活血通络汤治疗腰椎间盘突出症(血瘀证)疗效及对患者血液流变学和IL-1β、IL-6、TNF-α的影响

Therapeutic Effect of Using Huoxue Tongluo Decoction in the Treatment of Lubar Disc Herniation and Its Influence on Hemorheology and the Levels of IL-1β, IL-6 and TNF-α

目的:观察活血通络汤对血瘀证腰椎间盘突出症患者的临床疗效,并分析其对血液流变学及IL-1β、IL-6、TNF-α的影响。方法:将2020年3月~2021年3月我院住院的80例腰椎间盘突出症患者随机分成治疗组、对照组各40例,两组按我科优势病种方案进行牵引、针灸及中药外敷照射等常规治疗,其中对照组口服美洛昔康片,治疗组在此基础上内服活血通络汤,煎汤取汁,每日三次,每次150ml温服、1日1剂,2组患者均以1周为1个疗程,共治疗2个疗程。对2周后的各组疼痛视觉模拟评分(VAS)、下腰痛评定量表(JOA)评分、血液流变学指标及IL-1β、IL-6、TNF-α等血清指标数值采取功效评析。结果:治疗组与对照组患者的临床治疗有效率分别是92.50%(37/40)、67.50%(27/40),治疗组较对照组优,差异有统计学意义(P<0.05);治疗后两组的VAS数值、JOA数值较治疗前症状显著减轻(P<0.05)。治疗组疗后的VAS数值、JOA数值均优于对照组(P<0.05),血液流变学指标均优于对照组(P<0.05),血清IL-1β、IL-6、TNF-α水平较对照组降低明显(P<0.05)。结论:活血通络汤在血瘀证腰椎间盘突出症诊治中临床疗效较对照组改善显著。活血通络汤治疗腰椎间盘突出症能够抑制炎性相关因子的表达水平、改善JOA、VAS评分及血液流变学指标,提示中西医结合医治腰椎间盘突出症较西药治疗更能获得的显著的临床疗效。

Objective:To evaluate the clinical curative effect of Huoxuetongluo Decoction for lumbar disc herniation,and its influence on hemorheology,IL-1β,IL-6 and TNF-α.Methods:From May 2020 to May 2021,80 patients with lumbar disc herniation in our hospital were randomly divided into a treatment group and a controlled group with 40 cases in each group.The two groups were treated with routine treatments such as traction,acupuncture and traditional Chinese medicine external application and radiation according to our department’s dominant disease plan.The controlled group took Meloxicam Tablets orally,7.5 mg/time,2 times/d.On this basis,the treatment group took Huoxue Tongluo Decoction,decoction and juice,three times a day,150 ml each time warmly took,1 dose a day,2 groups of patients were treated with 1 week as a course of treatment,a total of 2 courses of treatment.After 2 weeks,the visual analogue scale of pain(VAS),low back pain rating scale(JOA)score,blood rheology index and serum index values?such as IL-1β,IL-6,TNF-αand so on in each group were evaluated for efficacy.Results:The effective rates of clinical treatment of patients in the treatment group and the controlled group were 92.50%(37/40)and 67.50%(27/40),respectively.The treatment group was better than the controlled group,and the difference was statistically significant(P<0.05).The VAS value and JOA value of the latter two groups were significantly reduced compared with the symptoms before treatment(P<0.05).The VAS value and JOA value of the treatment group after treatment were better than those of the controlled group(P<0.05).The hemorheology indexes of the treatment group patients after treatment were better than those of the controlled group(P<0.05).The treatment group patients after treatment the serum levels of IL-1β,IL-6 and TNF-αwere significantly lower than those in the controlled group(P<0.05).Conclusion:The clinical efficacy of Huoxue Tongluo Decoction based on“Xuanfu Theory”in the diagnosis and treatment of blood stasis type lumbar disc herniation is significantly improved compared with the controlled group.Using Huoxue Tongluo Decoction in the treatment of lumbar disc herniation can inhibit the expression level of inflammatory related factors and the JOA and VAS scores,and significantly improve the hemorheological indexes,suggesting that the treatment of lumbar disc herniation with integrated traditional Chinese and western medicine can achieve more significant benefits than the treatment of western medicine.