目的 评估联合应用醒脑开窍针刺法与盐酸氟桂利嗪对偏头痛患者临床症状、脑血流动力学及神经血管活性物质水平的干预效果。方法 选取2022年1月—2025年6月我院收治的132例偏头痛患者,按照治疗方式分为氟桂利嗪组、针刺组与联合组各44例。氟桂利嗪组接受盐酸氟桂利嗪治疗,针刺组接受醒脑开窍针刺法治疗,联合组接受醒脑开窍针刺法联合盐酸氟桂利嗪治疗。比较三组头痛控制情况（持续时间、发作频次、严重程度）,治疗前后中医症状积分、脑血流动力学[大脑前动脉（anterior cerebral artery,ACA）、大脑中动脉（middle cerebral artery,MCA）、大脑后动脉（posterior cerebral artery,PCA）、血管阻力指数（resistance index,RI）、搏动指数（pulsatility index,PI）]、神经血管活性物质[降钙素基因相关肽（calcitonin gene-related peptide,CGRP）、垂体腺苷酸环化酶激活多肽（pituitary adenylate cyclase-activating polypeptide,PACAP）、S100B蛋白、P物质（substance P,SP）],观察三组不良反应。结果 与治疗前比较,三组治疗后头痛发作次数、严重程度均降低,联合组低于针刺组与氟桂利嗪组;头痛持续时间均缩短,联合组短于针刺组与氟桂利嗪组;三组治疗后各项症状中医症状积分、ACA、MCA、PCA、RI、PI以及CGRP、PACAP、S100B蛋白、SP均降低,联合组低于针刺组与氟桂利嗪组。三组不良反应发生率差异无统计学意义。结论 醒脑开窍针刺法联合盐酸氟桂利嗪治疗可有效改善偏头痛患者头痛症状,优化局部脑血流状况,抑制神经血管活性物质,值得临床应用与借鉴。
Abstract
Objective To evaluate the intervention effect of Xingnao Kaiqiao acupuncture combined with flunarizine hydrochloride on clinical symptoms, cerebral hemodynamics and neural vasoactive substances in patients with migraine. Methods A total of 132 patients with migraine admitted to the hospital were enrolled between January 2022 and June 2025. According to different treatment methods, they were divided into flunarizine group (flunarizine hydrochloride), acupuncture group (Xingnao Kaiqiao acupuncture) and combination group (Xingnao Kaiqiao acupuncture combined with flunarizine hydrochloride), 44 cases in each group. The headache control (duration, onset frequency, severity), scores of TCM symptoms, cerebral hemodynamics[anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), resistance index (RI), pulsatility index (PI) ]and neural vasoactive substances[calcitonin gene-related peptide (CGRP), pituitary adenylate cyclase-activating polypeptide (PACAP), S100B protein, substance P (SP) ]were compared among the three groups, and adverse reactions in the three groups were observed. Results After treatment, onset frequency and severity of headache were decreased in the three groups, which were lower in combination group, and headache duration was shortened, which was shorter in combination group. After treatment, scores of TCM symptoms, ACA, MCA, PCA, RI, PI, CGRP, PACAP, S100B protein and SP were decreased in the three groups, which were lower in combination group. There was no significant difference in the incidence of adverse reactions among the three groups. Conclusion Xingnao Kaiqiao acupuncture combined with flunarizine hydrochloride can effectively improve headache symptoms in migraine patients, optimize local cerebral blood flow and inhibit neural vasoactive substances, which is worthy of clinical application and reference.
关键词
偏头痛 /
醒脑开窍针刺法 /
盐酸氟桂利嗪 /
脑血流动力学 /
神经血管活性肽
Key words
migraine /
Xingnao Kaiqiao acupuncture /
flunarizine hydrochloride /
cerebral hemodynamics /
neural vasoactive peptide
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] RAN Y, YIN Z, LIAN Y, et al.Gradually shifting clinical phenomics in migraine spectrum: a cross-sectional, multicenter study of 5438 patients[J]. J Headache Pain, 2022, 23(1): 89.
[2] 谢雪梅, 张曦, 邹兴菊, 等. 基于c-TCD及MRI探究偏头痛患者RLS与无症状性脑缺血损伤的相关性分析[J]. 中华神经外科疾病研究杂志, 2025, 19(4): 104-109.
[3] 黄建花, 陈玉柱, 佟菲, 等. 偏头痛持续状态的诊断及治疗策略进展[J]. 中国疼痛医学杂志, 2021, 27(1): 60-63.
[4] 马腾宇, 杨广娥. 偏头痛的遗传学研究进展[J]. 世界临床药物, 2023, 44(6): 531-535.
[5] 刘林林, 朱俊超, 白定群, 等. 经皮三叉神经刺激对慢性偏头痛大鼠的镇痛作用及机制研究[J]. 中国疼痛医学杂志, 2025, 31(7): 498-509.
