摘要
目的:观察丹鹿通督片治疗腰椎间盘突出症(LDH)肾虚瘀阻证的近期和远期疗效,及对髓核重吸收和免疫炎症因子的影响。方法:将160例患者随机按数字表法分成对照组和观察组各80例。对照组采用穴位按摩+针刺,1次/d。观察组治疗同对照组,并口服丹鹿通督片,4片/次,3次/d。两组疗程均连续治疗12周,并进行9个月的随访。采用视觉模拟(VAS)评分记录治疗前、治疗后1,2,3个月腰痛、腿痛程度;进行治疗前后日本骨科协会(JOA)评分和症状、体征评分;随访9个月,计算复发率,记录复发的时间和复发时的VAS和JOA评分;评价治疗后髓核吸收情况;检测治疗前后白细胞介素-1(IL-1),IL-17,肿瘤坏死因子-α(TNF-α),基质金属蛋白酶-3(MMP-3)水平。结果:经秩和检验,观察组临床疗效优于对照组(Z=2. 125,P <0. 05),观察组JOA评分疗效优于对照组(Z=1. 924,P <0. 05);观察组治疗后1,2,3个月腰痛、腿痛VAS评分均低于对照组(P <0. 01);治疗后观察组腰痛、腿痛VAS评分下降幅度均多于对照组(P <0. 01);观察组症状、体征评分均低于对照组(P <0. 01),观察组JOA量表各维度评分和JOA总分均高于对照组(P <0. 01);观察组髓核完全吸收率为61. 11%,高于对照组42. 03%(χ2=5. 138,P <0. 05);观察组IL-1,IL-17,TNF-α和MMP-3水平均低于对照组(P <0. 01);观察组复发率为23. 61%,低于对照组的40. 58%(χ~2=4. 668,P <0. 05);观察组平均复发时间长于对照组(P <0. 05),复发时VAS评分低于对照组(P <0. 05),JOA总分高于对照组(P <0. 05)。结论:在针刺与按摩治疗的基础上,加服丹鹿通督片治疗LDH(肾虚瘀阻证)近期可减轻疼痛和改善功能,提高临床疗效,远期可降低复发率,减轻复发程度,并可促进髓核重吸收和减轻神经根炎性刺激。
Objective:To observe short-term and long-term efficacies of Danlu Tongdu tablets on lumbar disc herniation(LDH)with kidney deficiency and stasis syndrome,and its effect on nucleus pulposus reabsorption and immunoinflammatory factors.Method:One hundred and sixty patients were randomly divided into control group(80 cases)and observation group by random number table.Patients in control group(80 cases)got acupoint massage and acupuncture,1 time/day.In addition to the therapy of control group,patients in observation group were also given Danlu Tongdu tablets,4 tablets/time,3 times/days.A course of treatment was 12 weeks,and a 9-month follow-up was recorded.Lumbago and leg pain were recorded by visual simulation(VAS)before treatment and at the first,second,third month after treatment.Before and after treatment,Japanese orthopaedic association(JOA),symptoms and signs were scored.During the 9-month follow-up,relapse rate and relapse time were recorded,and VAS and JOA were scored.Absorption of nucleus pulposus was assessed,and levels of interleukin-1(IL-1),IL-17,tumor necrosis factor-α(TNF-α),matrix metalloproteinases-3(MMP-3)were detected.Result:By rank sum test,the clinical efficacy in observation group was better than that in control group(Z=2.125,P<0.05),and scores of JOA was better than that in control group(Z=1.924,P<0.05).At the first,second and third months after treatment,VAS scores of low back pain,leg pain were lower than those in control group(P<0.01),while the decline range were more than that in control group(P<0.01).And scores of symptoms and signs were lower than that in control group(P<0.01),whereas scores by dimensions of JOA scale and the total score of JOA were all higher than those in control group(P<0.01).Complete absorptivity of nucleus pulposus in observation group was 61.11%,which was higher than 42.03%in observation group(χ2=5.138,P<0.05).Levels of IL-1,IL-17,TNF-αand MMP-3 were lower than that in control group(P<0.01).Relapse rate in observation group was 23.61%,which was lower than 40.58%in control group(χ~2=4.668,P<0.05).Average recurrence time was longer than that in control group(P<0.05),score of VAS was lower than that in control group(P<0.05),and the total score of JOA was higher than that in control group(P<0.05).Conclusion:In addition to acupuncture and massage therapy,Danlu Tongdu tablets can also be used to relieve pain and ameliorate function,improve clinical efficacy,reduce relapse rate,promote nucleus pulposus reabsorption,and relieve inflammation of nerve root.
作者
颜宾宏
牛乾
符致坚
杨帆
虞道锐
牛坤
YAN Bin-hong;NIU Qian;FU Zhi-jian;YANG Fan;YU Dao-rui;NIU Kun(First Affiliated Hospital of Hainan Medical College,Haikou570102,China;College of Traditional Chinese Medicine,Hainan Medical University,Haikou571101,China;Oriental Red Ginseng Academy of Ethnic Medicine,Haikou572600,China;College of Basic Medicine and Life Sciences,Hainan Medical College,Haikou571101,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2019年第22期66-71,共6页
Chinese Journal of Experimental Traditional Medical Formulae
基金
海南省自然科学基金项目(818MS061)
关键词
腰椎间盘突出症
肾虚瘀阻证
丹鹿通督片
复发率
髓核重吸收
免疫炎症因子
lumbar disc herniation
kidney deficiency and stasis syndrome
Danlu Tongdu tablets
relapse rate
nucleus pulposus reabsorption
immuno-inflammatory factors
