Al-Karagholi Mohammad Al-Mahdi, Kalatharan Veberka, Fagerberg Peter Schunck, Amin Faisal Mohammad
Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Front Neurol. 2023 Jul 6;14:1204734. doi: 10.3389/fneur.2023.1204734. eCollection 2023.
Intravenous infusion of human alpha calcitonin gene-related peptide (h-α-CGRP) has been applied to explore migraine pathogenesis and cerebral hemodynamics during the past three decades. Cumulative data implicate h-α-CGRP in regulating the vascular tone. In this systematic review, we searched PubMed and EMBASE for clinical studies investigating the vascular changes upon intravenous infusion of h-α-CGRP in humans. A total of 386 studies were screened by title and abstract. Of these, 11 studies with 61 healthy participants and 177 participants diagnosed with migraine were included. Several studies reported hemodynamic effects including flushing, palpitation, warm sensation, heart rate (HR), mean arterial blood pressure (MABP), mean blood flow velocity of middle cerebral artery (mean V), and diameter of superficial temporal artery (STA). Upon the start of h-α-CGRP infusion, 163 of 165 (99%) participants had flushing, 98 of 155 (63%) participants reported palpitation, and 160 of 165 (97%) participants reported warm sensation. HR increased with 14%-58% and MABP decreased with 7%-12%. The mean V was decreased with 9.5%-21%, and the diameter of the STA was dilated with 41%-43%. The vascular changes lasted from 20 to >120 min. Intravenous infusion of h-α-CGRP caused a universal vasodilation without any serious adverse events. The involvement of CGRP in the systemic hemodynamic raises concerns regarding long-term blockade of CGRP in migraine patients with and without cardiovascular complications.
在过去三十年中，静脉输注人α降钙素基因相关肽（h-α-CGRP）已被用于探索偏头痛的发病机制和脑血流动力学。累积数据表明h-α-CGRP参与调节血管张力。在本系统评价中，我们在PubMed和EMBASE中检索了关于静脉输注h-α-CGRP后人体血管变化的临床研究。通过标题和摘要共筛选出386项研究。其中，纳入了11项研究，包括61名健康参与者和177名被诊断为偏头痛的参与者。几项研究报告了血流动力学效应，包括脸红、心悸、温热感、心率（HR）、平均动脉血压（MABP）、大脑中动脉平均血流速度（平均V）和颞浅动脉（STA）直径。在开始输注h-α-CGRP时，165名参与者中有163名（99%）出现脸红，155名参与者中有98名（63%）报告有心悸，165名参与者中有160名（97%）报告有温热感。HR增加14%-58%，MABP降低7%-12%。平均V降低9.5%-21%，STA直径扩张41%-43%。血管变化持续20至>120分钟。静脉输注h-α-CGRP引起全身血管舒张，无任何严重不良事件。CGRP参与全身血流动力学引发了对有和没有心血管并发症的偏头痛患者长期阻断CGRP的担忧。
