加味乌附麻辛桂姜汤治疗慢性非特异性下腰痛寒湿瘀阻证的临床观察

Clinical Observation of Modified Wufu Maxin Guijiang Decoction Treatment to Chronic Nonspecific Low Back Pain(NLBP) with Syndrome of Cold Dampness and Stasis

目的:观察加味乌附麻辛桂姜汤治疗慢性非特异性下腰痛(NLBP)寒湿瘀阻证的近期和远期疗效及作用机制。方法:将119例符合要求患者按随机数字表分为对照组和观察组。对照组59例采用针刺+普拉提运动。观察组60例在对照组治疗的基础上服用加味乌附麻辛桂姜汤,1剂/d。两组疗程均为连续治疗6周。进行治疗前后简化McGill疼痛量表(SF-MPQ)[包括疼痛分级指数(PRI),疼痛视觉模拟评分(VAS)和现在疼痛状况(PPI)],Oswestry功能障碍指数(ODI),日本骨科协会下腰痛量表(JOA)和寒湿瘀阻证评分,治疗后患者行自我疗效评估;检测治疗前后肿瘤坏死因子-α(TNF-α),血栓素2(TXB2),6-酮-前列腺素Fla(6-Keto-PGFla)和白细胞介素-1β(IL-1β)水平。结果:经秩和检验,治疗后观察组临床疗效优于对照组(Z=2. 226,P <0. 05),自我疗效评估也优于对照组(Z=2. 104,P <0. 05);治疗后观察组SF-MPQ量表PRI,VAS和PPI评分均低于对照组(P <0. 01);观察组患者JOA量表评分高于对照组(P <0. 01),寒湿瘀阻证评分和ODI量表评分均低于对照组(P <0. 01);观察组患者TNF-α,IL-1β,TXB2水平均低于对照组(P <0. 01),6-Keto-PGFla高于对照组(P <0. 01),TXB2/6-Keto-PGFla低于对照组(P <0. 01)。结论:在针刺和运动疗法的基础上,采用加味乌附麻辛桂姜汤治疗慢性NLBP,近期能改善疼痛等症状,促进患者功能恢复,提高日常生活能力,远期能稳定病情,减少复发,并具有一定抗炎、镇痛作用。

Objective:To observe the short-term and long-term clinical effect of modified Wufu Maxin Guijiang decoction treatment to chronic nonspecific low back pain(NLBP)with syndrome of cold dampness and stasis,and to investigate the mechanism of anti-inflammatory and analgesia.Method:One hundred and nineteen eligible patients were randomly divided into control group(59 cases)and observation group(60 cases)by random number table.Patients in control group got acupuncture treatment and pilates.Based on the treatment in control group,patients in observation received additional modified Wufu Maxin Guijiang decoction,1 dose/day.The course of treatment was 6 weeks in both groups.Before and after treatment,scores of short-form McGill pain questionnaire(SF-MPQ),Oswestry disability index(ODI),Japanese orthopaedic association(JOA)and syndrome of cold dampness were graded.After treatment,the patients made self efficacy assessment.Levels of thromboxane 2(TXB2),6-Keto-PGFla,tumor necrosis factor-α(TNF-α)and interleukins-1β(IL-1β)were detected both before and after treatment.Result:After treatment,the rank sum test showed that the clinical efficacy in observation group was better than that in control group(Z=2.226,P<0.05),and the self efficacy assessment showed the efficacy in observation group was also better than that in control group(Z=2.104,P<0.05).Scores of SF-MPQ,PRI,VAS,PPI,ODI and syndrome of cold dampness and stasis in observation group were all lower than those in control group(P<0.01),and score of JOA was higher than that in control group(P<0.01).Levels of TXB2,TNF-α and IL-1β and TXB2/6-Keto-PGFlawere lower than those in control group(P<0.01),and the level of 6-Keto-PGFlawas higher than that in control group(P<0.01).Conclusion:Based on the acupuncture treatment and pilates,modified Wufu Maxin Guijiang decoction in the treatment of chronic NLBP can ameliorate symptoms of pain,promote the recovery of function,and enhance activity of daily living in a short term,reduce the recurrence and stabilize the disease condition in a long term,with certain effects of antiinflammatory and analgesia.