加巴喷丁联合A型肉毒素治疗复发性三叉神经痛的疗效分析

Efficacy of gabapentin combined with botulinum toxin type A in the treatment of recurrent trigeminal neuralgia

摘要:

目的 探讨加巴喷丁联合A型肉毒素治疗复发性三叉神经痛（TN）的疗效。方法 选取2018年1月—2020年8月华中科技大学协和江南医院收治的复发性TN患者110例作为研究对象。将患者分为试验组和对照组，各55例。对照组采用加巴喷丁治疗，试验组在对照组的基础上给予A型肉毒素治疗。对比两组患者的疗效及不良反应发生情况。结果 两组治疗前、治疗后2周、治疗后8周静息时VAS评分比较，经重复测量设计的方差分析，结果 ①不同时间点VAS评分有差异（F =9.046，P <0.05）；②两组VAS评分有差异（F =7.097，P <0.05），试验组治疗后VAS评分较对照组低，相对镇痛效果较好；③两组VAS评分变化趋势有差异（F =10.002，P <0.05）。试验组总有效率高于对照组（P <0.05）。试验组治疗前与治疗后8周的S100β、神经元特异性烯醇化酶差值高于对照组（P <0.05）。两组药物总不良反应率比较，差异无统计学意义（P >0.05）。结论 加巴喷丁联合A型肉毒素治疗复发性TN可增强疗效，降低S100β、NSE水平，且安全性良好。

Abstract:

Objective To explore the efficacy of gabapentin combined with botulinum toxin type A in the treatment of recurrent trigeminal neuralgia (TN) and its effects on neuron-specific enolase (NSE) and S100β.Methods A total of 110 patients with recurrent TN admitted to our hospital from January 2018 to August 2020 were selected and divided into the test group and the control group, with 55 cases in each group. The patients in the control group were treated with gabapentin. On the basis of the gabapentin, the test group was additionally given botulinum toxin type A. The therapeutic efficacy, serum levels of NSE and S100β, and adverse reactions of the two groups were compared.Results The Visual Analogue Scale (VAS) scores at rest before the treatment, 2 weeks after the treatment and 8 weeks after the treatment were compared between the two groups, and the repeated-measures analysis of variance demonstrated that the VAS scores were different among the time points (F = 9.046, P < 0.05) and between the test group and the control group (F = 7.097, P < 0.05). Specifically, the VAS scores of the test group were lower and indicated better analgesic effects compared with the control group. The change trends of the VAS scores were also different between the test group and the control group (P < 0.05). The overall effective rate in the test group was higher than that in the control group (P < 0.05). The differences of the serum levels of S100β and NSE before and after the treatment in the test group were higher than those in the control group (P < 0.05). There was no significant difference in the overall incidence of adverse drug reactions between the two groups (P > 0.05).Conclusions Gabapentin combined with botulinum toxin type A enhances the efficacy in the treatment of recurrent TN. It reduces the levels of S100β and NSE, and has fewer safety concerns.