中药内外治结合对放射性骨髓炎的疗效

The Curative Effect of Radioactive Osteomyelitis with Internal and External Combination Therapy of Chinese Medicine

目的:观察中药内外治结合疗法对慢性放射性骨髓炎的临床疗效及机制。方法:120例慢性放射性骨髓炎患者随机均分为中药组(采用中药内外治结合疗法治疗)与对照组(采用高压氧治疗),于治疗前和治疗4个疗程时,对两组患者进行疼痛评分;于治疗4个疗程时比较两组患者的治疗效果,同时检测血清中血管生成指标转化生长因子β1(TGF-β1)、血管内皮生长因子(VEGF)、肿瘤坏死因子(TNF-α)、白细胞介素-4(IL-4)及IL-6水平。结果:治疗前,两组患者疼痛评分比较,差异无统计学意义(P>0.05);与治疗前比较,治疗4个疗程时两组患者疼痛评分均明显降低,中药组疼痛评分降低更明显(P<0.05);治疗4个疗程时,中药组患者完全治愈及显效人数和总有效率均高于对照组(P<0.05);与对照组比较,中药组血清TGF-β1、VEGF及IL-4水平升高,而TNF-α及IL-6水平降低(P<0.05)。结论:中药内外治结合疗法对慢性放射性骨髓炎的疗效优于高压氧治疗,其治疗机制可能与TGF-β1、VEGF及IL-4水平升高,而TNF-α及IL-6水平降低有关。

Objective： To observe the clinical efficacy and mechanism of internal and external thera- pies with Chinese medicine in the treatment of chronic radioactive osteomyelitis. Methods： 120 cases of chronic radioactive osteomyelitis were randomly divided into two groups： Traditional Chinese medi- cine treated with internal and external therapy with Chinese medicine group, and control group （trea- ted with hyperbaric oxygen）. The pain scores of the two groups were evaluated before and after 4 cour- ses of treatment. The therapeutic effects of the two groups were compared in 4 courses of treatment, and serum angiogenesis index of transforming growth factor β （ TGF-β1 ）, vascular endothelial growth factor （VEGF）, tumor necrosis factor（TNF-α）, interleukin -4 （IL4） and the level of IL-6 were de- tected. Results： Before treatment, the pain index of the two groups was compared, and the difference was not statistically significant （ P 〉 0.05 ）. Compared before treatment, the pain index of the two groups decreased significantly in the 4 groups, and the pain index in the Chinese medicine group de- creased more obviously（P 〈 0.05 ）. In the course of 4 courses, the complete healing and total effective rate of Chinese medicine group were higher than that of the control group（P 〈 0.05）. Compared with the control group, the serum TGF-β1, VEGF and the level of IL4 in Chinese medicine group in- creased, while TNF-α and the level of IL-6 decreased（P 〈0.05）. Conclusions： The combination of Chinese medicine internal and external therapy for chronic radioactive osteomyelitis is better than hy- perbaric oxygen therapy. The therapeutic mechanism may be related to the increased level of TGF-β1, VEGF and IL-4 as well as the decreased level of TNF-et and IL-6.