| Background: Migraine is a common primary headache disease in the Department of Neurology.It is mostly characterized by recurrent episodes of unilateral,pulsating and moderate to severe headache.It usually lasts for 4-72 hours,often accompanied by nausea,severe vomiting,photophobia and other clinical symptoms,and daily physical activity may aggravate the symptoms of headache.A few patients are accompanied by vision,sensation,language and movement aura symptoms.Migraine reduces the quality of life,learning and working ability of patients,and brings huge financial burden to families and society.Migraine has been listed as an important disabling diseases in the world in 2004 and ranked 6th in disabling diseases.The prevalence of migraine is on the rise in the world recently,and a meta analysis published in 2017 shows that the prevalence of migraine is 11.6% in the world,13.8% for women and 6.9% for men.Epidemiological survey in China shows that the annual prevalence rate of migraine is about 9.3%.Migraine has become one of the global health burden diseases due to its high morbidity and disability.The pathogenesis of migraine is complex and it is still unknown.Studies have shown that diet,genetics,endocrinology,and mental factors are related to the incidence of migraine.At present,the pathogenesis of migraine mainly includes vascular theory,cortical spreading depression hypothesis,neurogenic inflammation theory,and trigeminovascular system theory.The scholars is more widely attentioned to trigeminovascular system theory,the activation of the trigeminovascular system caused the release of neuropeptides,resulting in the expansion of the extracranial vessels,degranulation of mast cells,and peripheral sensitization.Peripheral sensitization leads to central sensitization,and then causes the symptoms of headache.PACAP is a neuropeptide that is 68% homologous to VIP and belongs to the secretin/glucagon/VIP family.PACAP has two bioactive forms:PACAP-38 and PACAP-27.In mammals,PACAP is mainly present in the biologically active form of PACAP-38,accounting for approximately 90% of the total content.As neurotransmitter and Neuromodulation,PACAP plays a role in nerve nutrition,inhibition of neuronal apoptosis,neuroprotection,and regulation of cell differentiation in the nerve system.At present,clinical studies in foreign countries show that intravenous injection of exogenous PACAP-38 can cause migraine attacks in migraine patients.In the study of animal experiments,the results also showed that PACAP-38 was involved in the activation of the trigeminal system,and the activation of the trigeminal system played an important role in the pathogenesis of migraine.The study of plasma levels of endogenous PACAP-38 in different periods of migraine patients has not been reported in China at present.Therefore,the relationship between migraine and endogenous PACAP-38 level is analyzed by comparing the plasma PACAP-38 content in different periods of migraine patients,and this is a new idea for the treatment of migraine.Methods: This study included 65 migraineurs who were treated in the outpatient or inpatient department of the Liaoning province people's Hospital from October 2016 to October 2017.This study including 45 females and 20 males that average age was35.87±10.39 years,In the healthy control group,there were a total of 25 patients,with an average age of 37.40±11.12 years;including 16 females and 9 males.All the migraineurs met the following conditions: aged 14-80 years old,excluded other types of primary headache,secondary headache,other nervous system diseases,hypertension,diabetes and other serious chronic diseases,severe depression,and other psychiatric disorders,and patients who participated in the other drug trials within 3 months,pregnant women and lactating women are also excluded.The migraine group was divided according to whether the patient was in the attack phase,divided into 23 patients in the migraine ictal group and 42 in the migraine interictal group.Then according to the frequency of migraine attacks,the migraine group are divided into subgroups:17 cases in the episodic migraine attack group,6 cases in the chronic attack migraine group;29 cases in the episodic migraine interictal group,and 13 cases in the chronic migraine interictal group.Enzyme linked immunosorbent assay was used to determine the level of PACAP-38 in plasma,and we used SPSS19.0software for data statistics and analysis.Results:Plasma PACAP-38 levels(128.45±22.21 pg/m L)in the migraine ictal group were significantly higher than those in the migraine interictal group(109.81±14.44pg/m L),P<0.001,and there was a significant difference between the two groups.The plasma PACAP-38 level(109.81 ± 14.44 pg/m L)in the migraine interictal group was significantly lower than that in the healthy control group(127.76±20.74 pg/m L),P=0.001,and the difference was significant.There was no significant difference in plasma PACAP-38 level between migraine ictal group and healthy control group(P =0.90).In the migraine subgroup,the level of PACAP-38 in the episodic migraine ictal group was not significantly different from that in the chronic migraine ictal group,P=0.867.The level of PACAP-38 in the episodic migraine interictal group was not significantly different from that in the chronic migraine interictal group,P=0.879;There was a negative correlation between interictal PACAP-38 level and duration in migraine patients(r=-0.580;P<0.01).Conclusion:1.The level of plasma PACAP-38 in migraine ictal phase is significantly higher than that in migraine interictal phase.2.PACAP-38 may play an important role in the pathogenesis of migraine. |
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