本文關(guān)鍵詞：加減川芎茶調(diào)散對頻繁發(fā)作的偏頭痛（風(fēng)寒上擾證）患者CGRP及ET-1的影響　出處：《成都中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 加減川芎茶調(diào)散 偏頭痛 風(fēng)寒上擾證 CGRP ET-1 臨床研究

【摘要】：目的通過臨床研究加減川芎茶調(diào)散對頻繁發(fā)作的偏頭痛(風(fēng)寒上擾證)患者CGRP及ET-1的影響,為加減川芎茶調(diào)散防治偏頭痛的臨床療效,提供客觀的評價(jià)指標(biāo)。方法病例均選自2015年6月至2016年1月就診于成都中醫(yī)藥大學(xué)附屬醫(yī)院神經(jīng)內(nèi)科門診辨證屬風(fēng)寒上擾證頻繁發(fā)作的偏頭痛患者。采用隨機(jī)、對照、第三方盲的方法。研究共分2組,試驗(yàn)組與對照組比例為1：1,每組20例。對照組予以鹽酸氟桂利嗪(西安楊森制藥有限公司生產(chǎn),規(guī)格每粒5mg)預(yù)防性用藥,每次5-10 mg,每晚一次。偏頭痛發(fā)作時(shí)可使用雙氯芬酸鈉雙釋放腸溶膠囊(戴芬,德國泰姆勒制藥有限公司,規(guī)格每粒75mg)緩解治療性用藥,每次75mg,每日1-2次。試驗(yàn)組：鹽酸氟桂利嗪+加減川芎茶調(diào)散,鹽酸氟桂利嗪(西安楊森制藥有限公司生產(chǎn),規(guī)格每粒5mg)治療,每次5-10mg,每晚一次。加減川芎茶調(diào)散,具體煎服方法詳見3.2.1。療程共4周。治療前、后測定患者血清ET-1及CGRP含量,進(jìn)行中醫(yī)證候評分、偏頭痛療效評分、偏頭痛發(fā)作次數(shù)、持續(xù)時(shí)間及疼痛程度評分,以作為有效性評價(jià)。治療前、后分別行血、尿、糞常規(guī)、肝、腎功、心電圖檢查,用藥期間觀察生命體征,以作為安全性評價(jià)。隨訪期間進(jìn)行中醫(yī)證候評分、偏頭痛療效評分、偏頭痛發(fā)作次數(shù)、持續(xù)時(shí)間及疼痛程度評分以判定療效及復(fù)發(fā)情況。結(jié)果(1) CGRP及ET-1含量變化比較：①組內(nèi)比較：治療4周后試驗(yàn)組與對照組組內(nèi)CGRP及ET-1含量較治療前均降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。②組間比較：治療后兩組CGRP含量均有下降,與對照組比較,試驗(yàn)組下降趨勢更明顯,差異無統(tǒng)計(jì)學(xué)意義(P0.05)；治療后兩組ET-1含量均有下降,與對照組比較,試驗(yàn)組下降更明顯,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(2) CGRP及ET-1變化程度比較：①組內(nèi)比較：治療后試驗(yàn)組組內(nèi)CGRP及ET-1含量較治療前明顯下降,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；治療后對照組組內(nèi)CGRP及ET-1含量較治療前下降不明顯,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。②組間比較：治療后兩組CGRP及ET-1含量均有下降,與對照組比較,試驗(yàn)組下降更明顯,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)療效評價(jià)：①組內(nèi)比較：治療4周后試驗(yàn)組與對照組中醫(yī)證候評分、偏頭痛療效評分、偏頭痛發(fā)作次數(shù)、持續(xù)時(shí)間及疼痛程度評分較治療前均降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05),即兩組均有療效。②組間比較：治療4周后兩組間中醫(yī)證候評分、偏頭痛療效評分、偏頭痛發(fā)作次數(shù)及持續(xù)時(shí)間評分比較均有降低,試驗(yàn)組降低更明顯,差異有統(tǒng)計(jì)學(xué)意義(P0.05),偏頭痛疼痛程度評分組間比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05),但試驗(yàn)組偏頭痛疼痛程度評分均值低于對照組,即試驗(yàn)組療效優(yōu)于對照組。③中醫(yī)證候評分有效性分析,治療4周后試驗(yàn)組總有效率90%,對照組總有效率60%,兩組間有效率比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05),即試驗(yàn)組療效優(yōu)于對照組。④偏頭痛療效評分有效性分析,治療4周后試驗(yàn)組總有效率85%,對照組總有效率55%,兩組間有效率比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05),即試驗(yàn)組療效優(yōu)于對照組。(4)安全性評價(jià)：①試驗(yàn)組與對照組治療后血常規(guī)、尿常規(guī)、糞常規(guī)、肝、腎功能、心電圖等檢查組間及組內(nèi)比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。②通過對用藥前后體溫、心率、呼吸、血壓的安全性檢驗(yàn),兩組間及組內(nèi)比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。③通過對兩組間不良反應(yīng)檢驗(yàn),兩組間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(5)隨訪情況：①組內(nèi)比較,治療4周前與隨訪3月后中醫(yī)證候評分及偏頭痛療效評分試驗(yàn)組組內(nèi)比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),即試驗(yàn)組有遠(yuǎn)期療效；對照組組內(nèi)比較差異無統(tǒng)計(jì)學(xué)意義(P0.05),即對照組遠(yuǎn)期療效不明顯。治療4周前與隨訪3月后偏頭痛發(fā)作次數(shù)、持續(xù)時(shí)間及疼痛程度評分試驗(yàn)組與對照組組內(nèi)比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),即兩組均有遠(yuǎn)期療效。②組間比較,隨訪3月后兩組患者中醫(yī)證候評分、偏頭痛療效評分、偏頭痛發(fā)作次數(shù)及持續(xù)時(shí)間評分組間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),偏頭痛疼痛程度評分組間比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05),但試驗(yàn)組偏頭痛疼痛程度評分均值低于對照組。隨訪3月后試驗(yàn)組中醫(yī)證候評分、偏頭痛療效評分、偏頭痛發(fā)作次數(shù)、持續(xù)時(shí)間及疼痛程度評分均值低于對照組,即試驗(yàn)組遠(yuǎn)期療效優(yōu)于對照組。綜上所述,兩組均有預(yù)防作用,與對照組比較,試驗(yàn)組能夠有效地預(yù)防偏頭痛的復(fù)發(fā),降低復(fù)發(fā)率。結(jié)論(1)加減川芎茶調(diào)散能夠安全有效地改善頻繁發(fā)作的偏頭痛(風(fēng)寒上擾證)患者的癥狀。(2)推測加減川芎茶調(diào)散的配伍組分可能影響了CGRP及ET-1基因的表達(dá),使CGRP及ET-1合成釋放入血減少,削弱了兩者舒縮血管效應(yīng),達(dá)到防治偏頭痛的作用。(3)加減川芎茶調(diào)散在治療偏頭痛(風(fēng)寒上擾證)患者的同時(shí),可以有效地預(yù)防偏頭痛的復(fù)發(fā),結(jié)合現(xiàn)代醫(yī)學(xué)偏頭痛預(yù)防性用藥,可以增強(qiáng)預(yù)防效果。
