柴胡疏肝汤联合归脾汤加味治疗难治性癫痫肝郁脾虚证的临床观察

目的:探讨柴胡疏肝汤联合归脾汤加味治疗难治性癫痫(intractable epilepsy,IE)肝郁脾虚证的临床疗效及对抗氧自由基,P-糖蛋白(P-glycoprotein,P-gp),胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)表达的影响。方法:将符合IE肝郁脾虚证诊断标准60例患者,按随机数字表法分为对照组和观察组,各30例,对照组给予常规治疗,观察组在给予常规治疗基础上,给予柴胡疏肝汤联合归脾汤加味治疗,连续治疗3个月后,检测治疗后患者的视频脑电图(electroencephalogram,EEG)情况;记录治疗前后癫痫发作频次、发作持续时间、癫痫患者生活量表-31(quality of life in epilepsy-31,QOLIE-31);检测治疗前后血清总超氧化物歧化酶(superoxide dismutase,SOD),丙二醛(malondialdehyde,MDA),P-gp,IGF-1的水平;计算治疗前后癫痫发作次数、发作持续时间,QOLIE-31各项评分,SOD,MDA,P-gp,IGF-1水平的差值。结果:观察组治疗后癫痫发作频次低于对照组(P0.05),持续时间显著低于对照组(P0.01),痫样放电例数少于对照组(P0.05),各项生活质量评分均显著高于对照组(P0.01),SOD水平显著高于对照组(P0.01),MDA,P-gp水平显著低于对照组(P0.01),IGF-1水平低于对照组(P0.05);与对照组差值比较,观察组发作频次减少程度较明显(P0.05),持续时间减少程度显著(P0.01),各项生活质量评分上升程度较明显(P0.05),SOD增加和P-gp减少程度显著(P0.01),MDA,IGF-1减少程度较明显(P0.05)。结论:柴胡疏肝汤联合归脾汤加味治疗IE肝郁脾虚证患者可减少癫痫的发作频次和发作持续时间、痫样放电,提高患者生活质量,作用机制可能与清除氧自由基、提高抗癫痫药(antiepileptic drugs,AEDs)敏感性、减少脑损伤有关。

Clinical Observation of Chaihu Shugan Tang Combined with Guipitang in Treatment of Intractable Epilepsy of Liver Stagnation and Spleen Deficiency Syndrome

Objective:To investigate the clinical efficacy of Chaihu Shugan Tang combined with Guipitang in the treatment of intractable epilepsy (IE) of liver stagnation and spleen deficiency syndrome, and explore its effect on expression levels of oxygen free radicals, P-glycoprotein (P-gp), and insulin-like growth factor-1 (IGF-1). Method:The 60 patients complying with IE diagnosis standard of liver stagnation and spleen deficiency syndrome were randomly divided into control group and experimental group according to random number table, with 30 cases in each group. The patients in control group received routine treatment, while the patients in experimental group additionally received Chaihu Shugan Tang combined with Guipitang treatment on the basis of routine treatment. After continuous treatment for 3 months, video electroencephalogram (EEG) was observed, epileptic seizure frequency, seizure duration, Quality of Life in Epilepsy-31 (QOLIE-31) were recorded before and after treatment; serum total superoxide dismutase (SOD), malondialdehyde (MDA), P-gp, and IGF-1 levels were detected before and after treatment; the number of epileptic seizures, seizure duration, scores of QOLIE-31, as well as the changes in SOD, MDA, P-gp and IGF-1 levels were calculated. Result:the frequency of seizures in experimental group after treatment was lower than that of control group (P<0.05), the duration was significantly lower than that in control group (P<0.01); the number of epileptiform discharges was less than that of control group (P<0.05); QOLIE-31 scores were significantly higher than those in control group (P<0.01); the level of SOD was significantly higher than that in the control group (P<0.01), while MDA and P-gp levels were significantly lower than those of control group (P<0.01), and IGF-1 level was lower than that in control group (P<0.05). As compared with the changes in control group, the decrease degree of seizure frequency was more obvious in experimental group (P<0.05); the decrease degree of seizure duration was significant (P<0.01); the increase in QOLIE-31 scores was more obvious (P<0.05); the increase in SOD and decrease in P-gp were significant (P<0.01); and the decrease in MDA and IGF-1 was more obvious in experimental group (P<0.05). Conclusion:Chaihu Shugan Tang combined with Guipitang in the treatment of IE patients with liver stagnation and spleen deficiency can reduce the seizure frequency and the duration of seizures, epileptiform discharge, improve the quality of life for patients, and the mechanism may be related to scavenging oxygen free radicals, improving the sensitivity of antiepileptic drugs (AEDs) and reducing the damages to the brain.