身痛逐瘀汤加减治疗急性期椎间盘源性腰痛风寒瘀阻证的临床观察

Clinical Efficacy of Modified Shentong Zhuyutang in Treatment of Acute Discogenic Low Back Pain Due to Wind-Cold and Stasis Obstruction Syndrome

目的:评价身痛逐瘀汤加减联合塞来昔布胶囊治疗急性期椎间盘源性腰痛(DLBP)风寒瘀阻证的疗效及抗炎、镇痛作用。方法:将140例符合要求的患者按随机数字表法分为对照组和观察组各70例。两组患者均口服塞来昔布胶囊,200 mg/次,1次/d;对照组口服通络活血胶囊,6粒/次,3次/d;观察组口服身痛逐瘀汤加减,1剂/d;两组疗程均为3周。进行治疗前后简化Mc Gill疼痛量表(SF-MPQ),SF-MPQ含疼痛分级指数(PRI),现时疼痛强度(PPI)和视觉模拟量表(VAS)3个因子;评价Oswestry功能障碍指数(ODI),风寒瘀阻证、日常生活能力(ADL)评分和Schober试验;检测治疗前后肿瘤坏死因子-α(TNF-α),白细胞介素-1β(IL-1β),IL-6,血栓素B2(TXB2)和6-酮-前列腺素F1α(6-keto-PGF1α)水平;进行安全性评价。结果:治疗后,观察组SF-MPQ量表各维度(PRI,VAS和PPI)评分均低于对照组(P<0.01);观察组风寒瘀阻证和ODI评分均低于对照组(P<0.01),ADL评分和Schober试验均高于对照组(P<0.01);观察组TNF-α,IL-1β,IL-6和TXB2水平均低于对照组(P<0.01);6-keto-PGF1α水平高于对照组(P<0.01);观察组临床的优良率为(51/63)80.95%,高于对照组的(39/63)61.90%(χ^(2)=5.601,P<0.05);没有发现服用中药相关不良反应。结论:身痛逐瘀汤加减联合塞来昔布胶囊治疗急性期DLBP风寒瘀阻证患者,具有抗炎、镇痛作用,能有效缓解腰痛程度,改善腰椎活动功能,提高了日常生活活动能力,临床优良率较高,且使用安全。

Objective:To evaluate of modified Shentong Zhuyutang combined with celecoxib capsules in the treatment of acute discogenic low back pain due to wind-cold and stasis obstruction sydrome.Method:One hundred and forty eligible patients were randomly divided into control group(70 cases)and observation group(70 cases).Patients in both groups took the celecoxib capsules orally,200 mg/time.On this basis,patients in the control group were further treated with Tongluo Huoxue capsule orally,6 capsules/time,3 times/day,while those in the observation group received the modified Shentong Zhuyutang,1 bag/day,for three weeks.The short-form Mc Gillpain questionnaire(SF-MPQ),including pain rating index(PRI),present pain intensity(PPI),and visual analog scale(VAS),Oswestry disability index(ODI),wind-cold obstruction and stasis syndrome,and abilities of daily living(ADL)scoring and the Schober’s test were conducted before and after treatment.The tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),IL-6,thromboxane B2(TXB2),and 6-keto prostaglandin F1α(6-keto-PGF1α)levels before and after treatment were measured,followed by the safety evaluation.Result:The PRI,VAS,and PPI scores in SF-MPQ of the observation group were reduced in contrast to those in the control group(P<0.01).The wind-cold and stasis obstruction syndrome and ODI scores in the observation group also declined as compared with those of the control group(P<0.01),while the ADL and Schober’s test scores were elevated(P<0.01).The TNF-α,IL-1β,IL-6,and TXB2levels in the observation group were lower than those in the control group(P<0.01),whereas the 6-keto-PGF1αwas higher(P<0.01).The excellent and good rate of the observation group was(51/63)80.95%,significantly better than(39/63)61.90%of the control group(χ^(2)=5.601,P<0.05).No adverse reactions occurred after the intake of Chinese medicinal prescriptions.Conclusion:The modified Shentong Zhuyutang combined with celecoxib capsules is efficient and safe in inhibiting inflammation,easing back pain,enhancing lumbar spine mobility,and improving the ADL of patients with acute DLBP of wind-cold obstruction syndrome.