逐瘀活络方联合A型肉毒毒素治疗瘀阻脑络型三叉神经痛临床分析

目的:探讨逐瘀活络方联合A型肉毒毒素治疗三叉神经痛(PTN)瘀阻脑络型的疗效以及对血清5-羟色胺(5-HT),C-反应蛋白(CRP)和同型半胱氨酸(HCY)含量的影响。方法:选择四川医科大学附属第一医院收治的PTN瘀阻脑络型患者共130例,参照数字表法随机分为对照组和治疗组,每组均65例;对照组给予A型肉毒毒素局部多点注射治疗,2.5~5.0 U/每点,每次注射总量为40~150 U。治疗组在对照组基础上给予逐瘀活络方治疗。比较两组患者生存质量评分和视觉模拟评分(VAS);分析两组疗后临床疗效;检测两组血清5-HT,CRP和HCY含量。结果:治疗后,治疗组生存质量各指标评分均明显低于对照组(P0.01);治疗组患者临床总有效率为93.85%,高于对照组的80%(P0.05);治疗后2,4周,治疗组VAS评分分别低于对照组(P0.01);治疗后,治疗组患者血清5-HT含量明显高于对照组,CRP和HCY含量显著低于对照组,比较差异均有统计学意义(P0.01)。结论:在西药A型肉毒毒素治疗治疗基础上,逐瘀活络方治疗PTN瘀阻脑络证可明显改善患者生存质量,降低VAS评分,提高临床治疗效果,上调血清5-HT水平及下调血清CRP和HCY水平可能是其作用机制之一。

Clinical Analysis of Zhuyu Huoluo Detection Combined with Botulinum Toxin A in Treating Trigeminal Neuralgia with Blood Stasis Resistance Type

Objective: To investigate the clinical efficacy of Zhuyu Huoluo detection combined with botulinum toxin A in treating primary trigeminal neuralgia (PTN) (blood stasis resistance type) and observe its effect on levels of 5-hydroxytryptamine (5-HT), C-reactin protein(CRP) and homocysteic acid (HCY) in serum. Method: One hundred and thirty eligible PTN cases in our hospital were randomly divided into control group and treatment group (65 cases of each group) by random number table. Patients of control group were treated with botulinum toxin A local multipoint injection (2.5-5.0 U/point, 40-150 U/time). Based on the treatment of control group, patients in treatment group were also treated with Zhuyu Huoluo detection. Scores of survival quality and visual analogue scale (VAS) were compared between two groups. Clinical efficacy was analyzed after treatment between both groups. Levels of 5-HT, CRP and HCY in serum were detected in two groups. Result: Scores of survival quality in treatment group were significantly lower than those in control group after treatment (P<0.01). Clinical total effective rate of treatment group was 93.85%, higher than 80% in control group(P<0.05). VAS scores in treatment group were significantly lower than those in control group after treatment of 2 and 4 weeks (P<0.01). Level of 5-HT in serum of treatment group was significantly higher than that of control group after treatment while CRP and HCY levels were significantly lower than those in control group(P<0.01). Conclusion: On the basis of western medicine treatment of botulinum toxin A, Zhuyu Huoluo detection in treating PTN of blood stasis resistance type could obviously improve survival quality, decrease VAS scores and improve clinical efficacy, and its mechanism may be associated with reducing levels of HCY and CRP and increasing 5-HT level in serum.