Abstract:

Objective　To observe the effect of liver-sparing and brain-benefiting acupuncture method combined with zolmitriptan in the treatment of migraine with hyperactivity of liver-yang syndrome. Methods　A total of 90 patients with migraine with hyperactivity of liver-yang syndrome who were admitted to Affiliated Hospital of Shaanxi University of Chinese Medicine from May 2021 to October 2022 were selected as the study subjects. Using the envelope method, the patients were divided into the control group (45 cases) and the acupuncture group (45 cases). There were 19 males and 26 females in the control group, aged 19-74 (49.63±7.84) years, course of the disease 1-32 (6.85±1.45) years. There were 16 males and 29 females in the acupuncture group, aged 20-75 (48.78±8.02) years, course of the disease 1-29 (6.79±1.50) years. The control group was treated with zolmitriptan, while the acupuncture group was treated in addition to the control group with liver-sparing and brain-benefiting acupuncture method. Both groups were treated continuously for 2 weeks. Compare the pain levels [visual analogue scale (VAS)] before and after treatment in the two groups at 1 h, 2 h, and 4 h; the levels of vaso-active substance [calcitonin gene-related peptide (CGRP), endothelin-1 (ET-1), β-epinephrine (β-EP), 5-hydroxytryptamine (5-HT)], the levels of inflammatory response-related enzymes [cyclooxygenase-2 (COX-2), nitric oxide synthase (iNOS)], the migraine symptom scores (headache severity, accompanying symptoms, monthly attack frequency and duration per attack), the traditional Chinese medicine syndrome scores (headache and dizziness, irritability and restlessness, insomnia and frequent dreams, tinnitus and vertigo, facial flushing and redness, bitter mouth and dry throat) before and after treatment; and the occurrence of adverse reactions during treatment. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　At 1 h, 2 h, and 4 h after treatment, the VAS scores of the acupuncture group were all lower than those of the control group [(3.28±0.70) points vs. (4.02±1.14) points, (2.67±0.68) points vs. (3.20±0.54) points, (1.87±0.42) points vs. (2.34±0.51) points] (all P<0.05). After treatment, the levels of CGRP and ET-1 in the acupuncture group were lower than those in the control group [(10.14±1.44) ng/L vs. (13.36±1.87) ng/L, (56.74±5.51) ng/L vs. (65.86±5.87) ng/L], while the levels of β-EP and 5-HT were higher than those in the control group [(83.45±9.61) ng/L vs. (71.63±8.47) ng/L, (298.86±30.48) ng/L vs. (272.36±28.94) ng/L] (all P<0.05); the levels of COX-2 and iNOS in the acupuncture group were lower than those in the control group [(1.84±0.51) μg/L vs. (2.21±0.63) μg/L, (1.35±0.48) μg/L vs. (3.08±0.77) μg/L] (both P<0.05); the scores for headache severity, accompanying symptoms, monthly attack frequency and duration per attack in the acupuncture group were lower than those in the control group (all P<0.05); the scores for headache and dizziness, irritability and restlessness, insomnia and frequent dreams, tinnitus and vertigo, facial flushing and redness, bitter mouth and dry throat in the acupuncture group were lower than those in the control group (all P<0.05). During the treatment period, no adverse reactions occurred in either group. Conclusion　Liver-sparing and brain-boosting acupuncture combined with zolmitriptan has a better therapeutic effect on patients with migraine with hyperactivity of liver-yang syndrome. It can relieve pain, alleviate the symptoms of migraine, and regulate the levels of vaso-active substance and inflammatory response-related enzymes.

Key words: Migraine,  , Liver-sparing and brain-benefiting acupuncture method,  , Zolmitriptan,  , Acute attacks,  , Vaso-active substance,  , Inflammatory response-related enzymes

摘要：

目的　观察疏肝益脑针刺法联合佐米曲普坦治疗肝阳上亢证偏头痛的效果。方法　选取2021年5月至2022年10月陕西中医药大学附属医院收治的90例肝阳上亢证偏头痛患者作为研究对象。采用信封法，将患者分为对照组（45例）和针刺组（45例）。对照组男19例，女26例；年龄19～74（49.63±7.84）岁；病程1～32（6.85±1.45）年。针刺组男16例，女29例；年龄20～75（48.78±8.02）岁；病程1～29（6.79±1.50）年。对照组采用佐米曲普坦治疗，针刺组在对照组基础上联合疏肝益脑针刺法治疗。两组均连续治疗2周。比较两组治疗前和治疗后1 h、2 h、4 h疼痛程度［视觉模拟评分（VAS）］，治疗前后血管活性物质水平［降钙素基因相关肽（CGRP）、内皮素-1（ET-1）、β-内咖肽（β-EP）、5-羟色胺（5-HT）］、炎症反应相关酶水平［环氧合酶-2（COX-2）、一氧化氮合酶（iNOS）］、偏头痛症状积分（头痛严重程度、伴随症状、每月发作次数及每次持续时间）、中医证候评分（头胀痛、易怒烦躁、少寐多梦、耳鸣眩晕、面红目赤、口苦咽干），治疗期间不良反应发生情况。采用独立样本t检验、配对t检验和χ²检验进行统计学分析。结果　治疗后1 h、2 h、4 h，针刺组VAS评分均低于对照组［（3.28±0.70）分比（4.02±1.14）分、（2.67±0.68）分比（3.20±0.54）分、（1.87±0.42）分比（2.34±0.51）分］（均P<0.05）。治疗后，针刺组CGRP、ET-1水平均低于对照组［（10.14±1.44）ng/L比（13.36±1.87）ng/L、（56.74±5.51）ng/L比（65.86±5.87）ng/L］，β-EP、5-HT水平均高于对照组［（83.45±9.61）ng/L比（71.63±8.47）ng/L、（298.86±30.48）ng/L比（272.36±28.94）ng/L］（均P<0.05）；针刺组COX-2、iNOS水平均低于对照组［（1.84±0.51）μg/L比（2.21±0.63）μg/L、（1.35±0.48）μg/L比（3.08±0.77）μg/L］（均P<0.05）；针刺组头痛严重程度、伴随症状、每月发作次数及每次持续时间积分均低于对照组（均P<0.05）；针刺组头胀痛、易怒烦躁、少寐多梦、耳鸣眩晕、面红目赤、口苦咽干评分均低于对照组（均P<0.05）。治疗期间，两组均未发生不良反应。结论　疏肝益脑针刺法联合佐米曲普坦治疗肝阳上亢证偏头痛患者的效果较好，可缓解疼痛，减轻偏头痛症状，调节血管活性物质、炎症反应相关酶水平。

关键词: 偏头痛, 疏肝益脑针刺法, 佐米曲普坦, 急性发作, 血管活性物质, 炎症反应相关酶