中医综合疗法对肾虚血瘀型腰椎间盘突出症患者疗效及血清PGE2、5-HT、SOD水平的影响

Effects of Traditional Chinese Medicine Comprehensive Therapy on the Curative Effect in Patients with Lumbar Disc Herniation of Kidney Deficiency and Blood Stasis Type and on Levels of Serum PGE2,5-HT and SOD

【目的】探讨中医综合疗法对肾虚血瘀型腰椎间盘突出症患者临床疗效及血清前列腺素E2(PGE2)、5-羟色胺(5-HT)、超氧化物歧化酶(SOD)水平的影响。【方法】将81例肾虚血瘀型腰椎间盘突出症患者随机分成试验组41例和对照组40例。对照组给予骨盆牵引联合体外冲击波(取夹脊和大肠俞等穴)治疗,治疗组在对照组的基础上给予正骨手法及补阳还五汤口服治疗,疗程为2周。观察2组患者治疗前后疼痛视觉模拟量表(VAS)评分、腰椎功能日本骨科协会(JOA)评分、中医证候积分及血清PGE2、5-HT、SOD水平的变化情况,并评价2组患者的临床疗效。【结果】(1)76例患者完成随访,其中试验组39例,对照组37例。(2)治疗2周后,试验组的总有效率为92.31%(36/39),对照组为70.27%(26/37);组间比较,试验组的疗效明显优于对照组,差异有统计学意义(P<0.05)。(3)治疗后,2组患者的VAS评分和中医证候积分均较治疗前明显降低(P<0.05),JOA评分较治疗前明显升高(P<0.05),且试验组对VAS评分和中医证候积分的降低作用及对JOA评分的升高作用均明显优于对照组,差异均有统计学意义(P<0.01)。(4)治疗后,2组患者血清PGE2、5-HT水平均较治疗前明显降低(P<0.05),血清SOD水平均较治疗前明显升高(P<0.05),且试验组患者对血清PGE2、5-HT水平的降低作用和对血清SOD水平的升高作用均明显优于对照组,差异均有统计学意义(P<0.01)。【结论】中医综合治疗肾虚血瘀型腰椎间盘突出症疗效确切,不仅能降低患者体内炎症水平,减少炎症因子表达,还能提高血清SOD水平,减轻自由基对椎间盘的损伤,从而改善患者疼痛症状及腰椎活动功能。

Objective To investigate the effect of traditional Chinese medicine(TCM)comprehensive therapy on clinical the efficacy and serum levels of prostaglandin E2(PGE2),5-hydroxytryptamine(5-HT)and superoxide dismutase(SOD)in the patients with lumbar disc herniation(LDH)of kidney deficiency and blood stasis type.Methods Eighty-one patients with kidney deficiency and blood stasis type of LDH were randomly divided into trial group(41 cases)and control group(40 cases).The control group was treated with pelvic traction combined with extracorporeal shock wave(ESW)therapy on the acupoints of Jiaji(EX-B2)and Dachangshu(BL25),and the treatment group was treated with bone-setting manipulation and oral administration of Buyang Huanwu Decoction on the basis of treatment for the control group.The course of treatment lasted for 2 weeks.Visual analogue scale(VAS)scores,Japanese Orthopaedic Association(JOA)lumbar function scores,TCM syndrome scores and serum PGE2,5-HT and SOD levels in the two groups were observed before and after treatment,and the clinical efficacy of the two groups was also evaluated.Results(1)A total of 76 patients were successfully followed up,including 39 cases of the trial group and 37 cases of the control group.(2)After 2 weeks of treatment,the total effective rate of the trial group was 92.31%(36/39)and that of the control group was 70.27%(26/37).The intergroup comparison showed that the efficacy of the trial group was significantly superior to that of the control group,and the difference was statistically significant(P<0.05).(3)After treatment,VAS scores and TCM syndrome scores of the two groups were significantly decreased and JOA scores were significantly increased compared with those before treatment(P<0.05),and the effect on lowering VAS scores and TCM syndrome scores and on increasing JOA scores in the trial group were significantly superior to that in the control group,the differences being statistically significant(P<0.01).(4)After treatment,the levels of serum PGE2 and 5-HT of the two groups were significantly decreased(P<0.05),and the level of SOD in serum was significantly increased(P<0.05),and the effect on lowering serum PGE2 and 5-HT levels and on increasing serum SOD level in the trial group was significantly superior to that in the control group,the differences being statistically significant(P<0.01).Conclusion The TCM comprehensive treatment exerts certain effect in treating LDH of kidney deficiency and blood stasis type.It is effective not only on reducing the levels of inflammatory factors and decreasing their expression,but also on increasing the serum SOD level,reducing the damage of free radicals to the disc,so as to relieve the pain symptoms and improve the lumbar motor function of the patients.