[Abstract]:Objective to study the effect of Chuanxiong Chai powder on CGRP and ET-1 in patients with frequent migraine (cold and wind disturbance), and provide an objective evaluation index for the treatment of migraine with Chuanxiong Chai powder. Methods all cases were selected from June 2015 to January 2016 in the outpatient department of Neurology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine. A randomized, controlled, third - party blind method was used. The study was divided into 2 groups. The proportion of the test group and the control group was 1:1, with 20 cases in each group. The control group was given flunarizine hydrochloride (Xi'an Janssen Pharmaceutical Ltd, specifications of each 5mg) preventive medication, every 5-10 mg, once a night. Migraine can be used when Diclofenac Sodium Dual Release Enteric-coated Capsules (Dai Fen, German Temmler Pharma, specifications of each 75mg) relief medication, 75mg each time, 1-2 times a day. Test group: flunarizine hydrochloride + Decoction of Chuanxiong chatiao San, flunarizine hydrochloride (Xi'an Janssen Pharmaceutical Ltd, specifications of each 5mg) treatment, 5-10mg each time, once every night. In addition and subtraction of Chuanxiong tea, the specific method of decocting clothing is detailed in 3.2.1. The course of treatment was 4 weeks. Before and after treatment, the serum ET-1 and CGRP levels were measured. TCM syndrome score, migraine efficacy score, migraine attack frequency, duration and pain score were taken as effective evaluation. Before and after treatment, blood, urine, fecal routine, liver, kidney work, electrocardiogram were examined, and life signs were observed during the drug use as a safety evaluation. During the follow-up period, TCM syndrome score, migraine efficacy score, migraine attack frequency, duration and pain score were used to determine the efficacy and recurrence. Results (1) the changes of CGRP and ET-1 contents were compared: (1) comparison between groups: after 4 weeks of treatment, the contents of CGRP and ET-1 in the experimental group and the control group were lower than those before treatment, the difference was statistically significant (P0.05). The comparison between groups: after treatment two groups CGRP decreased. Compared with the control group, the test group decreased more significantly, the difference was not statistically significant (P0.05); the two groups after treatment ET-1 decreased. Compared with the control group, the test group decreased more significantly, the difference was statistically significant (P0.05). (2) compare the degree of CGRP and ET-1 changes: comparison within group: after treatment of CGRP and ET-1 in the experimental group was significantly lower than that before treatment, the difference was statistically significant (P0.05); the control group after treatment in group CGRP and ET-1 content decreased significantly, the difference was not statistically significant (P0.05). (2) group comparison: after treatment, the content of CGRP and ET-1 decreased in two groups. Compared with the control group, the decrease of the test group was more obvious, the difference was statistically significant (P0.05). (3) efficacy evaluation: comparison within group: the treatment group with the control group after 4 weeks of TCM syndrome score, migraine score, migraine attack frequency, duration and degree of pain scores were decreased significantly compared with before treatment, the difference was statistically significant (P0.05), the two groups have the curative effect. The comparison between groups: after 4 weeks of treatment between the two groups of TCM syndrome score, migraine