强直性脊柱炎早中期腰背痛的中医干预研究

Research on Treating Early Middle of Ankylosing Spondylitis Patients with Low Back Pain with Traditional Chinese Medicine Intervention

目的:研究强直性脊柱炎早中期腰背痛采用中医干预的临床效果。方法:将2010年1月—2015年12月本院收治的早中期强直性脊柱炎患者86例按照随机数字表法分为对照组和观察组患者各43例。对照组患者口服柳氮磺胺吡啶片,观察组则采用强督活络经验汤剂内服进行中医干预,2周为1个疗程,连续用药6个疗程。对比两组干预的临床效果,用疼痛视觉模拟评分(VAS)对腰脊、关节痛感进行评价,评估脊柱功能的改善情况,监测血液流变及血清肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-17(IL-17)、基质金属蛋白酶-9(MMP-9)水平变化。结果:与对照组72.1%相比,观察组有效率为93.0%,显著升高(χ~2=6.541,P<0.05);治疗后与对照组相比,观察组患者的腰脊、关节痛感评分均显著降低(P<0.05);观察组患者治疗后的脊柱功能改善优于对照组,其脊柱活动度、胸廓活动度评分与对照组相比显著升高,而疾病活动指数(BASDAI)、功能指数(BASFI)则显著降低(P<0.05);观察组患者经治疗后的血液流变指标及血清因子TNF-α、IL-6、IL-17、MMP-9水平显著低于对照组患者(P<0.05)。结论:中医干预强直性脊柱炎早中期腰背痛患者疗效肯定,能明显减轻患者的腰脊、关节痛感,提高脊柱功能,其机制可能与改善局部患处血液微循环、调控TNF-α、IL-6、IL-17、MMP-9等因子水平有一定相关性,值得临床深入研究。

Objective：To investigate the clinical efficacy of treating early middle of ankylosing spondylitis patients with low back pain with raditional Chinese medicine intervention. Methods ： A total of 86 ankylosing spondylitis patients were randomly di- vided into a control group of 43 cases and an observation group of 43 cases from January 2010 to December 2015. Patients in the control group were treated with sulfasalazine tablets while those in the observation group were treated with qiangduhuoluo decoc- tion,2 weeks for a course,6 courses for treatment. The research was aimed at comparing the effectiveness,evaluating the patients＇ lumbar spine and joint pain with VAS scores, observing the improvement of spinal function, and monitoring the change of hemody- namic indexes ,TNF- α,IL- 6, IL- 17 and MMP- 9 levels. Results：The efficiency of patients in the observation group was 93. 0% ,which was higher than the control group＇s 72.1% （X^2 = 6. 541 ,P 〈0.05）. The VAS scores of lumbar spine and joint pain for patients in the observation group after treatment were lower than that of the control group（ P 〈 0. 05 ）. The improvement of pa- tients＇ spinal function for patients in the observation group was better than that of the control group, and the spinal motion and tho- racic spine mobility activity scores were higher than that of the control group. The BASDAI and BASFI were lower than that of the control group（ P 〈 0. 05 ）. The hemodynamic indexes ,TNF-α, IL- 6, IL- 17 and MMP- 9 levels of the patients in the observa- tion group were lower than that of the control group after treatment （ P 〈 0. 05 ）. Conclusion ： The therapy has definite curative effect. It is good to relieve the patients＇ lumbar spine and joint pain and improve the spinal function. The mechanism may be asso- ciated with improving the local blood microcirculation and regulating the levels of TNF-α, IL-6, IL-17 and MMP-9, worthy of clinical investigation.