阳和汤加味对早期胸腰椎结核患者炎症因子和骨代谢的影响

Effects of Modified Yanghe Decoction on inflammatory factors and bone metabolism markers of thoracolumbar tuberculosis in early stage

目的观察阳和汤加味辅助抗结核药物治疗胸腰椎结核的疗效及对血清炎症因子水平和骨代谢标志物的影响。方法纳入2019年6月至2022年2月在武汉市中西医结合医院脊柱外科和武汉市肺科医院外科就诊的60例早期胸腰椎结核患者,随机分为2组,每组30例,对照组给予常规抗结核药物治疗,观察组在对照组的基础上给予阳和汤加味,均干预3个月。观察2组患者临床症状:背部疼痛数字评分法(numerical rating scale,NRS)、Oswestry功能障碍指数(Oswestry disability index,ODI)评分;细胞因子水平:肿瘤坏死因子-α(tumor necrosis factor-m,TNF-α)、γ干扰素(interferon-γ,IFN-γ)、白细胞介素-10(interleukin-10,IL-10);骨代谢标志物水平:Ⅰ型前胶原N端前肽(procollagen type 1 amino-terminal propeptide,PINP)、Ⅰ型胶原交联C-末端肽(β-crosslaps,β-CTX)。结果(1)观察组27例,对照组28例完成本次研究,最终纳入统计分析;(2)临床疗效比较:治疗后,两组NRS、ODI评分均较治疗前明显降低(P<0.05),观察组ODI评分低于对照组(P<0.05),观察组NRS评分低于对照组,但差异无统计学意义(P>0.05);(3)细胞因子水平比较:治疗后,观察组TNF-α、IL-10水平较治疗前明显降低(P<0.05),IFN-γ水平较治疗前明显升高(P<0.05);对照组TNF-α水平较治疗前降低(P<0.05),IFN-γ、IL-10水平与治疗前比较无明显变化。治疗后,观察组TNF-α、IL-10水平低于对照组(P<0.05),IFN-γ水平高于对照组(P<0.05);(4)骨代谢标志物水平比较:治疗后,观察组PINP水平较治疗前明显升高(P<0.05),β-CTX水平较治疗前明显降低(P<0.05);对照组PINP水平较治疗前无显著变化、β-CTX水平较治疗前降低(P<0.05)。治疗后,观察组PINP水平高于对照组(P<0.05),β-CTX水平低于对照组(P<0.05)。结论阳和汤加味辅助抗结核药物治疗胸腰椎结核,可显著缓解患者疼痛,改善患者腰背部功能障碍,其作用机制可能与减轻脊柱结核患者炎症反应并调控成骨破骨细胞代谢有关。

Objective To observe the clinical effects of Modified Yanghe Decoction with auxiliary antituberculosis drugs in the treatment of thoracolumbar tuberculosis in early stage and to investigate the effects of the therapy on inflammatory factors levels and bone metabolism markers.Methods Sixty patients with early thoracolumbar tuberculosis were enrolled and randomly divided into 2 groups,each with 30 cases.Control group was treated with conventional antituberculosis drugs,and observation group was treated with Modified Yanghe Decoction with auxiliary antituberculosis drugs on the basis of the control group,both for 3 months.Observe the clinical symptoms of 2 groups of patients:back pain numerical rating scale(NRS),Oswestry disability index(ODI);cytokines levels:tumor necrosis factor-α(TNF-α),gamma interferon(IFN-γ),interleukin-10(IL-10);bone metabolism markers levels:typeⅠprocollagen N-terminal propeptide(PINP)and typeⅠcollagen cross-linked C-terminal peptide(β-CTX).Results(1)The study was completed by 27 cases in observation group and 28 cases in control group and all the results were finally included in the statistical analysis;(2)Comparisons of the clinical efficacy before and after treatment:After treatment,the NRS and ODI scores of two groups significantly decreased(P<0.05),the ODI score of observation group was lower than control group(P<0.05),and the NRS score of observation group was lower than control group,but the differences were not statistically significant;(3)Comparisons of cytokines levels before and after treatment:After treatment,the levels of TNF-αand IL-10 in observation group significantly decreased(P<0.05),and the level of IFN-γsignificantly increased(P<0.05);the level of TNF-αin the control group decreased(P<0.05),and the levels of IFN-γand IL-10 did not change significantly.After treatment,the levels of TNF-αand IL-10 in observation group were lower than those in control group(P<0.05),and the level of IFN-γwas higher than that in control group(P<0.05);(4)Comparisons of bone metabolism markers levels before and after treatment:after treatment,the level of PINP in observation group significantly increased(P<0.05),and the level ofβ-CTX significantly decreased(P<0.05).After treatment,the PINP level in control group did not change significantly,and the level ofβ-CTX decreased than that before treatment(P<0.05).After treatment,the PINP level of observation group was higher than that in control group(P<0.05),and theβ-CTX level was lower than that in control group(P<0.05).Conclusion Modified Yanghe Decoction with auxiliary antituberculosis drugs in treating thoracolumbar tuberculosis can significantly relieve pain and improve the dysfunction of the lumbar dorsal regions.The possible mechanism was related to the decreased inflammation response of spinal tuberculosis and the metabolism regulation of osteoblast and osteoclast in patients.