原发性三叉神经痛患者伽玛刀治疗术前、后血浆P物质水平的观察

目的观察三叉神经痛患者伽玛刀治疗前后血浆P物质的变化,探讨其在三叉神经痛病因及伽玛刀治疗机制中的意义。方法对48例接受伽玛刀治疗的原发性三叉神经痛患者随访疗效,并于术前、术后4、8周测定血浆P物质水平。结果①术后4、8周时的治疗有效率分别为40%、56%;②术后4、8周的血浆SP分别为(86±19)ng/L、(75±16)ng/L]较治疗前(109±24)ng/L]下降,差异均有统计学意义(分别t=9.756、13.357,均P=0.000);③术后4周、8周时治疗有效组的SP下降率分别为(25.8±12.9)%(、33.9±12.6)%]高于同期治疗无效组分别为(16.6±10.3)%(、26.3±8.9)%],差异均有统计学意义(分别t=2.748、2.336,P=0.009、0.024);④术后4周时的疗效与SP下降率正相关(rs=0.421,P=0.003)。结论三叉神经痛患者伽玛刀术后血浆P水平下降,P物质可能参与了三叉神经痛的发病机制、并与伽玛刀的早期疗效有关。

A comparative study of substance P in patients with primary trigeminal neuralgia before and after gamma knife radiosurgery

Objective to investigate the dynamic changes of substance P(SP) in patients with primary trigeminal neuralgia before and after gamma knife radiosurgery(GKR) and further recognize the signify of altered SP.Methods Forty-eight patients with trigeminal neuralgia received gamma knife radiosurgery entered a follow-up study,and underwent a SP detection before and after radiation.Results On week 4,8 after GKR,the response rate of the patients was 40%,56%,while the level of serum SP (86± 19)ng/L,(75± 16)ng/L respectively ] was significantly depressed compared with that pretherapy (109 ±24)ng/L,t=9.756,13.357 respectively;both P=0.000].Compared with invalid patient(16.6± 10.3)%、(26.3± 8.9)%],the decline rate of SP on week 4,8 was significantly higher in valid patients(25.8 ±12.9)%,(33.9± 12.6)%,t=2.748,2.336;P=0.009,0.024 respectively].It was showed that the decline rate of SP on week 4 was positively related with the efficacy of GKR(rs=0.421,P=0.003).Conclusion There is a distinguished descending tendency in patients with trigeminal neuralgia after GKR,which suggest that SP might mediate the pathomechanism of TN and the therapeutic effect in early stage of GKR.