加味羌活汤内服和离子导入治疗风寒湿痹证神经根型颈椎病67例临床分析

Clinical Effects of Jiawei Qianghuo Decoction Combined with Iontophoresis in Treating Cervical Spondylotic Radiculopathy with Anemofrigid-damp Arthralgia Syndrome

目的:观察加味羌活汤内服和离子导入治疗神经根型颈椎病(CSR)风寒湿痹证的临床疗效及其对患者血清白介素-1β(interleukin-1β,IL-1β)和肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平的影响。方法:将134例CSR患者随机按数字表法分为对照组和治疗组各67例。对照组使用根痛平颗粒口服,8 g/1次,2次/d,同时进行颈椎按摩手法放松、牵引,20 min/次,1次/d;治疗组采用加味羌活汤,1剂/d,水煎煮,分早晚分2次内服,同时将另1剂加味羌活汤研成粗粉,用75%乙醇浸泡1个月,用时取汁液加热10 min,用离子导入治疗,25 min/次,1次/d。两组疗程均为4周。比较两组临床疗效,采用颈椎病临床评价量表(CASCS),评价两组患者主观症状、适应能力和临床体征,疼痛分级指数(PRI)评价两组患者疼痛,分析两组患者治疗前后血清IL-1β和TNF-α含量变化。结果:治疗组总有效率为91.04%,优于对照组总有效率的77.61%(P<0.05);治疗组治疗后CASCS各项评分和总评分明显高于对照组(P<0.05);治疗组治疗后临床症状和PRI评分较对照组均明显下降(P<0.05);治疗组治疗后血清IL-1β,TNF-α含量均低于对照组(P<0.05)。结论:加味羌活汤内服和离子导入治疗CSR风寒湿痹证神经根型颈椎病可改善临床症状、体征和适应能力,减轻疼痛,降低血清IL-1β和TNF-α含量,具有良好的临床疗效。

Objective： To observe the clinical efficacy of Jiawei Qianghuo decoction combined with lonphoresis in the treatment of cervical spondylotic radiculopathy（ CSA） with anemofrigid-damp arthralgia syndrome and its influence on hemorheology and interleukin-1 beta（ IL-1β） and tumor necrosis factor alpha（ TNF-α） in serum. Method： One hundred and thirty four patients with CSA were randomly divided into control group and treatment group according to number table,with 67 patients in each group. The control group was treated with Gentongping granule（ 8 g /1 time and 2 times / d） and massage manipulation with relax and traction on cervical vertebra（ 20 min /1 time and 1 time / d）. Treatment group was given with additional Jiawei Qianghuo decoction（ 1dose / d and oral,bid） and another Jiawei Qianghuo decoction was grinded into coarse powder,soaked in 75% wine for 1 month and heated for 10 min when it is used by iontophoresis（ 25 min / time,qd）. The treatment course was4 weeks for both groups. Clinical effect of both groups was compared. Subjective symptoms,adaptability,and clinical physical signs were assessed by the clinical assessment scale for cervical spondylosis（ CASCS）. Pain rating index（ PRI） was adopted to evaluate the pain in both groups. IL-1β and TNF-α changes before and after treatment were analyzed in both groups. Result： The total effective rate of the treatment group and control group was91. 04% and 77. 61% respectively,with significant difference between two groups（ P〈0. 05）. Each and total scores for CASCS in treatment group after treatment were higher than those in control group（ P〈0. 05）. Clinical symptoms and PRI scores in treatment group after treatment were significantly lower than those in control group（ P〈0. 05）. After treatment IL-1β and TNF-α in serum in treatment group were lower than those in control group（ P〈0. 05）. Conclusion： Oral Jiawei Qianghuo decoction combined with iontophoresis can improve clinical symptoms,physical signs and adaptability,relieve pain and reduce IL-1β and TNF-α in serum,with a good therapeutic effect.