麻黄附子细辛汤加味治疗寒湿型腰椎间盘突出症的疗效观察

Effect of modified Mahuang Fuzi Xixin Decoction in the treatment of cold-wet type lumbar disc herniation

目的:探讨麻黄附子细辛汤加味治疗寒湿型腰椎间盘突出症(LDH)的疗效及机制。方法:选择寒湿型LDH病人130例,随机均分为观察组与对照组,各65例。对照组采用西药、牵引等常规治疗,观察组在对照组基础上给予麻黄附子细辛汤加味治疗,连续治疗6周。比较治疗前后Oswestry功能障碍指数(ODI)、疼痛视觉模拟(VAS)评分、日本骨科协会评估治疗分数(JOA)评分和血清疼痛介质、炎性因子水平及中医证候积分,并评价综合疗效。结果:治疗后2组病人VAS评分、ODI均较治疗前明显降低,JOA评分明显增加(P<0.01),且观察组VAS评分、ODI均明显低于对照组,JOA评分明显高于对照组(P<0.01)。治疗后2组血清白细胞介素1β、肿瘤坏死因子α、前列腺素E2、5-羟色胺水平均明显降低(P<0.01),且观察组以上指标均明显低于对照组(P<0.01)。治疗后2组腰腿疼痛、遇寒痛增、屈伸不利、麻木发凉、夜间疼痛等中医证候积分均明显降低,且观察组均明显低于对照组(P<0.01)。观察组治疗总有效率为91.11%(59/65),高于对照组的77.78%(50/65)(P<0.05)。结论:常规治疗基础上给予麻黄附子细辛汤加味治疗能有效改善寒湿型LDH腰腿痛症状,提高短期疗效,可能与麻黄附子细辛汤降低炎症反应及疼痛介质水平有关。

Objective:To investigate the effects of modified Mahuang Fuzi Xixin Decoction in the treatment of cold-wet type lumbar disc herniation(LDH),and its mechanism.Methods:A total of 130 patients with cold-wet type LDH were randomly divided into the observation group and the control group(65 cases in each group).The control group was treated with conventional treatments such as western medicine and traction,and the observation group was additionally treated with modified Mahuang Fuzi Xixin Decoction based on the control group for 6 weeks.The Oswestry dysfunction index(ODI),pain visual analogue(VAS)score,JOA Low Back Pain Score,levels of serum pain mediator and inflammatory factors,and TCM syndrome score in two groups before and after treatment were compared,and the comprehensive efficacy in two groups was evaluated.Results:After treatment,the VAS score and ODI significantly decreased,and the JOA score significantly increased in two groups compared with before treatment(P<0.01).After treatment,the VAS score and ODI in observation group were significantly lower than those in control group,and the JOA score in observation group was significantly higher than that in control group(P<0.01).After treatment,the serum levels of interleukin-1β(IL-1β),tumor necrosis factorα(TNF-α),prostaglandin E2(PEG2),and serotonin(5-HT)significantly decreased in two groups,and wich in observation group were significantly lower than those in control group(P<0.01).After treatment,the scores of TCM syndromes(such as waist and leg pain,cold pain increasing,unfavorable flexion and extension,numbness and coldness,nighttime pain)in two groups significantly decreased,and which in observation group was significantly lower than that in control group(P<0.01).The total effective rate in observation group(91.11%)was significantly higher than that in control group(77.78%)(P<0.05).Conclusions:On the basis of conventional treatment,the treatment of modified Mahuang Fuzi Xixin Decoction can effectively improve the symptoms of cold-wet type LDH low back pain,and improve the short-term curative effect,which may be related to the decreasing of inflammatory reaction and pain medium level induced by modified Mahuang Fuzi Xixin Decoction.