针刺联合益肾活血汤治疗肝肾亏虚型腰椎管狭窄症疗效及对炎症因子、疼痛介质的影响

Curative Effect of Acupuncture Combined with Yishen Huoxue Decoction for Lumbar Spinal Stenosis of Liver-Kidney Deficiency Type and Its Effect on Inflammatory Factors and Pain Mediators

目的:观察针刺联合益肾活血汤治疗肝肾亏虚型腰椎管狭窄症的疗效及对炎症因子、疼痛介质的影响。方法:选取92例肝肾亏虚型腰椎管狭窄症患者,按随机数字表法分为联用组及西药组各46例。西药组采用常规现代医学疗法治疗,联用组在西药基础上,采用针刺联合益肾活血汤治疗。2组均连续治疗1个月。比较2组临床疗效,比较2组治疗前后中医证候积分、疼痛视觉模拟评分法(VAS)评分、间歇性跛行评分、日本骨科协会评估治疗分数(JOA)评分、血清炎症因子[白细胞介素-6 (IL-6)、白细胞介素-4 (IL-4)、肿瘤坏死因子-α (TNF-α)]水平的变化。结果:联用组总有效率为91.30%,西药组为76.09%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组腰膝酸痛、腰腿发凉、间歇性跛行、神疲懒言、面色?白的中医证候积分均较治疗前下降,联用组上述5项中医证候积分均低于西药组(P<0.05)。治疗后,2组VAS评分均较治疗前下降,JOA评分均较治疗前上升,差异均有统计学意义(P<0.05);治疗后,联用组VAS评分低于西药组,JOA评分高于西药组,差异均有统计学意义(P<0.05)。治疗后,2组血清IL-6、TNF-α水平均较治疗前下降,IL-4水平均较治疗前上升,差异均有统计学意义(P<0.05);治疗后,联用组血清IL-6、TNF-α水平低于西药组,IL-4水平高于西药组,差异均有统计学意义(P<0.05)。结论:针刺联合益肾活血汤治疗肝肾亏虚型腰椎管狭窄症的疗效显著,能缓解腰痛、间歇性跛行等临床症状,改善腰椎功能,调节炎性反应递质与抗炎因子的失衡状态。

Objective:To observe the curative effect of acupuncture combined with Yishen Huoxue Decoction for lumbar spinal stenosis of liver-kidney deficiency type and its effect on inflammatory factors and pain mediators.Methods:A total of 92 cases of patients with lumbar spinal stenosis of liver-kidney deficiency type were selected and divided into the combination group and the western medicine group according to the random number table method,with 46 cases in each group.The western medicine group was treated with routine modern medical therapy,and the combination group was additionally treated with acupuncture combined with Yishen Huoxue Decoction based on western medicine treatment.Both groups were treated for one month.The clinical effects in the two groups were compared.Before and after treatment,the changes in traditional Chinese medicine(TCM) syndrome scores,Visual Analogue Scale(VAS) scores of pain,intermittent claudication scores,Japanese Orthopaedic Association(JOA) scores and levels of inflammatory factors including interleukin-6(IL-6),interleukin-4(IL-4) and tumor necrosis factor-α(TNF-α) in serum were compared between the two groups.Results:The clinical effect was 91.30% in the combination group and 76.09% in the western treatment group,the difference being significant(P<0.05).After treatment,the scores of TCM syndromes including soreness and pain in waist and knee,cold waist and legs,intermittent claudication,mental fatigue and disinclination to talk,and pale complexion in the two groups were decreased when compared with those before treatment;all the above 5 TCM syndrome scores in the combination group were lower than those in the western medicine group(P<0.05).After treatment,VAS scores in the two groups were decreased when compared with those before treatment,and JOA scores were increased,differences being significant(P<0.05);VAS score in the combination treatment group was lower than those in the western medicine group,and JOA score was higher than that in the western medicine group,differences being significant(P<0.05).After treatment,the levels of IL-6and TNF-α in serum were decreased when compared with those before treatment,and the levels of IL-4in serum were increased,differences being significant(P<0.05);the levels of IL-6 and TNF-α in serum in the combination group were lower than those in the western medicine group,and the level of IL-4 in serum was higher than that in the western medicine group,differences being significant(P<0.05).Conclusion:Acupuncture combined with Yishen Huoxue Decoction has a significant curative effect in the treatment of lumbar spinal stenosis of liver-kidney deficiency type,which can relieve the clinical symptoms such as lumbago and intermittent claudication,improve the lumbar function,and regulate the imbalance between inflammatory response transmitters and anti-inflammatory factors.