Riesco Nuria, Cernuda-Morollón Eva, Pascual Julio
Service of Neurology, University Hospital Central de Asturias, Oviedo, Spain.
Service of Neurology, University Hospital Marqués de Valdecilla and IDIVAL, Av. Valdecilla s/n, 39008, Santander, Spain.
Curr Pain Headache Rep. 2017 Apr;21(4):18. doi: 10.1007/s11916-017-0618-8.
The purpose of this review is to revise current evidence on trigemino-vascular system (TVS) neuropeptides as potential biomarkers for chronic primary headaches, mainly for chronic migraine (CM).
Within sensory neuropeptides, released by an activated trigeminal nerve, calcitonin gene-related peptide (CGRP) levels seem to be a good biomarker of acute migraine and somewhat sensitive and specific for CM. CGRP, however, is not increased in 20-30% of CM patients, which suggests that CGRP is not the only neuropeptide involved in migraine pain generation and maintenance. Data for other sensory neuropeptides are inconsistent (neurokinin, substance P) or absent (amylin and cholecystokinin-8). Among parasympathetic neuropeptides, vasoactive intestinal polypeptide (VIP) is increased interictally in CM, and in at least some migraine cases ictally, pituitary adenylate cyclase-activating peptide (PACAP) has been shown to be increased ictally in jugular blood, but interictal, peripheral data do not indicate such an increase, and there are no data for other parasympathetic peptides. Finally, S100B, as a potential marker of glial TVS activation, has been studied with inconsistent results in migraine patients. Current data on TVS neuropeptides as potential migraine biomarkers must be taken with caution, even for the promising case of CGRP. We do not know with certainty whether increased levels are the reflection of TVS activation, the reliability and homogeneity of the different laboratory tests, or what is the influence on these measurements of the short half-life of many of these peptides or of preventive treatments. One further limitation would be whether the described increases in levels of some neuropeptides such as CGRP are specific for migraine versus other headaches.
本综述旨在修订有关三叉神经血管系统（TVS）神经肽作为慢性原发性头痛，主要是慢性偏头痛（CM）潜在生物标志物的现有证据。
在由激活的三叉神经释放的感觉神经肽中，降钙素基因相关肽（CGRP）水平似乎是急性偏头痛的良好生物标志物，对CM有一定的敏感性和特异性。然而，20%-30%的CM患者CGRP水平并未升高，这表明CGRP并非参与偏头痛疼痛产生和维持的唯一神经肽。其他感觉神经肽的数据不一致（神经激肽、P物质）或缺乏（胰淀素和胆囊收缩素-8）。在副交感神经肽中，CM发作间期血管活性肠肽（VIP）升高，至少在一些偏头痛病例中，发作期颈静脉血中垂体腺苷酸环化酶激活肽（PACAP）升高，但发作间期外周数据未显示此类升高，且没有其他副交感神经肽的数据。最后，作为胶质TVS激活潜在标志物的S100B，在偏头痛患者中的研究结果不一致。关于TVS神经肽作为潜在偏头痛生物标志物的当前数据必须谨慎对待，即使对于前景看好的CGRP也是如此。我们不确定水平升高是TVS激活的反映、不同实验室检测的可靠性和同质性，还是这些肽中许多肽的短半衰期或预防性治疗对这些测量的影响。另一个局限性在于，某些神经肽如CGRP水平升高是否对偏头痛与其他头痛具有特异性。