[6] YAO C, WANG Y, WANG L, et al.Burden of headache disorders in China, 1990-2017: findings from the Global Burden of Disease Study 2017[J]. J Headache Pain, 2019, 20(1): 102.
[7] 朱树信, 何鸿卓, 唐宁衎. 盐酸氟桂利嗪治疗偏头痛性眩晕对患者临床症状及血清神经血管活性肽、血管内皮活性物质水平的影响[J]. 中国血液流变学杂志, 2024, 34(2): 214-217.
[8] 薛铮, 张瀛颖, 卢磊, 等. 眩晕宁片联合氟桂利嗪治疗前庭性偏头痛的疗效及对血液流变学、脑血流和血清神经递质水平的影响[J]. 西北药学杂志, 2025, 40(2): 119-125.
[9] 啜阿丹, 王丽彦, 林禹舜. 川芎定痛饮加减联合盐酸氟桂利嗪胶囊治疗偏头痛疗效及对脑血流动力学和血清神经递质的影响[J]. 辽宁中医杂志, 2024, 51(9): 119-122.
[10] 张威, 章梅玲, 褚佳育. 针刺、推拿联合盐酸氟桂利嗪胶囊对偏头痛患者疼痛改善程度及脑血流灌注的影响[J]. 新中医, 2021, 53(21): 193-197.
[11] 谢谢, 张贤梅, 黄天慧, 等. 盐酸氟桂利嗪联合针刺穴位运动治疗对偏头痛患者的疗效及神经血管活性物质和脑血流动力的影响[J]. 时珍国医国药, 2023, 34(6): 1427-1429.
[12] 杨奇峰. 醒脑开窍针刺辨证取穴治疗偏头痛 (肝阳上亢证) 的临床观察[D]. 长春: 长春中医药大学, 2023.
[13] 中国医师协会神经内科医师分会, 中国研究型医院学会头痛与感觉障碍专业委员会. 中国偏头痛诊治指南 (2022版)[J]. 中国疼痛医学杂志, 2022, 28(12): 881-898.
[14] 国家中医药管理局. 中医病证诊断疗效标准[M]. 北京: 中国中医药出版社, 2017: 287.
[15] 郝同, 樊欢欢, 曹克刚. 基于257例偏头痛病人头痛日记数据探讨头痛VAS评分的影响因素[J]. 中西医结合心脑血管病杂志, 2024, 22(23): 4270-4273.
[16] 郑筱萸. 中药新药临床研究指导原则[M]. 北京: 中国医药科技出版社, 2002: 112-113.
[17] 薛铮, 张瀛颖, 卢磊, 等. 眩晕宁片联合氟桂利嗪治疗前庭性偏头痛的疗效及对血液流变学、脑血流和血清神经递质水平的影响[J]. 西北药学杂志, 2025, 40(2): 119-125.
[18] 刘文瑜, 易志红, 陈利江, 等. 针刺联合散偏汤对偏头痛患者血清CGRP、5-HT及NOS水平的影响[J]. 上海针灸杂志, 2020, 39(1): 15-19.
[19] 李荣宗, 齐立, 卢春玲, 等. 尼莫地平联合氟桂利嗪对偏头痛患者血管收缩及NF-平联、COX-2表达的影响[J]. 湖南师范大学学报 (医学版), 2020, 17(2): 65-68.
[20] 张玲, 胡玉. 天麻钩藤饮结合针刺治疗偏头痛肝阳上亢证疗效观察[J]. 实用中医药杂志, 2025, 41(07): 1343-1345.
[21] 罗莹, 王彦红. 醒脑开窍针刺法治疗前庭性偏头痛[J]. 长春中医药大学学报, 2020, 36(01): 113-115.
[22] 刘潇, 曹丹娜, 王杨, 等. 针刺百会穴中枢效应的BOLD-fMRI研究展望[J]. 中国中西医结合影像学杂志, 2025, 23(3): 392-396, 402.
[23] 胡科, 任应国, 贾东佩. 土苓温胆汤联合醒脑开窍针刺法对痰浊上扰型偏头痛患者脑血流及血清5-HT、LPA、MMP-9水平的影响[J]. 新中医, 2021, 53(13): 148-153.
[24] 邓凯烽, 李雪, 陆惠玲, 等. 针刺对偏头痛患者疼痛及脑血流动力学的影响: 随机对照研究[J]. 中国针灸, 2021, 41(2): 115-120.
[25] 张亚兰, 宋伯骐, 贺煜竣, 等. 针刺对偏头痛大鼠脑干IL-6、TNF-头及三叉神经脊束核CGRP水平的影响[J]. 中国中医药信息杂志, 2022, 29(1): 59-64.
[26] 刘利, 杨春霞, 邓娟娟. 小醒脑开窍”针刺法对后循环缺血性眩晕患者的辅助治疗[J]. 吉林中医药, 2022, 42(4): 471-474.
基金
黑龙江省自然科学基金项目“基于IRE1/ASK1JNK神经元自噬信号通路的电针抗抑郁”（LH2022H082）
PDF(2057 KB)
