摘要
目的:观察身痛逐瘀汤合地龙汤加减治疗腰椎间盘突出症(LDH)气滞血瘀证的临床疗效及对髓核重吸收和免疫炎症因子的影响,从重吸收的角度探讨其治疗机制.方法:选择广州中医药大学第四临床医学院2020年6月至2023年1月的120例LDH患者作为研究对象,采用随机数字表法分为对照组52例(脱落8例)和观察组49例(脱落11例).对照组予以常规治疗方案,观察组在常规治疗基础上加用身痛逐瘀汤合地龙汤加减治疗.分别于治疗前、治疗3疗程后测定患者的视觉模拟评分法(VAS)、Oswestry功能障碍指数问卷(ODI)、日本骨科协会评分(JOA)、中医证候积分,抽取静脉血完成血清学指标测定,并于治疗后6个月随访时完善核磁共振检查,计算吸收率.结果:与本组治疗前比较,两组患者治疗后VAS评分、ODI评分、中医证候积分、血清肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶-9(MMP-9)、血管内皮生长因子(VEGF)水平均明显降低(P＜0.05),JOA评分明显增加(P＜0.05).与对照组治疗后比较,观察组VAS评分、ODI评分、中医证候积分、血清TNF-α、MMP-9、VEGF水平均明显降低(P＜0.05),JOA评分明显升高(P＜0.05).观察组发生髓核吸收的比例为57.14％(28/49),明显高于对照组21.15％(11/52)(x2=6.161,P＜0.05).结论:身痛逐瘀汤合地龙汤加减治疗气滞血瘀型LDH能有效缓解疼痛,改善腰椎功能和中医临床症状,影像学提示能促进髓核突出重吸收,实验室检测能降低血清TNF-α、MMP-9、VEGF水平,有利于患者康复.
Abstract
Objective:To observe the clinical efficacy of Shentong Zhuyutang combined with Dilongtang in the treatment of lumbar disc herniation(LDH)with Qi stagnation and blood stasis syndrome,and its effect on nucleus pulposus reabsorption and immune-inflammatory factors,exploring its therapeutic mechanism from the perspective of reabsorption.Methods:A total of 120 patients with LDH from the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine,treated between June 2020 and January 2023,were randomly divided into the control group(52 cases,with 8 dropouts)and the observation group(49 cases,with 11 dropouts)according to a random number table.The control group received routine treatment,while the observation group was treated with Shentong Zhuyutang combined with Dilongtang in addition to routine treatment.Visual Analogue Scale(VAS),Oswestry Disability Index(ODI),Japanese Orthopaedic Association(JOA)score,and traditional Chinese medicine(TCM)syndrome score were measured before treatment and after 3 courses of treatment.Venous blood samples were collected for the determination of serological indexes.MR examination was performed during the 6-month follow-up to calculate the absorption rate.Results:After treatment,both groups showed significant reductions in VAS,ODI,TCM syndrome score,serum tumor necrosis factor(TNF)-α,matrix metalloproteinase(MMP)-9,and vascular endothelial growth factor(VEGF)levels,and a significant increase in JO A score compared with pre-treatment values(P＜0.05).Compared with the control group,the observation group showed significantly lower VAS,ODI,TCM syndrome score,serum TNF-α,MMP-9,and VEGF levels,and a significantly higher JOA score(P＜0.05).The proportion of nucleus pulposus reabsorption in the observation group was 57.14％(28/49),significantly higher than 21.15％(11/52)in the control group(x2=6.161,P＜0.05).Conclusion:Shentong Zhuyutang combined with Dilongtang can effectively relieve pain,improve lumbar function,and alleviate TCM clinical symptoms in LDH patients with Qi stagnation and blood stasis syndrome.Imaging findings suggest that the treatment promotes the reabsorption of nucleus pulposus protrusion,while laboratory testing shows reduced serum levels of TNF-α,MMP-9,and VEGF,which contribute to the rehabilitation of patients.
国家科技期刊平台
NSTL
维普
万方数据