本文選題：神經(jīng)病理性疼痛　切入點(diǎn)：二甲雙胍　出處：《江蘇大學(xué)》2016年碩士論文

【摘要】：神經(jīng)病理性疼痛(NP)是一種由軀體感覺(jué)系統(tǒng)的損害或疾病所導(dǎo)致的疼痛。因其特有的發(fā)病機(jī)制和難治性,使其成為臨床中的治療難點(diǎn)。加巴噴丁和曲馬多是目前臨床治療NP的常規(guī)用藥,但僅有1/4的患者達(dá)到50%的疼痛緩解。有研究稱二甲雙胍作為腺苷酸活化蛋白激酶(AMPK)激活劑,可通過(guò)抑制相關(guān)信號(hào)通路而減輕疼痛癥狀。當(dāng)前二甲雙胍用于治療NP的臨床研究較少,本研究從治療的角度出發(fā)聯(lián)合用藥,為二甲雙胍能否安全用于臨床治療NP提供研究數(shù)據(jù)�！灸康摹�1、觀察二甲雙胍對(duì)不同年齡段患者NP的治療作用及對(duì)抑郁焦慮的影響。2、觀察各組不良反應(yīng)及炎性因子的變化,評(píng)價(jià)二甲雙胍治療NP的臨床應(yīng)用的安全性和可能的作用機(jī)制�！痉椒ā�1、選取2013年9月~2015年7月至江蘇大學(xué)附屬醫(yī)院診斷為NP且符合納入與排除標(biāo)準(zhǔn)的患者168例,運(yùn)用隨機(jī)區(qū)組設(shè)計(jì)原則將NP患者分為三個(gè)年齡區(qū)段:A區(qū)(n=48,18~40歲)、B區(qū)(n=54,41~60歲)和C區(qū)(n=66,60歲以上)。2、將三個(gè)年齡區(qū)段再分為兩個(gè)亞組。Ⅰ組:按我院常規(guī)療法給予加巴噴丁膠囊口服,每日3次,每次300mg;鹽酸曲馬多緩釋片口服,每日2次,每次100mg。Ⅱ組:在Ⅰ組用藥基礎(chǔ)上加服鹽酸二甲雙胍緩釋片,每日2次,每次500mg。兩組療程均為期6個(gè)月。3、記錄和分析患者治療前(T0)、治療后3個(gè)月(T1)、治療后6個(gè)月(T2)的視覺(jué)模擬法(VAS)評(píng)分、抑郁焦慮評(píng)分、血清中高敏C反應(yīng)蛋白(HS-CPR)水平、血清腫瘤壞死因子-α(TNF-α)水平、肝腎功能指標(biāo)及用藥后不良反應(yīng)�！窘Y(jié)果】1、在T0時(shí)點(diǎn),Ⅰ組和Ⅱ組的各區(qū)段VAS評(píng)分無(wú)明顯差異(P0.05);在T1、T2時(shí)點(diǎn),同Ⅰ組相比,Ⅱ組VAS評(píng)分下降明顯且隨治療時(shí)間的延長(zhǎng),VAS評(píng)分不斷下降(P0.05),且年齡區(qū)段越年輕,VAS評(píng)分下降越明顯(P0.05)。Ⅰ組和Ⅱ組治療方法與時(shí)間在VAS評(píng)分上有交互作用(P0.05);VAS評(píng)分的組間比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05);VAS評(píng)分時(shí)間間比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2、在T2時(shí)點(diǎn),疼痛緩解度(PAR)比較中,Ⅰ組和Ⅱ組的總有效率無(wú)差異(P0.05),但Ⅱ組的總顯效率高于Ⅰ組(P0.05)。3、在T0時(shí)點(diǎn),區(qū)段越年輕,抑郁焦慮評(píng)分越低(P0.05);經(jīng)治療后,各區(qū)組抑郁焦慮評(píng)分均有緩解(P0.05);同年齡區(qū)段內(nèi)比較,Ⅱ組抑郁焦慮評(píng)分下降較Ⅰ組顯著(P0.05)。Ⅰ組和Ⅱ組抑郁焦慮評(píng)分在時(shí)間間比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4、Ⅰ組和Ⅱ組的VAS評(píng)分和抑郁焦慮評(píng)分間在三個(gè)時(shí)點(diǎn)呈正相關(guān)(P0.05)。5、在T0時(shí)點(diǎn),Ⅰ組和Ⅱ組血清中HS-CRP水平變化同年齡成正比(P0.05);在T2時(shí)點(diǎn),HS-CRP和腫瘤壞死因子-α(TNF-α)較T0時(shí)點(diǎn)有所下降(P0.05);同年齡區(qū)段中Ⅱ組HS-CPR和TNF-α水平較Ⅰ組降低明顯(P0.05)。6、Ⅰ組和Ⅱ組的HS-CRP和VAS評(píng)分間在T0及T2時(shí)點(diǎn)呈正相關(guān)(P0.05)。7、Ⅱ組的谷草轉(zhuǎn)氨酶、谷丙轉(zhuǎn)氨酶、血尿素氮、肌酐、空腹血糖、維生素B12在三個(gè)時(shí)點(diǎn)均無(wú)明顯變化(P0.05)。8、治療后,Ⅰ組和Ⅱ組患者胃腸道不適、頭暈、嗜睡及共濟(jì)失調(diào)癥狀發(fā)生率比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。【結(jié)論】1、與加巴噴丁和曲馬多治療組相比,二甲雙胍聯(lián)合這兩種藥物治療具有更好的鎮(zhèn)痛效果,不良反應(yīng)并未見(jiàn)增加。2、疼痛程度、抑郁焦慮程度、炎性因子水平三者間呈正相關(guān)。3、治療效果受到年齡因素影響即年齡越輕,治療效果越好。
[Abstract]:Neuropathic pain (NP) is a kind of the somatosensory system damage or disease caused by pain. Because of its unique mechanism and refractory, make it become difficult to treat in clinic. Gabapentin and tramadol is routine medication for the treatment of NP at present, but only 1/4 patients reached 50% pain relief. There are studies that metformin protein kinase (AMPK) activation of adenylate as activator, can relieve pain by inhibiting the signaling pathway. The metformin in the treatment of NP in clinical research less, this study starting from the angle of combination therapy, is safe for clinical treatment of NP metformin can provide research data. [Objective] 1, treatment to observe the effect of metformin on patients of different age NP and effect on depression and anxiety of.2, observe the adverse reaction and inflammatory factors, evaluation of the two metformin treatment N P clinical safety and possible mechanism. [Methods] 1, September 2013 ~2015 year in July to the Affiliated Hospital of Jiangsu University diagnosed NP and 168 patients met the inclusion and exclusion criteria, using randomized block design principles of the NP patients were divided into three sections: A age (n=48,18~40 years), B (n=54,41~60 years old) and C (n=66,60 years old).2, three age sections divided into two subgroups. Group I: give oral gabapentin according to conventional therapy in our hospital, 3 times daily, 300mg each time; Tramadol Hydrochloride Sustained Release Tablets oral, 2 times a day, each time 100mg. II Group: in group 1, on the basis of the drug take Metformin Hydrochloride Sustained Release Tablets, 2 times a day, each time 500mg. two groups were treated for 6 months.3, recorded and analyzed before treatment (T0), 3 months after treatment (T1), 6 months after treatment (T2) and the visual analog scale (VAS) score, depression score, serum high 鏁廋鍙嶅簲铔嬬櫧(HS-CPR)姘村鉤,琛，

本文編號(hào)：1704979