补肾逐瘀汤联合西药治疗肾虚血瘀型腰椎间盘突出症疗效观察及对炎症因子的影响

Effect Observation on Bushen Zhuyu Tang Combined with Western Medicine for Lumbar Disc Herniation with Kidney Deficiency and Blood Stasis Type and Its effect on Inflammatory Factors

目的:观察补肾逐瘀汤联合西药治疗肾虚血瘀型腰椎间盘突出症(LDH)的临床疗效及对血清炎症因子水平的影响。方法:将84例LDH患者随机分为对照组和治疗组,每组42例;对照组口服塞来昔布胶囊及甲钴胺片治疗,治疗组在对照组基础上加用补肾逐瘀汤内服;2组均治疗4周,观察比较2组改良下腰痛评分法(M-JOA)评分、功能障碍指数问卷(Oswestry)评分、肾虚血瘀证症状评分及临床疗效;检测2组治疗前后血清白细胞介素-17 (IL-17)、IL-6、IL-1β水平。结果:总有效率治疗组为95.24%,对照组为76.19%,2组比较,差异有统计学意义(P <0.05)。治疗后,2组患者M-JOA、Oswestry评分均较治疗前明显降低(P <0.05);且治疗组上述2项评分低于对照组(P <0.05)。治疗后,2组患者腰痛如刺/痛有定处、拒按、膝腿无力、面色白、畏寒肢冷等证候积分均较治疗前明显降低(P <0.05);且治疗组上述各项评分低于对照组(P <0.05)。治疗后,2组血清IL-17、IL-6、IL-1β水平均较治疗前明显下降(P <0.05);且治疗组血清IL-17、IL-6、IL-1β水平下降较对照组更显著(P <0.05)。结论:补肾逐瘀汤治疗LDH可明显改善症状,提高临床疗效,其抑制患者血清IL-17、IL-6、IL-1β水平可能是疗效机制之一。

Objective: To observe the clinical effect of the therapy of Bushen Zhuyu tang combined with western medicine in the treatment of lumbar disc herniation(LDH) with kidney deficiency and blood stasis type and its effect on the level of inflammatory factors in serum. Methods: Eighty-four patients with LDH were randomly divided into the control group and the treatment group, with 42 patients in each group. The control group was treated with celecoxib capsules and mecobalamine tablets orally;the treatment group was additionally treated with Bushen Zhuyu tang based on the treatment of the control group. The two groups were treated for four weeks,and the score of the lower back pain of modified Japanese Orthopedic Association(M-JOA),the score of questionnaire of Oswestry Dability Index(Oswestry) and the symptom score of syndrome of kidney deficiency and blood stasis as well as the clinical effect were observed and compared in the two groups. Levels of IL-17, IL-6 and IL-1β in serum were measured before and after treatment in both groups. Results: The total effective rate was 95.24% in the treatment group and 76.19% in the control group, the difference being significant(P < 0.05). After treatment, the scores of M-JOA and Oswestry in the two groups were significantly decreased when compared with those before treatment(P < 0.05);the above two scores in the treatment group were significantly lower than those in the control group(P < 0.05). After treatment, scores of symptoms such as pricking pain in the back pain or fixed pain, back pain refusing to pressure, weak knees and legs,pallid complexion and extreme chilliness were significantly decreased when compared with those before treatment(P < 0.05);the above scores in the treatment group were significantly lower than those in the control group(P < 0.05). After treatment, levels of IL-17, IL-6 and IL-1β in serum in both groups were significantly decreased compared with those before treatment(P<0.05);levels of IL-17,IL-6 and IL-1β in the treatment group were significantly lower than those in the control group(P<0.05). Conclusion: Bushen Zhuyu tang can significantly improve the symptoms and clinical effect of LDH, and the inhibition of IL-17, IL-6 and IL-1β in serum of patients may be one of the therapeutic mechanisms.