针刺联合腰椎定点旋转复位治疗气滞血瘀型腰椎间盘突出症疗效及对患者炎症介质、血液流变学的影响

Clinical effect of acupuncture combined with lumbar fixed-point rotation reduction in the treatment of lumbar disc herniation with qi stagnation and blood stasis type and its influence on inflammatory mediators and hemorheology

目的观察针刺联合腰椎定点旋转复位治疗气滞血瘀型腰椎间盘突出症疗效及对患者炎症介质、血液流变学的影响。方法将120例腰椎间盘突出症患者按照随机数字表法分为2组。对照组60例予针刺疗法治疗;观察组60例在对照组治疗基础上加用腰椎定点旋转复位疗法治疗。2组均2周为1个疗程,2个疗程后统计临床疗效,并观察2组治疗前后Oswestry功能障碍指数(ODI)评分、疼痛视觉模拟评分(VAS)、中医证候评分及炎症介质[血清肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)、环氧合酶-2(COX-2)、前列腺素E 2(PGE 2)]和血液流变学[全血黏度(高切、低切)、血浆黏度、红细胞聚集指数]水平。结果观察组总有效率93.33%(56/60),对照组总有效率78.33%(47/60),观察组临床疗效优于对照组(P<0.05)。治疗后2组ODI评分、疼痛VAS、中医证候各项评分及总评分均较本组治疗前降低(P<0.05),且观察组均低于对照组(P<0.05)。治疗后2组血清TNF-α、IL-1β、COX-2及PGE 2水平均低于本组治疗前(P<0.05),且观察组均低于对照组(P<0.05)。治疗后2组全血黏度(高切、低切)、血浆黏度及红细胞聚集指数均较本组治疗前降低(P<0.05),且观察组均低于对照组(P<0.05)。结论针刺联合腰椎定点旋转复位治疗气滞血瘀型腰椎间盘突出症疗效确切,能提高患者腰椎功能,缓解疼痛,其作用机制可能与抑制血清炎症介质生成、改善血液流变学状态有关。

Objective To observe the effect of acupuncture combined with lumbar fixed-point rotation reduction in the treatment of lumbar disc herniation with qi stagnation and blood stasis type and its influence on inflammatory mediators and hemorheology.Methods 120 patients with lumbar disc herniation were randomly divided into two groups according to the random number table method.60 cases in control group were treated by acupuncture.60 cases in observation group were treated by lumbar fixed-point rotation reduction on the basis of the control group.Both groups were treated for one course of treatment for two weeks.After two courses of treatment,the clinical effect was observed,and the Oswestry dysfunction index(ODI),pain visual analogue score(VAS),TCM syndrome score,inflammatory mediators[tumor necrosis factorα(TNF-α),interleukin-1β(IL-1β),cyclooxygenase-2(COX-2),prostaglandin E 2(PGE 2)]and hemorheology[whole blood viscosity(high cut,low cut),plasma viscosity,RBC aggregation index]were observed before and after treatment.Results The total effective rate of the observation group was 93.33%(56/60),and that of the control group was 78.33%(47/60).The clinical effect of the observation group was better than that of the control group(P<0.05).After treatment,the ODI score,pain VAS score,TCM syndrome scores and total scores of the two groups were all decreased(P<0.05),and the observation group was lower than the control group(P<0.05).After treatment,the levels of TNF-α,IL-1β,COX-2 and PGE 2 in the two groups were lower than those in the group before treatment(P<0.05),and the observation group was lower than the control group(P<0.05).After treatment,the whole blood viscosity(high cut,low cut),plasma viscosity and red blood cell aggregation index of the two groups were decreased(P<0.05),and the observation group was lower than the control group(P<0.05).Conclusion Acupuncture combined with lumbar fixed-point rotation reduction is effective in the treatment of lumbar disc herniation with qi stagnation and blood stasis type,and can improve the lumbar function and relieve pain,which may be related to the inhibition of serum inflammatory mediators and the reduction of whole blood viscosity.