耳穴压豆联合氟桂利嗪治疗无先兆型偏头痛的临床观察

Effect of otopoint pellet-pressing combined with medication on clinical symptoms of migraine patients and changes of plasma 5-HT and CGRP contents

目的:探讨耳穴压豆联合氟桂利嗪对无先兆型偏头痛的近、远期临床疗效,临床症状及血浆5-羟色胺(5-HT)、降钙素基因相关肽(CGRP)的影响。方法:将无先兆型偏头痛患者按随机数字表法分为对照组48例和治疗组49例。对照组口服氟桂利嗪胶囊(10 mg/次,2次/d),治疗组在此基础上予耳穴压豆,取双侧脑、颞、神门、交感及皮质下耳穴,将王不留行籽贴压在其穴区,以双手的拇、食指同时进行捻压,手法由轻到重,直至局部出现酸、胀、麻等感觉,每穴按压约2 min,3次/d。两组均连续治疗1个月。观察两组近、远期的临床疗效和治疗前后的临床症状评分、血浆5-HT及CGRP水平的变化。结果:与治疗前比较,两组治疗1个月结束时、治疗后6个月时临床症状评分、血浆CGRP含量均降低(P<0. 05),血浆5-HT含量明显增加(P<0. 05)。治疗组的近期和远期的控显率、总有效率均高于对照组(P<0. 05)。治疗1个月结束时、治疗后6个月时,和对照组比较,治疗组的临床症状评分、血浆CGRP含量均降低(P<0. 05),血浆5-HT含量升高(P<0. 05)。结论:采用氟桂利嗪治疗无先兆型偏头痛患者时予以耳穴压豆干预,可有效缓解临床症状,提高近、远期临床疗效,其作用机制可与升高血浆中的5-HT及降低CGRP水平有关。

ObjectiveTo investigate the short-term and long-term clinical effects of otopoint pellet-pressing combined with medication in the treatment of patients with migraine without aura and its impact on plasma 5-hydroxytryptamine(5-HT)and calcitonin gene-related peptide(CGRP)contents.MethodsPatients with migraine without aura were randomly divided into medication(control)group(n=48)and otopoint pellet-pressing plus medication(treatment)group(n=49).Patients of the control group were given oral Flunarizine capsules(10 mg/time)twice a day,and those of the treatment group received same dosage of Flunarizine and pellet-pressing of otopoints Nao(Brain),Nie(Temporal),Shenmen(Shenmen),Jiaogan(Sympathy)and Pizhixia(Subcortex),2 min/point,3 times a day,simultaneously.The treatment was conducted for 1 month.The short-term and long-term clinical effects were evaluated according to Yang and colleagues’methods,and'Guiding principles for clinical research of new TCM drugs(trial)'.The contents of plasma 5-HT and CGRP were detected by ELISA.ResultsAfter one month’s treatment,of the 48 and 49 patients in the control and treatment groups,10(20.83%)and 17(34.69%)were under control,19(39.59%)and 23(46.94%)experienced marked improvement,10(20.83%)and 7(14.29%)were effective,9(18.75%)and 2(4.08%)failed,with the total effective rates being 81.25%and 95.92%,respectively.Six months’follow-up survey showed that of the 48 and 49 patients in the control and treatment groups,4(8.33%)and 11(22.45%)were under control,20(41.67%)and 24(48.98%)experienced marked improvement,11(22.92%)and 9(18.37%)were effective,and 13(27.08%)and 5(10.20%)failed,with the total effective rates being 72.92%and 89.80%,respectively.The number of headache attacks,duration of each attack and the degree of headache were significantly decreased after 1 and 6 months’treatment in both groups in comparison with their own pre-treatment(P<0.05).The contents of plasma 5-HT at the time-points of 1 and 6 months were markedly increased(P<0.05),and those of plasma CGRP at the two time points markedly decreased in both groups in comparison with their own pre-treatment(P<0.05).The therapeutic effects of the treatment group were obviously superior to those of the control group in lowering the number of headache attacks,duration of each attack and the degree of headache and plasma CGRP content,as well as in increasing plasma 5-HT levels after 1 and 6 months’treatment(P<0.05).ConclusionOtopoint pellet-pressing combined with oral administration of Flunarizine can significantly improve the clinical symptoms in patients with migraine without aura,and possess a stable long-term clinical effect,which may be associated with its effect in increasing plasma 5-HT and decreasing CGRP levels.