枕三经排刺联合宣通汤治疗前庭性偏头痛临床研究

Clinical Study on Combination Use of Three-Meridian Needling in Rows at Occiput and Xuantong Decoction for Vestibular Migraine

目的:观察枕三经排刺联合宣通汤治疗前庭性偏头痛的临床疗效。方法:选择前庭性偏头痛患者80例,根据随机数字表法分为2组各40例。西医组给予常规西医治疗,联合组在西医组治疗的基础上给予宣通汤、枕三经排刺治疗。比较2组治疗前后降钙素基因相关肽(CGRP)、一氧化氮(NO)、内皮素-1(ET-1)、5-羟色胺(5-HT)、基质金属蛋白酶-9(MMP-9)、P物质(SP)水平,视动试验、自发性眼震试验、冷热试验、扫视试验异常率及中医证候评分、眩晕障碍量表(DHI)评分、Berg平衡量表(BBS)评分、头痛影响测试(HIT-6)评分、欧洲五维健康量表(EQ-5D)评分。比较2组临床疗效。结果:治疗后,2组CGRP、SP水平均较治疗前降低(P<0.05),联合组低于西医组(P<0.05);2组5-HT水平较治疗前升高(P<0.05),联合组高于西医组(P<0.05)。治疗后,2组NO、ET-1、MMP-9水平均较治疗前降低(P<0.05),联合组低于西医组(P<0.05)。治疗后,联合组视动试验、自发性眼震试验异常率均较治疗前降低(P<0.05),且低于西医组(P<0.05);2组冷热试验、扫视试验异常率均较治疗前降低(P<0.05),但2组比较,差异均无统计学意义(P>0.05)。治疗后,2组中医证候评分均较治疗前降低(P<0.05),联合组低于西医组(P<0.05)。治疗后,2组眩晕发作频率较治疗前降低(P<0.05),且联合组低于西医组(P<0.05);2组每次眩晕持续时间均较治疗前缩短(P<0.05),且联合组短于西医组(P<0.05)。治疗后,2组DHI、HIT-6、EQ-5D评分均较治疗前降低(P<0.05),联合组低于西医组(P<0.05);2组BBS评分均较治疗前升高(P<0.05),联合组高于西医组(P<0.05)。总有效率联合组97.50%,高于西医组80.00%(P<0.05)。结论:枕三经排刺联合宣通汤治疗前庭性偏头痛患者,可改善CGRP、SP、5-HT、NO、ET-1、MMP-9水平,缓解眩晕、头痛症状,改善眼球震颤、平衡障碍,提升生活质量及临床疗效。

Objective:To observe the clinical effect of the combination use of three-meridian needling in rows at occiput and Xuantong Decoction on vestibular migraine.Methods:A total of 80 patients with vestibular migraine were selected and divided into the western group and the combination group according to the random number table method,with 40 cases in each group.The western medicine group was treated with routine western medicine,and the combination group was treated with Xuantong Decoction and three-meridian needling in rows at occiput based on the treatment of the western medicine group.The levels of calcitonin gene related peptide(CGRP),nitric oxide(NO),endothelin-1(ET-1),5-hydroxytryptamine(5-HT),matrix metalloproteinase-9(MMP-9)and substance P(SP),abnormal rates of optokinetic test,spontaneous nystagmus test,cold and heat test and saccade test,traditional Chinese medicine syndrome scores,and scores of Dizziness Handicap Inventory(DHI),Berg Balance Scale(BBS),Headache Impact Test(HIT-6)and Europe Health-Related Quality of Life Questionnaire 5-Dimensions Scale(EQ-5D)before and after treatment,and the clinical effects were compared between the two groups.Results:After treatment,the contents of CGRP and SP in the two groups were reduced when compared with those before treatment(P<0.05),and the above two contents in the combination group were lower than those in the western medicine group(P<0.05);the 5-HT contents in the two groups were increased when compared with those before treatment(P<0.05),and the 5-HT content in the combination group was higher than that in the western medicine group(P<0.05).After treatment,the contents of NO,ET-1 and MMP-9 in the two groups were decreased when compared with those before treatment(P<0.05),and above three contents in the combination group were lower than those in the western medicine group(P<0.05).After treatment,the abnormal rates of optokinetic test and spontaneous nystagmus test in the combination group were decreased when compared with those before treatment(P<0.05),and the above two rates were lower than those in the western medicine group(P<0.05);the abnormal rates of caloric test and saccade test in the two groups were decreased(P<0.05),there being no significance in the difference(P>0.05).After treatment,the traditional Chinese medicine syndrome scores in the two groups were decreased when compared with those before treatment(P<0.05),and the above scores in the combination group were lower than those in the western medicine group(P<0.05).After treatment,the frequency of vertigo attack in the two groups were decreased when compared with those before treatment(P<0.05),and the frequency of vertigo attack in the combination group was lower than that in the western medicine group(P<0.05);the duration of vertigo each time in the two groups were shortened when compared with those before treatment(P<0.05),and the duration of vertigo each time in the combination group was shorter than that in the western medicine group(P<0.05).After treatment,the scores of DHI,HIT-6 and EQ-5 D in the two groups were reduced when compared with those before treatment(P<0.05),and the above three scores in the combination group were lower than those in the western medicine group(P<0.05);the BBS scores in the two groups were increased when compared with those before treatment(P<0.05),and the BBS score in the combination group was higher than that in the western medicine group(P<0.05).The total effective rate in the combination group was 97.50%,higher than that of 80.00%in the western medicine group(P<0.05).Conclusion:The combination use of three-meridian needling in rows at occiput and Xuantong Decoction can improve the levels of CGRP,SP,5-HT,NO,ET-1 and MMP-9 of patient with vestibular migraine,relieve the symptoms of vertigo and headache,mitigate the nystagmus and balance disorder,and enhance the quality of life and clinical effect.