氟桂利嗪联合卡马西平治疗偏头痛的疗效及作用机制

摘要

Objective It is to approach the clinical efficacy and mechanism of flunarizine combined with carbamazepine in migraine. Methods 156 patients with migraine were divided into 2 groups,78 cases in each group. The patients in control group were treated with flunarizine,while the observation group was given carbamazepine. The courses of treatment in both groups were three months. The differences of HAMA,HAMD,BRMS,headache degree,seizure frequency,duration time, accompanying symptoms,adverse reaction,mean flow velocity of intracranial vessel,ET,NO,5 -HT and β-EP before and after treatment were observed in two groups. Results The HAMA,HAMD,BRMS,headache degree,seizure frequency and duration time after treatment were obviously improved than before treatment in both groups(all P<0. 01),while the improve-ment in observation group was significantly larger than those in control group(P<0. 05 or P<0. 01). The disappeared rates of nausea,vomiting,photophobia,fear of sound in observation group were significantly higher than those in control group( all P<0. 05). There was no significant difference in adverse reaction between the two groups(all P>0. 05). The mean flow ve-locity of intracranial vessel in both groups after treatment was obviously slower than before treatment(P<0. 05 or P<0. 01), while the value in observation group was significantly smaller than that in control group(P<0. 05 or P<0. 01). The levels of NO,5 -HT and β-EP in both groups after treatment were obviously higher than before treatment(all P <0. 01),whereas the levels of ET were decreased(all P<0. 01). However,the levels of NO,5 -HT and β -EP in observation group were significantly improved than those in control group(P<0. 05 or P<0. 01). Conclusion Flunarizine combined with carbamaz-epine for migraine can effectively improve the bad mood such as anxiety,depression and mania,relieve headache,reduce fre-quency,and shorten duration time,with high security and significant efficacy. Based on this,the regulatory functions for ves-sel,nerve and neurotransmitter of two drugs are significantly improved,so as to improve the bad mood,relieve migraine symp-toms,and so on in a virtuous circle.%目的：探讨氟桂利嗪联合卡马西平治疗偏头痛的临床疗效及作用机制。方法将156例偏头痛患者随机分为2组，对照组78例给予氟桂利嗪睡前口服，观察组78例在此基础上联合卡马西平餐后口服，2组均以3个月为1个疗程。观察2组治疗前后汉密尔顿焦虑量表（ HAMA）、汉密尔顿抑郁量表（ HAMD）、贝克-拉范森躁狂量表（ BRMS）评分及头痛程度、发作频率、发作时间、伴随症状、颅内动脉血流速度、内皮素（ET）、一氧化氮（NO）、5-羟色胺（5-HT）和β-内啡肽（β-EP）水平的变化。结果治疗后2组 HAMD 评分、HAMA 评分、BRMS评分、疼痛程度、发作频率和发作时间均较治疗前显著改善（ P 均<0.01），且观察组改善幅度均显著大于对照组（P <0.05或 P <0.01）；观察组恶心、呕吐、畏光、怕声的消失率均显著高于对照组（P均<0.05）；2组不良反应发生率比较差异无统计学意义（P>0.05）。治疗后2组颅内动脉血流速度均较治疗前显著减慢（P<0.05或 P<0.01），且观察组显著慢于对照组（P <0.05或 P <0.01）。治疗后2组血浆NO、5-HT和β-EP水平均较治疗前显著上升（P均<0.01），ET 水平均显著下降（P 均<0.01），而观察组各指标改善情况均优于对照组（P均<0.05）。结论氟桂利嗪联合卡马西平可显著改善偏头痛患者焦虑、抑郁和狂躁等不良情绪，缓解头痛程度，降低发作频率，缩短发作时间，调节血管、神经和神经递质的功能，在改善不良情绪的同时，有效缓解偏头痛病情，形成良性循环。