附子汤合芍药甘草汤加味离子导入治疗寒湿瘀阻证非特异性下腰痛

Clinical Effect of Iontophoresis Therapy of Fuzitang Combined with Shaoyao Gancaotang on Non-specific Low Back Pain

目的:评价附子汤合芍药甘草汤加味离子导入治疗非特异性下腰痛(NLBP)寒湿瘀阻证的临床疗效及对白细胞介素-1β(IL-1β),血栓素2(TXB2),6-酮前列腺素F_(lα)(6-Keto-PGF_(lα)),降钙素基因相关肽(CGRP),血管活性肠肽(VIP)的影响。方法:将176例患者以入诊先后顺序随机按数字表法分为对照组和观察组。对照组采用腰腿痛丸+电针治疗,观察组采用附子汤合芍药甘草汤离子导入+电针。两组疗程均为治疗4周。进行治疗前后简化McG ill疼痛量表(SF-MPQ),压痛情况评分,并进行压痛和痛阈值的测量;功能情况采用日本骨科协会(JOA)法评估;进行寒湿瘀阻证和总体感觉(PGIC)评价;检测治疗前后IL-1β,TXB2,6-Keto-PGF_(lα),CGRP和VIP水平;进行安全性评价。结果:观察组JOA总改善率为95.18%,高于对照组的83.95%(χ~2=5.564,P<0.05);观察组疼痛感觉评分、疼痛情绪评分、疼痛总分、目测类比疼痛评分和现在疼痛状况评分均低于对照组(P<0.01);观察组硬度值低于对照组,压痛和中医证候评分均低于对照组,痛阈值高于对照组(P<0.05,P<0.01);观察组JOA量表主观症状、临床体征、日常活动受限度及总分均高于对照组(P<0.01);观察组PGIC"明显好转"的患者为68.67%,多于对照组的50.62%(χ~2=5.558,P<0.05);观察组IL-1β,TXB2,CGRP和VIP水平均低于对照组,6-KetoPGF_(lα)高于对照组(P<0.01)。结论:采用附子汤合芍药甘草汤加味离子导入治疗NLBP寒湿瘀阻证患者,能改善血液循环,促进腰部功能的恢复,减轻疼痛,提高患者活动能力。

Objective： To evaluate the clinical efficacy of iontophoresis therapy of Fuzitang combined with Shaoyao Gancaotang on non-specific low back pain（ NLBP） cold dampness and blood stasis syndrome and investigate its effects on levels of interleukin-1β（ IL-1β）,thromboxane 2（ TXB2）,6-keto prostaglandin F_（lα）（ 6-Keto-PGF_（lα））,calcitonin gene related peptide（ CGRP）,and vasoactive intestinal peptide（ VIP）. Method：One hundred and seventy-six patients were randomly divided into control group and observation group by random number table. Patients in control group received Yaotuitong pills ＋ electroacupuncture,and patients in observation group received Fuzitang,Shaoyao Gancaotang combined with electroacupuncture. The treatment course was 4weeks for both groups. Before and after treatment,scores of tenderness condition in simplified Mc Gill pain scale（ SF-MPQ） were graded,and the tenderness and pain thresholds were measured. functions were evaluated by usingJapan orthopedics association（ JOA） method, and patients＇ global impression of change（ PGIC） and cold dampness and blood stasis syndrome were evaluated discussed. In addition,levels of IL-1β,TXB2,6-Keto-PGF_（lα）,CGRP and VIP were detected,and safety evaluation was conducted. Result： The total amelioration rate of JOA was 95. 18% in observation group,higher than 83. 95% in control group（ χ~2= 5. 564,P〈0. 05）. Scores of the pain feeling,pain emotion,visual analog pain,current pain conditions and total pain score in the observation group were all lower than those in control group（ P〈0. 01）. The hardness value,tenderness and traditional Chinese medicine（ TCM） syndrome scores were lower than those in in control group,but pain threshold value was higher than that in control group（ P〈0. 05 and P〈0. 01）. Scores of subjective symptoms,clinical symptoms,limitation of daily activities,and the total sore of JOA scale in observation group were higher than those in control group（ P〈0. 01）. In addition,the markedly improved rate was 68. 67% in observation group,higher than 50. 62% in control group（ χ~2= 5. 558,P〈0. 05）,and the levels of IL-1β,TXB2,CGRP and VIP were lower than those in control group,while 6-Keto-PGF_（lα）was higher than that in control group（ P〈0. 01）. Conclusion： Iontophoresis therapy of electroacupuncture combined with Fuzitang and modified Shaoyao Gancaotang can relieve patients＇ pain,promote the recovery of lumbar function and improve activity ability in the patients with non-specific low back pain with cold dampness and blood stasis syndrome.