score, migraine attack frequency and duration scores were lower in experimental group decreased more significantly, the difference was statistically significant (P0.05), migraine pain scores were compared between groups, the difference was not statistically significant (P0.05), but the test migraine pain group mean scores were lower than the control group, the experimental group than the control group. (3) validity analysis of TCM syndrome score. After 4 weeks of treatment, the total effective rate of the experimental group was 90%, and the total effective rate of the control group was 60%. The difference between the two groups was statistically significant (P0.05), that is, the curative effect of the experimental group was better than that of the control group. (4) effective analysis of migraine efficacy score. After 4 weeks of treatment, the total effective rate of the experimental group was 85%, and the total effective rate of the control group was 55%. The difference between the two groups was statistically significant (P0.05), that is, the efficacy of the experimental group was better than that of the control group. (4) safety evaluation: (1) there was no significant difference in blood routine, urine routine, fecal routine, liver, renal function and electrocardiogram between the experimental group and the control group after treatment (P0.05). (2) there was no statistical difference between the two groups and the group (P0.05) through the test of the safety of the body temperature, heart rate, respiration and blood pressure before and after the drug use. (3) there was no statistical difference between the two groups through the test of adverse reactions between the two groups (P0.05). (5) follow up: comparison group, treatment 4 weeks ago after the March follow-up score and TCM syndrome score and the curative effect of migraine in test group had significant difference (P0.05), the experimental group has long-term effect; the control group there was no significant difference in the control group (P0.05), long term the effect is not obvious. The number of migraine attacks, duration and pain scores before and after treatment 4 weeks ago and after March were compared between the experimental group and the control group, the difference was statistically significant (P0.05), that is, the two groups had long-term curative effect. The comparison between groups, followed up after March two groups of TCM syndrome score, migraine score, migraine frequency and duration was statistically significant score difference between the two groups (P0.05), migraine pain scores were compared between groups, the difference was not statistically significant (P0.05), but the test group of migraine pain score is lower than the mean control group. Follow up in March, the TCM syndrome score, migraine efficacy score, migraine attack frequency, duration and pain score in the experimental group were lower than those in the control group, that is, the long-term effect of the experimental group is better than that of the control group. To sum up, the two groups have preventive effect. Compared with the control group, the experimental group can effectively prevent the recurrence of migraine and reduce the recurrence rate. Conclusion (1) the addition and subtraction of Chuanxiong tea dispersal can effectively improve the symptoms of frequent migraine (wind and cold disturbance). (2) it is presumed that the addition and subtraction of the compatibility components of Chuanxiong tea dispersal may affect the CGRP and ET-1 genes
【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R277.7

