针药并用治疗脊髓亚急性联合变性临床观察及其机制研究

Clinical Observation of Acupuncture Combined with Medication in Treating Subacute Combined Degeneration of Spinal Cord and Mechanism Study

目的观察针药并用治疗脊髓亚急性联合变性的临床疗效,探究其可能的疗效机制。方法选择脊髓亚急性联合变性患者86例作为研究对象,根据入组顺序编号,采用随机数字表法将其分为对照组和观察组,每组43例。对照组予以常规西医治疗,观察组在对照组基础上予以针刺及中药治疗。两组患者治疗前后均行神经肌电图检测、血清维生素B12(VB12)、甲基丙二酸(MMA)及同型半胱氨酸(Hcy)水平检测,同时对两组患者治疗前后行神经系统损伤(步态,对温、痛、振动、关节位置等感觉障碍,锥体束受累)评估。收集两组患者治疗期间不良反应。比较两组临床总有效率。结果两组治疗后运动神经及感觉神经电生理异常率均较治疗前明显下降(P<0.05),且观察组异常率低于对照组(P<0.05)。两组治疗后血清VB12均较治疗前上升(P<0.05),且观察组高于对照组(P<0.05);两组治疗后血清MMA、Hcy水平低于治疗前(P<0.05),且观察组低于对照组(P<0.05)。两组治疗后步态、感觉障碍、锥体束受累评分均较治疗前下降(P<0.05),且观察组低于对照组(P<0.05)。观察组总有效率高于对照组(P<0.05)。两组患者治疗期间药物不良反应率比较差异无统计学意义(P>0.05)。结论针药并用治疗脊髓亚急性联合变性更利于患者神经系统损伤恢复,提高临床疗效,可能与针药并用更利于患者血清VB12、MMA、Hcy恢复正常水平有关。

Objective To observe the clinical efficacy of acupuncture plus medication in treating subacute combined degeneration of spinal cord and to explore the plausible mechanism in achieving efficacy.Method Eighty-six patients with subacute combined degeneration of spinal cord were recruited as subjects and coded according to their recruitment sequence.They were divided into a control group and an observation group using the random number table method,with 43 cases in each group.The control group was given conventional Western medicine treatment,while the observation group was given additional acupuncture and Chinese medication.Before and after treatment,the two groups both received nerve electromyographical examination and detection of serum levels of vitamin B12(VB12),methylmalonic acid(MMA)and homocysteine(Hcy);meanwhile,the two groups of patients also underwent the evaluation of nervous system injures(gait,dysfunctions in sensing temperature,pain,vibration and joint location,etc.and pyramidal tract manifestations).The adverse reactions that occurred in the two groups during treatment were collected.The clinical total efficacy was compared between the two groups.Result The abnormality rates in motor nerve and sensory nerve electrophysiological examinations dropped notably after treatment in both groups(P<0.05),and were lower in the observation group than in the control group(P<0.05).After treatment,the serum VB12 increased in both groups(P<0.05),and was higher in the observation group than in the control group(P<0.05);after treatment,the serum levels of MMA and Hcy dropped in both groups(P<0.05),and were lower in the observation group than in the control group(P<0.05).The scores of gait,sensory dysfunctions and pyramidal manifestations declined after treatment in both groups(P<0.05),and were lower in the observation group than in the control group(P<0.05).The total effective rate in the observation group was higher than that in the control group(P<0.05).There was no significant difference in the drug-induced adverse reactions between the two groups during treatment(P>0.05).Conclusion In treatment of subacute combined degeneration of spinal cord,acupuncture combined with medication is more beneficial to the recovery of the nervous system injuries and can enhance the clinical efficacy,which may be associated with its more significant effects in correcting the abnormal levels of VB12,MMA and Hcy in serum.