强腰宣痹方内服与热熨治疗退行性腰椎管狭窄症47例

Qiangyao Xuanbi Decoction Orally Formula and Ironing in Treatment of 47 Cases with Degenerative Lumbar Spinal Stenosis

目的：探讨强腰宣痹方内服与热熨治疗退行性腰椎管狭窄症（DLSS）的疗效及对血液流变学和血清炎性因子的影响。方法：将95例DLSS患者随机按数字表法分为对照组48例和中药组47例。对照组给予氨糖美辛肠溶片,1～2片/次,2次/d。中药组采用内服和热熨治疗,两组疗程均为4周。观察两组行走能力;进行腰腿疼痛直观模拟（VAS）评分;整体症状采用日本矫形外科学会（JOA）评分;检测治疗前后血液流变学和血清炎性炎子,包括白细胞介素-1β（IL^-1β）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）和C-反应蛋白（CRP）。结果：中药组优良率为76.6%,对照组为56.25%,中药组优于对照组（P〈0.05）;治疗后两组行走能力和腰腿疼痛VAS评分均比治疗前下降（P〈0.01）,JOA评分较治疗前上升（P〈0.01）;随访期两组行走能力和腰腿疼痛VAS评分比治疗后升高（P〈0.05）,JOA评分比治疗后下降（P〈0.05）;中药组在治疗后和随访期行走能力评分和腰腿疼痛VAS评分低于对照组（P〈0.01）,JOA评分高于对照组（P〈0.01）;治疗后中药组血液流变学指标全血黏度、血浆黏度、纤维蛋白原和红细胞压积的改善均优于对照组（P〈0.01）;中药组治疗后CRP,IL-6,IL^-1β和TNF-α水平低于对照组（P〈0.01）。结论：强腰宣痹方内服与热熨治疗DLSS能缓解临床症状、提高患者生活能力,其作用机制可能改善血液循环,抑制炎性物质,减轻炎性损伤有关。

Objective： Discuss curative effect of conservative treatment of using Qiangyao Xuanbi decoction through taken orally and hot compress to cure degenerative lumbar spinal stenosis（DLSS） and influence to hemorheology and serous inflammatory factor. Method： Ninety-five patients with DLSS were randomly divided into control group（48 cases） and Chinese medicine group（47 cases）. In control group received glucosomine and indomethacin erterucoated tablets,1-2 tablets /time,2 times /day. Patients in control group received chinese herbs orally and ironing with Chinese medicine, course of treatment in two groups were both 4 weeks.Patients＇ stepping abilities in two groups were observed. Visual analogue scales（VAS） of lumbar and leg ache in two groups were graded. The overall symptoms were graded by Japan orthopedic assoctation（JOA） scales. Before and after treatment,hemorheology and serous inflammatory factor were detected,which including interleukin-1β（IL-1β）,interleukin-6（IL-6）,tumor necrosis factor（TNF-α） and C-reactive protein（CRP）. Result： The excellent rate in Chinese medicine group was 76. 6% superior to 56. 25% control group（P〈0. 05）. After treatment,compared with the time before treatment,scores of stepping abilities and VAS of lumbar and leg ache in two groups decreased（P〈0. 01）,and JOA scores increased（P〈0. 01）. In follow-up period,scores of stepping abilities and VAS of lumbar and leg ache in two groups increased（P〈0. 01）,and JOA scores decreased at the same time（P〈0. 01）. After treatment and in follow-up period,stepping abilities and VAS of lumbar and leg ache in Chinese medicine group were lower than those in control group（P〈0. 01）,and score of JOA was higher than in control group（P〈0. 01）. Amelioration of whole blood viscosity（low shear and high shear）,plasma viscosity,fibrinogen and hematokrit of hemodynamic indexes in Chinese medicine group were superior to those in control group（P〈0. 01）. Levels of CRP,IL-6,IL-1βand TNF-α in Chinese medicine group were lower than those in control group（P〈0. 01）. Conclusion： Conservative treatment of Qiangyao Xuanbi decoction curing degenerative lumbar spinal stenosis can remit clinical symptoms and improve the abilities of patients＇ lives,its＇ mechanism of action may be related to ameliorating blood circulation,restraining inflammatory substances and relieving inflammatory injury.