比(314.1±40.1)ng/L,(38.2±6.1)ng/L比(52.1±9.1)ng/L],而β-EP水平均高于治疗前,且观察组高于对照组[(268.1±38.1)ng/L比(214.1±29.0)ng/L],两组比较,差异均有统计学意义(均P<0.001)。观察组治疗后EQ-5D各维度评分均低于对照组(均P<0.001)。两组患者不良反应发生率差异无统计学意义(P>0.05)。结论奥卡西平联合巴氯芬治疗TN效果优于卡马西平联合巴氯芬,可明显缓解疼痛,改善疼痛递质水平及生活质量,且不良反应较少。

Objective To investigate the clinical efficacy of oxcarbazepine versus carbamazepine combined with baclofen in the treatment of trigeminal neuralgia.Methods A total of 74 patients with trigeminal neuralgia who received treatment in Haiyang People's Hospital from May 2019 to May 2021 were prospectively included in this study.They were randomly divided into an observation group and a control group(n=37 per group).The observation group was treated with oxcarbazepine combined with baclofen,while the control group was treated with carbamazepine combined with baclofen.Both groups were treated for 4 successive weeks.Clinical efficacy,adverse reactions,Visual Analogue Scale(VAS)scores before and after treatment,levels of pain transmitters[substance P(SP),5-hydroxytryptamine(5-HT),β-endorphin(β-EP)],and quality of life were compared between the two groups.Results The total effective rate in the observation group was 97.3%(36/37),which was significantly higher than 83.8%(31/37)in the control group(χ^(2)=3.95,P<0.05).Before treatment,there were no significant differences in VAS score,SP,5-HT,β-EP levels,and EQ-5D Health-Related Quality of Life Questionnaire(EQ-5D)score between the two groups(all P>0.05).After treatment,VAS score,SP,5-HT levels,and EQ-5D score in each group were significantly decreased compared with those before treatment.After treatment,VAS score,SP and 5-HT levels in the observation group were significantly lower than those in the control group[(3.1±0.8)points vs.(4.2±0.9)points,(240.1±34.1)ng/L vs.(314.1±40.1)ng/L,(38.2±6.1)ng/L vs.(52.1±9.1)ng/L,all P<0.001].After treatment,β-EP level in each group was significantly increased compared with that before treatment(P<0.001).After treatment,β-EP level in the observation group was significantly higher than that in the control group[(268.1±38.1)ng/L vs.(214.1±29.0)ng/L,P<0.001].After treatment,EQ-5D scores in the observation group were significantly lower than those in the control group(all P<0.001).There was no significant difference in incidence of adverse reactions between the two groups(P>0.05).Conclusion Oxcarbazepine combined with baclofen has superior efficacy in the treatment of trigeminal neuralgia to carbamazepine combined with baclofen.The former can more obviously relieve pain,reduce pain neurotransmitter levels,improve quality of life,and has less adverse reactions.