温针灸联合穴位放血治疗腰椎间盘突出症疗效及对炎症因子、β-EP的影响

Effect of Warm Acupuncture Combined with Acupoint Bloodletting in the Treatment of Lumbar Disc Herniation and its Influence on Inflammatory Factors and β-EP

目的探讨温针灸联合穴位放血治疗腰椎间盘突出症(lumbardischerniation,LDH)的临床疗效。方法将70例LDH患者按照随机数字表法分为2组,每组35例,对照组予以温针灸治疗,观察组予以温针灸联合穴位(委中、腰阳关)放血治疗。疗程均为4周。比较两组治疗前后McGill疼痛询问量表(McGill pain questionnaire,MPQ)评分、日本骨科协会(Japanese orthopaedic association,JOA)下腰痛疾患评分,比较两组血清IL-1β、IL-6、β-内啡肽(β-endorphin,β-EP)水平,比较两组临床疗效。结果与治疗前比较,治疗后两组疼痛评级指数A(pain rating index A,PRI A)、疼痛评级指数S(pain rating index S,PRI S)、疼痛视觉模拟评分(visual analogue scale,VAS)和现在疼痛状况(present pain intensity,PPI)评分均降低(P<0.01),主观症状、临床体征、日常活动受限评分均升高(P<0.01),血清IL-1β、IL-6水平降低(P<0.01),β-EP水平升高(P<0.01);治疗后,观察组PRI A、PRI S、VAS、PPI评分低于对照组(P<0.01),主观症状、临床体征、日常活动受限评分高于对照组,血清IL-1β、IL-6水平低于对照组(P<0.01),β-EP水平高于对照组(P<0.01);观察组临床疗效优于对照组(P<0.05)。结论温针灸联合穴位放血可有效缓解腰腿部疼痛及相关症状,改善腰椎功能,治疗LDH效果显著,其作用机制可能与抑制炎症因子表达,上调β-EP表达有关。

Objective To investigate the clinical efficacy of warm acupuncture combined with acupoint bloodletting in the treatment of lumbar disc herniation(LDH).Methods 70 patients with LDH were divided into two groups according to the digital random table method,with 35 patients in each group.The control group were treated with warm acupuncture,the observation group were treated with warm acupuncture combined with bloodletting at acupoints[Weizhong(BL40)and Yaoyangguan(DU3)].The course of treatment was for 4 weeks.The scores of McGill pain inquiry scale(MPQ)and low back pain disease score in Japanese Orthopaedic Association(JOA)were compared between the two groups before and after treatment,and the serum levels of IL-1β,IL-6 andβ-endorphin(β-EP)were compared between the two groups before and after treatment.Results Compared with before treatment,the pain rating index A(PRI A),pain rating index S(PRI S),visual analogue scale(VAS)and present pain intensity(PPI)decreased(P<0.01),subjective symptoms,clinical signs,and the daily activity restriction score increased(P<0.01),and the levels of serum IL-1β、IL-6 decreased(P<0.01),β-EP level increased(P<0.01);the scores of PRI A,PRI S,VAS and PPI of the observation group were lower than those of the control group(P<0.01),subjective symptoms,clinical signs,and the daily activity restriction score were higher than those of the control group,and the levels of serum IL-1βand IL-6 were lower than those of the control group(P<0.01),the level ofβ-EP was higher than that of the control group(P<0.01);the clinical effect of the observation group was better than that of the control group(P<0.05).Conclusion Warm acupuncture combined with acupoint bloodletting can effectively relieve the pain and related symptoms of waist and leg,improve the lumbar function,and it has a significant effect on LDH.The mechanism of action may be related to the inhibition of inflammatory factor expression and the up-regulation ofβ-EP expression.