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7 諶峗;劉彥梅;郭鋒;陳根;陳臨溪;秦旭平;;Inhibitory effects of CGRP and ERK1/2 signal pathway on rat vascular smooth muscle cell proliferation: role of caveolae and caveolin-1[A];中南地區(qū)第八屆生理學(xué)學(xué)術(shù)大會(huì)論文摘要匯編[C];2012年

8 謝文霞;楊建榮;陳勇;夏君慧;黃河;;腹針對頸性眩暈患者血漿ET-1、CGRP水平影響的研究[A];中國針灸學(xué)會(huì)2009學(xué)術(shù)年會(huì)論文集（下集）[C];2009年

9 謝文霞;楊建榮;陳勇;夏君慧;黃河;;腹針對頸性眩暈患者血漿ET-1、CGRP水平的影響[A];2011中國針灸學(xué)會(huì)年會(huì)論文集（摘要）[C];2011年

10 劉俊嶺;王友京;羅明富;陳淑萍;董曉彤;王雙昆;王淑斌;高永輝;;脊髓等組織及血漿NO和CGRP在針刺改善心肌缺血中的作用[A];中國生理學(xué)會(huì)第五屆全國心血管、呼吸和腎臟生理學(xué)學(xué)術(shù)會(huì)議論文摘要匯編[C];2005年

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1 ;CGRP心血管作用研究進(jìn)展[N];中國醫(yī)藥報(bào);2004年

2 ;老年原發(fā)性高血壓與舒血管活性物質(zhì)的關(guān)系[N];中國醫(yī)藥報(bào);2003年

3 余志平;機(jī)制不同各有所長[N];醫(yī)藥經(jīng)濟(jì)報(bào);2001年

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2 張慧宇;CGRP在骨修復(fù)與炎癥性骨疾病中的生物學(xué)作用及機(jī)制的研究[D];第三軍醫(yī)大學(xué);2016年

3 郭韌;CGRP介導(dǎo)人體內(nèi)硝酸酯類藥物的藥理作用及與相關(guān)藥物代謝酶的關(guān)系[D];中南大學(xué);2009年

4 鄭求烈;補(bǔ)充復(fù)合中藥對運(yùn)動(dòng)大鼠心肌損傷標(biāo)志物及CGRP含量的影響[D];北京體育大學(xué);2013年

5 付紅敏;CGRP在高氧誘導(dǎo)肺泡Ⅱ型上皮細(xì)胞損傷中的作用及其信號(hào)轉(zhuǎn)導(dǎo)途徑探討[D];重慶醫(yī)科大學(xué);2009年

6 于金錄;重組表達(dá)NT4-CGRP腺相關(guān)病毒的構(gòu)建及對雞胚血管痙攣的治療作用研究[D];吉林大學(xué);2011年

7 金大成;CGRP和NGF對全腦缺血再灌注大鼠腦組織的保護(hù)作用及機(jī)制[D];中國醫(yī)科大學(xué);2003年

8 商立軍;CGRP對正常及模擬缺血缺氧心肌鈣通道的作用及心肌細(xì)胞數(shù)學(xué)模型的仿真研究[D];第四軍醫(yī)大學(xué);2000年

9 李先偉;CGRP在大鼠肺動(dòng)脈高壓血管重構(gòu)和博萊霉素誘導(dǎo)肺纖維化中的作用及機(jī)制[D];中南大學(xué);2012年

10 馬宏敏;CGRP在面神經(jīng)損傷再生中作用機(jī)制的實(shí)驗(yàn)研究[D];中國人民解放軍第四軍醫(yī)大學(xué);2003年

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2 陳彥強(qiáng);肉毒毒素A對神經(jīng)源性疼痛大鼠行為學(xué)及脊髓前角運(yùn)動(dòng)神經(jīng)元CGRP的影響[D];蘭州大學(xué);2015年

3 閆麗璇;糖尿病人SP、CGRP、cTnI、NE、Ach改變與術(shù)中心血管事件風(fēng)險(xiǎn)相關(guān)性的研究[D];山西醫(yī)科大學(xué);2015年

4 張婷;CGRP對大鼠骨毮間充質(zhì)干細(xì)胞增殖和成骨分化的影響[D];山東大學(xué);2015年

5 孫嵩;NGF調(diào)控CGRP表達(dá)促進(jìn)MG-63細(xì)胞增殖分化的實(shí)驗(yàn)研究[D];第三軍醫(yī)大學(xué);2015年

6 趙上下;邵氏“五針法”對哮喘模型大鼠CGRP、NGF影響的實(shí)驗(yàn)研究[D];河南中醫(yī)學(xué)院;2015年

7 常坤鵬;人尿激肽原酶預(yù)處理對大鼠腦缺血后腦組織中CGRP、RAMP1及VEGF表達(dá)的影響[D];安徽醫(yī)科大學(xué);2015年

8 全海燕;CGRP通過cAMP/PPARγ/eNOS途徑改善血管內(nèi)皮細(xì)胞胰島素抵抗[D];南華大學(xué);2015年

9 崔銀潔;截癱三聯(lián)針復(fù)合康復(fù)訓(xùn)練對脊髓損傷患者5-HT CGRP的影響[D];成都中醫(yī)藥大學(xué);2015年

10 歐云娜;治腸法對腸道菌群失調(diào)合并過敏性哮喘大鼠肺腸組織神經(jīng)肽SP、CGRP、VIP分泌機(jī)制的影響[D];成都中醫(yī)藥大學(xué);2015年

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