拨针疗法联合中药对腰椎间盘突出症患者术后神经根水肿时间、疼痛介质及血清miR-141-3p的影响

Effects of scraping needle therapy combined with Chinese medication on nerve root edema duration, pain mediators, and serum miR-141-3p after lumbar disc herniation operation

目的 观察拨针疗法联合消髓化核汤对腰椎间盘突出症患者臭氧射频消融术后神经根水肿时间、疼痛介质及血清mi R-141-3p的影响。方法 将92例行臭氧联合低温等离子射频消融术的腰椎间盘突出症患者随机分为消髓化核汤组和拨针联合组,每组46例。消髓化核汤组予消髓化核汤治疗,拨针联合组在消髓化核汤组基础上予拨针疗法治疗。观察两组神经根水肿消失时间及治疗前后中医证候积分、疼痛视觉模拟量表(visual analog scale, VAS)评分、炎症指标[微小核糖核酸-141-3p(miRNA-141-3p, miR-141-3p)、可溶性肿瘤坏死因子Ⅰ型受体(soluble tumor necrosis factor receptor typeⅠ, sTNFRⅠ)、白细胞介素-17(interleukin-17,IL-17)、磷脂酶A2(phospholipase A2, PLA2)]和疼痛介质指标[甲硫氨酸脑啡肽(methionine enkephalin,Met-EnK)、缓激肽(bradykinin,BK)、 5-羟色胺(5-hydroxy tryptamine,5-HT)、 6-酮前列腺素E1α(6-keto-prostaglandin E1α, 6-keto-PGE1α)]水平的变化,并比较两组临床疗效。结果 拨针联合组总有效率为97.8%,高于消髓化核汤组的82.6%(P<0.05)。治疗后,两组中医证候积分较治疗前降低(P<0.05),且拨针联合组低于消髓化核汤组(P<0.05)。治疗后,两组VAS评分较治疗前降低(P<0.05),拨针联合组低于消髓化核汤组(P<0.05)。拨针联合组患者神经根水肿消失时间短于消髓化核汤组(P<0.05)。治疗后,两组血清IL-17、PLA2、miR-141-3p含量较治疗前降低(P<0.05),且拨针联合组低于消髓化核汤组(P<0.05);两组血清s TNFRⅠ含量较治疗前升高(P<0.05),且拨针联合组高于消髓化核汤组(P<0.05)。治疗后,两组血清Met-En K含量较治疗前升高(P<0.05),且拨针联合组高于消髓化核汤组(P<0.05);两组血清6-keto-PGE1α、5-HT、BK含量较治疗前降低(P<0.05),且拨针联合组低于消髓化核汤组(P<0.05)。结论 拨针疗法联合消髓化核汤治疗可降低腰椎间盘突出症术后血清IL-17、PLA2、miR-141-3p水平,改善疼痛介质指标,促进神经根水肿消退,提升临床疗效。

Objective To observe the effects of scraping needle therapy plus Xiao Sui Hua He decoction on nerve root edema duration,pain mediators,and serum miR-141-3p after ozone-combined radiofrequency ablation in lumbar disc herniation(LDH)patients.Method Ninety-two LDH patients undergoing ozone-combined low-temperature plasma radiofrequency ablation were randomized into a Xiao Sui Hua He decoction group and a combined scraping needle group,each consisting of 46 cases.The Xiao Sui Hua He decoction group received the corresponding decoction for treatment,and the combined scraping needle group additionally received scraping needle therapy.The nerve root edema relief time was compared between the two groups.Before and after the treatment,symptom score of traditional Chinese medicine(TCM),visual analog scale(VAS)score,inflammatory indicators[miRNA-141-3p(miR-141-3p),soluble tumor necrosis factor receptor typeⅠ(sTNFRⅠ),interleukin-17(IL-17),and phospholipase A2(PLA2)],and pain mediators[methionine enkephalin(Met-Enk),bradykinin(BK),5-hydroxytryptamine(5-HT),and 6-keto-prostaglandin E1a(6-keto-PGE1a)]in the two groups were observed,and the clinical efficacy was compared between the two groups.Result The total effective rate was 97.8%in the combined scraping needle group,higher than 82.6%in the Xiao Sui Hua He decoction group(P<0.05).After the treatment,the TCM symptom score dropped in both groups(P<0.05)and was lower in the combined scraping needle group than in the Xiao Sui Hua He decoction group(P<0.05).The VAS score decreased in the two groups after the treatment(P<0.05)and was lower in the combined scraping needle group than in the Xiao Sui Hua He decoction group(P<0.05).The combined scraping needle group took a shorter time than the Xiao Sui Hua He decoction group in releasing nerve root edema(P<0.05).After the treatment,the serum contents of IL-17,PLA2,and miR-141-3p dropped in both groups(P<0.05)and were lower in the combined scraping needle group(P<0.05);the serum content of sTNFRⅠincreased in the two groups(P<0.05)and was higher in the combined scraping needle group(P<0.05).After the treatment,the serum Met-Enk content increased in the two groups(P<0.05)and was higher in the combined scraping needle group(P<0.05);the serum contents of 6-keto-PGE1a,5-HT,and BK decreased in both groups(P<0.05)and were lower in the combined scraping needle group than in the Xiao Sui Hua He decoction group(P<0.05).Conclusion Scraping needle therapy plus Xiao Sui Hua He decoction can lower the serum levels of IL-17,PLA2,and miR-141-3p,improve pain mediator indexes,promote the relief of nerve root edema,and enhance clinical efficacy for postoperative LDH.