浮针再灌注联合天麻钩藤饮治疗中青年颈性颈椎病急性发作期的临床研究

Clinical Efficacy and Mechanism of Floating Needle Reperfusion Combined with Tianma Gouteng Decoction in the Treatment of Middle-aged and Young Patients with Cervical Spondylopathy during the Acute Stage

目的观察浮针再灌注联合天麻钩藤饮治疗中青年颈性颈椎病急性发作期的临床疗效并探讨其可能的作用机制。方法 90例中青年颈性颈椎病急性发作期患者随机分为对照组与治疗组各45例,对照组在常规治疗基础上给予天麻钩藤饮,治疗组在常规治疗基础上给予浮针再灌注联合天麻钩藤饮治疗。比较两组临床疗效,中医证候、疼痛、眩晕及功能障碍评分,影像学变化、颈椎肌力和活动度、椎-基底动脉血流动力学指标、血清内皮素(ET)、神经元特异性烯醇化酶(NSE)、炎症因子及氧化应激水平。结果治疗组临床疗效为93.33%,高于对照组的75.56%(P <0.05)。治疗后,两组中医证候积分、视觉模拟量表(VAS)评分、国际眩晕障碍评分量表(DHI)评分和颈椎功能障碍指数(NDI)评分均降低,颈椎肌力评分升高,活动度评分降低,且治疗组优于对照组(P <0.05);治疗后,两组患者中立位曲度、最大屈位角、最大伸位角以及颈曲深度水平均升高,且治疗组优于对照组(P <0.05);治疗后,两组患者左椎动脉(LVA)和基底动脉(BA)的收缩期、舒张期及平均血流速度均显著升高,且治疗组高于对照组(P <0.05);治疗后,两组患者血清ET和NSE明显低于治疗前,且治疗组低于对照组(P <0.05);两组患者治疗后肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和白细胞介素-1β(IL-1β)水平均降低,血清总抗氧化能力(T-AOC)升高,丙二醛(MDA)、氧化型谷胱甘肽(GSSG)水平降低(P <0.05),且治疗组优于对照组(P <0.05)。结论浮针再灌注联合天麻钩藤饮治疗中青年颈性颈椎病急性发作期疗效显著,可降低中医证候、疼痛、眩晕和功能障碍评分,改善颈椎活动、颈椎肌力和动脉血流动力学指标,下调血清ET和NSE水平,减轻炎症水平,改善氧化应激,且具有较好的安全性。

Objective:To observe the clinical efficacy and possible mechanism of floating needle reperfusion combined with Tianma Gouteng Decoction in the treatment of middle-aged and young patients with cervical spondylosis during the acute stage. Methods:A total of 90 middle-aged and young patients with cervical spondylosis during the acute stage were randomly divided into the control group and treatment group,45 cases in each group.The control group was given Tianma Gouteng Decoction on the basis of conventional treatment,while the treatment group was given floating needle reperfusion combined with Tianma Gouteng Decoction. The clinical efficacy,syndromes,pain,dizziness and dysfunction scores,imaging changes,cervical spine muscle strength and mobility,vertebral-basal artery hemodynamics,serum endothelin(ET),neuron-specific enolization Enzyme(NSE),inflammatory factors and oxidative stress levels were compared. Results:The clinical efficacy of the treatment group(93.33%)was better than the control group(75.56%),and the difference was statistically significant(P < 0.05). After treatment,the scores of the syndromes for dizziness,headache,flushing,upset,irritability,and insomnia were reduced in the two groups,and the scores above the treatment group were lower than those of the control group(P < 0.05);after treatment,VAS,DHI and NDI were significantly reduced,and the treatment group was lower than the control group(P < 0.05);after treatment,the neutral curvature,maximum flexion angle,maximum extension angle anddepth of stiffness increased in the two groups,and the treatment group was better than the control group(P < 0.05);after treatment,the cervical spine muscle strength scores of the two groups increased and the mobility scores de-creased,and the treatment group was better than the control group(P < 0.05);after treatment,the systolic,diastolicand average blood flow velocity of LVA and BA were significantly increased,and the treatment group was higherthan the control group(P < 0.05);after treatment,the serum ET and NSE of the two groups were significantly lowerthan before treatment,and the treatment group was lower than the control group(P < 0.05);the levels of TNF-α,IL-6 and IL-1β after treatment in the two groups decreased,and the treatment group was lower than the controlgroup(P < 0.05);the serum T-AOC increased,MDA and GSSG levels decreased,and the treatment group was bet-ter than the control group(P < 0.05). Conclusion:Floating needle reperfusion combined with Tianma Gouteng Decoction is effective in the treatment of middle-aged and young patients with cervical spondylosis during the acutestage. It can reduce TCM syndromes,pain,dizziness and dysfunction scores,and improve cervical spine activity,cervical spine muscle strength,arterial hemodynamics,down-regulate serum ET and NSE levels,reduce inflamma-tion levels,improve oxidative stress,and have good safety.