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目的观察三叉神经痛患者伽玛刀治疗前后血浆P物质的变化,探讨其在三叉神经痛病因及伽玛刀治疗机制中的意义。方法对48例接受伽玛刀治疗的原发性三叉神经痛患者随访疗效,并于术前、术后4、8周测定血浆P物质水平。结果①术后4、8周时的治疗有效率分别为40%、56%;②术后4、8周的血浆SP[分别为(86±19)ng/L、(75±16)ng/L]较治疗前[(109±24)ng/L]下降,差异均有统计学意义(分别t=9.756、13.357,均P=0.000);③术后4周、8周时治疗有效组的SP下降率[分别为(25.8±12.9)%(、33.9±12.6)%]高于同期治疗无效组[分别为(16.6±10.3)%(、26.3±8.9)%],差异均有统计学意义(分别t=2.748、2.336,P=0.009、0.024);④术后4周时的疗效与SP下降率正相关(rs=0.421,P=0.003)。结论三叉神经痛患者伽玛刀术后血浆P水平下降,P物质可能参与了三叉神经痛的发病机制、并与伽玛刀的早期疗效有关。
Objective To observe the changes of plasma substance P before and after treatment with gamma knife in patients with trigeminal neuralgia and to explore its significance in the pathogenesis of trigeminal neuralgia and the mechanism of gamma knife treatment. Methods Forty-eight patients with primary trigeminal neuralgia undergoing gamma knife treatment were followed up and plasma P level was measured preoperatively and 4 and 8 weeks after operation. Results ① At 4 and 8 weeks postoperatively, the effective rates of treatment were 40% and 56% respectively; ② The levels of plasma SP [(86 ± 19) ng / L, (75 ± 16) ng / (P <0.05); (3) After 4 weeks and 8 weeks of treatment, the effective dose of L group was significantly lower than that before treatment [(109 ± 24) ng / L] (25.8 ± 12.9%, 33.9 ± 12.6%, respectively] were higher than those in the ineffective group (16.6 ± 10.3%, 26.3 ± 8.9%, respectively), the differences were statistically significant (T = 2.748,2.336, P = 0.009,0.024, respectively); ④The therapeutic effect at 4 weeks after operation was positively correlated with the rate of SP decline (rs = 0.421, P = 0.003). Conclusion The plasma P level of Gamma Knife decreased in patients with trigeminal neuralgia, and substance P may be involved in the pathogenesis of trigeminal neuralgia and is related to the early curative effect of gamma knife.