针刺结合麦肯基疗法治疗非特异性下腰痛的疗效观察及对血清IL-1β、IL-6、TNF-α的影响

Observation on the Curative Effect of Acupuncture Combined with Mckenzie Therapy in the Treatment of Non-Specific Low Back Pain and Its Effect on Serum IL-1β,IL-6 and TNF-α

目的:探讨针刺结合麦肯基疗法治疗非特异性下腰痛的疗效及对血清白介素-1β(IL-1β)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)的影响。方法:将110例非特异性下腰痛患者随机分为治疗组与对照组,每组55例,对照组患者予麦肯基疗法治疗,治疗组患者予针刺结合麦肯基疗法治疗,两组均持续治疗4周。比较两组患者临床疗效、腰部功能障碍[魁北克腰痛障碍评分量表(QBPDS)评分]、疼痛情况(VAS评分)、腰部活动度、表面肌电信号[伸展时的屈曲放松比值(EXT/MVF)、屈曲时的屈曲放松比值(FLEX/MVF)]、血清炎症因子(IL-1β、IL-6、TNF-α)。结果:治疗组总有效率[96.36%(53/55)]高于对照组[85.45%(47/55)],差异有统计学意义(P<0.05);两组患者治疗后1周、2周、4周JOA评分均较治疗前升高(P<0.05),且治疗组患者治疗后1周、2周、4周JOA评分均高于对照组(P<0.05);两组患者治疗后1周、2周、4周QBPDS评分、VAS评分较治疗前降低(P<0.05),且治疗组患者治疗后1周、2周、4周QBPDS评分、VAS评分均低于对照组(P<0.05);两组患者治疗后腰部前屈、后伸、左侧弯、右侧弯、左旋、右旋活动范围均较治疗前增加(P<0.05),且治疗组患者治疗后腰部前屈、后伸、左侧弯、右侧弯、左旋、右旋活动范围均大于对照组(P<0.05);两组患者治疗后双侧竖脊肌、多裂肌FLEX/MVF、EXT/MVF值均较治疗前增大(P<0.05),且治疗组患者治疗后双侧竖脊肌、多裂肌EXT/MVF、FLEX/MVF值均高于对照组(P<0.05);两组患者治疗后血清IL-1β、IL-6、TNF-α水平均较治疗前降低(P<0.05),且治疗组患者治疗后血清IL-1β、IL-6、TNF-α水平均低于对照组(P<0.05)。结论:针刺结合麦肯基疗法治疗非特异性下腰痛有较好疗效,可有效缓解患者疼痛,改善竖脊肌、多裂肌主动活动功能,提高腰椎活动度,降低机体炎症反应。

Objective:To investigate the efficacy of acupuncture combined with Mckenzie therapy in the treatment of non-specific low back pain and its effect on serum interleukin-1β(IL-1β),interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α).Methods:A total of 110 patients with non-specific low back pain were randomly divided into treatment and control groups,with 55 patients in each group.Patients were treated by Mckenzie therapy in control group and acupuncture combined with Mckenzie therapy in treatment group.The patients were treated continuously for 4 weeks in both two groups.The clinical efficacy,lumbar dysfunction [Quebec Back Pain Disorders Scale(QBPDS) score],pain status(VAS score),lumbar range of motion,surface electromyography[flexion-relaxation ratio in extension(EXT/MVF) and flexion-relaxation ratio in flexion(FLEX/MVF)] and serum inflammatory factors(IL-1β,IL-6 and TNF-α) were compared between the two groups.Results:The total effective rate was 96.36%(53/55) in treatment group and 85.45%(47/55) in control group.The treatment group showed higher total effective rate than control group and the difference was statistically significant(P<0.05).The JOA scores at 1 week,2 weeks and 4 weeks after treatment were all higher than those before treatment in two groups(P<0.05),and the treatment group showed higher JOA score than control group at 1 week,2 weeks and 4weeks after treatment(P<0.05).The QBPDS scores and VAS scores at 1 week,2 weeks and 4 weeks after treatment were lower than those before treatment in two groups(P<0.05),and the treatment group showed lower QBPDS score and VAS score than control group at 1 week,2 weeks and 4 weeks after treatment(P<0.05).After treatment,the range of motion of lumbar flexion,extension,left bending,right bending,left rotation and right rotation increased compared with those before treatment in two groups(P<0.05),and the treatment group showed greater lumbar flexion,extension,left bending,right bending,left rotation and right rotation range of motion than control group after treatment(P<0.05).After treatment,the FLEX/MVF and EXT/MVF values of bilateral erector spinae and multifidus increased compared with those before treatment in two groups(P<0.05),and the treatment group showed higher FLEX/MVF and EXT/MVF values of bilateral erector spinae and multifidus than control group after treatment(P<0.05).After treatment,the levels of serum IL-1β,IL-6 and TNF-α decreased in two groups(P<0.05),and the treatment group showed lower levels of serum IL-1β,IL-6 and TNF-α than control group after treatment(P<0.05).Conclusion:Acupuncture combined with Mckenzie therapy shows good effect on non-specific low back pain,which can effectively relieve pain,improve the active function of erector spinae and multifidus,improve lumbar spine mobility and reduce the body’s inflammatory response.