灯盏花素穴位注射联合针灸对腰椎间盘突出症患者腰背伸肌群表面肌电指标及血清MMP3、PGE_(2)、IL-1β表达的作用

Effect of Acupoint Injection with Breviscapin Combined with Acupuncture on Surface Electromyography Indexes of Lumbar and Back Extensor and Levels of Serum MMP3,PGE_(2)and IL-1βin Patients with Lumbar Disc Herniation

目的探讨灯盏花素穴位注射联合针灸对腰椎间盘突出症(Lumbar disc herniation,LDH)患者腰背伸肌群表面肌电指标及血清基质金属蛋白酶3(Matrix metalloproteinase 3,MMP3)、前列腺素E2(Prostaglandin E_(2),PGE_(2))、白细胞介素-1β(Interleukin-1β,IL-1β)表达的作用。方法应用前瞻性随机对照研究方法选取2020年3月—2022年5月收治的LDH患者186例,以随机数字表法分为观察组(62例)、对照A组(62例)、对照B组(62例)。对照A组予以灯盏花素穴位注射,对照B组予以针灸,观察组予以灯盏花素穴位注射联合针灸,均治疗1个月。比较3组疗效、不良反应与治疗前、治疗1个月后疼痛程度评分(Visual Analogue Scale/Score,VAS)、日本骨科协会下腰痛功能评价表评分(Japanese Orthopaedic Association Scores,JOA)、日常生活能力评分(Barthel,BI)、腰背伸肌群表面肌电指标(积分肌电值、平均功率频率)、血液流变学指标、血清免疫功能指标[免疫球蛋白G(Immunoglobulin G,IgG)、免疫球蛋白M(Immunoglobulin M,IgM)、补体C_(3)]、MMP3、PGE_(2)、IL-1β水平。结果观察组治疗1个月后总有效率93.55%(58/62)高于对照A组7742%(48/62)、对照B组80.65%(50/62)(P<0.05);3组治疗1个月后VAS评分较治疗前降低,且观察组低于对照A组、对照B组,JOA、BI评分与积分肌电值、平均功率频率较治疗前增高,且观察组高于对照A组、对照B组(P<0.05);3组治疗1个月后全血低切黏度、全血高切黏度、血浆黏度、红细胞压积、红细胞聚集指数较治疗前降低,且观察组低于对照A组、对照B组(P<0.05);3组治疗1个月后血清IgG、IgM、补体C_(3)、MMP3、PGE_(2)、IL-1β水平较治疗前降低,且观察组低于对照A组、对照B组(P<0.05);3组治疗期间不良反应发生率相比,差异无统计学意义(P>0.05)。结论应用灯盏花素穴位注射联合针灸治疗LDH可缓解疼痛程度与腰背伸肌群疲劳程度,提升腰背伸肌群肌肉收缩性,改善腰椎功能及日常生活能力,改善血液流变学、免疫功能,下调血清MMP3、PGE_(2)、IL-1β表达,疗效显著,且安全性好。

Objective To explore the effect of acupoint injection with breviscapin combined with acupuncture on the surface electromyography(EMG)indicators of the lumbar and back extensor muscles and the levels of serum matrix metalloproteinase 3(MMP3),prostaglandin E_(2)(PGE_(2))and interleukin-1β(IL-1β)in patients with lumbar disc herniation(LDH).Methods From March 2020 to May 2022,a total of 186 patients with LDH in the hospital were selected by prospective randomized controlled research methods.They were divided into observation group(62 cases),control group A(62 cases)and control group B(62 cases)by random number table.The control group A was given acupoint injection with breviscapin,the control group B was given acupoint injection with breviscapin and moxibustion,and the observation group was given acupoint injection with compound betamethasone combined with acupuncture.All were treated for 1 month.The efficacy and adverse effects,the pain severity score(VAS),lumbar function score(JOA)and barthel index score(BI),the surface EMG indexes of the waist and back extensors(in⁃tegrated EMG value,frequency of average power),hemorheology indexes and serum immune function indexes[immunoglobulin G(IgG),immunoglobulin M(IgM),complement C_(3)],the levels of MMP3,PGE_(2) and IL-1βbefore and 1 month after treatment of the three groups were compared.Results The total effective rate of the observation group after 1 month of treatment was 93.55%(58/62),higher than 77.42%(48/62)of control group A and 80.65%(50/62)of control group B(P<0.05).The VAS scores of the three groups after 1 month of treatment were lower than those before treatment,and the score of the observation group was lower than that of control group A and control group B.The scores of JOA and BI,integrated EMG value and average power frequency were higher than those before treatment,and the results of the observation group were higher than those of control group A and control group B(P<0.05).After 1 month of treatment in the three groups,the values of whole blood low-shear viscosi⁃ty,whole blood high-shear viscosity,plasma viscosity,hematocrit and erythrocyte aggregation index were lower than those before treatment,and the indexes of the observation group were lower than those of control group A and control group B(P<0.05).Ser⁃um levels of IgG,IgM,complement C_(3),MMP3,PGE_(2) and IL-1βin the three groups after 1 month of treatment were lower than those before treatment,and the levels of the observation group were lower than those of control group A and control group B(P<0.05).There was no significant difference in the incidence of adverse reactions during the treatment period of the three groups(P>0.05).Conclusion The application of acupoint injection with breviscapin combined with acupuncture in the treatment of pa⁃tients with LDH can alleviate the degree of pain and fatigue of the low back extensor muscles,enhance the muscle contractility of the low back extensors,improve the function of the lumbar spine and the ability of daily living,improve hemorheology and immune function,and down-regulate serum levels of MMP3,PGE_(2) and IL-1β.The curative effect is remarkable,and the safety is good.