加味乌附麻辛桂姜汤治疗慢性非特异性下腰痛寒湿瘀阻证的临床观察
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摘要
目的:观察加味乌附麻辛桂姜汤治疗慢性非特异性下腰痛(NLBP)寒湿瘀阻证的近期和远期疗效及作用机制。方法:将119例符合要求患者按随机数字表分为对照组和观察组。对照组59例采用针刺+普拉提运动。观察组60例在对照组治疗的基础上服用加味乌附麻辛桂姜汤,1剂/d。两组疗程均为连续治疗6周。进行治疗前后简化McGill疼痛量表(SF-MPQ)[包括疼痛分级指数(PRI),疼痛视觉模拟评分(VAS)和现在疼痛状况(PPI)],Oswestry功能障碍指数(ODI),日本骨科协会下腰痛量表(JOA)和寒湿瘀阻证评分,治疗后患者行自我疗效评估;检测治疗前后肿瘤坏死因子-α(TNF-α),血栓素2(TXB2),6-酮-前列腺素Fla(6-Keto-PGFla)和白细胞介素-1β(IL-1β)水平。结果:经秩和检验,治疗后观察组临床疗效优于对照组(Z=2. 226,P <0. 05),自我疗效评估也优于对照组(Z=2. 104,P <0. 05);治疗后观察组SF-MPQ量表PRI,VAS和PPI评分均低于对照组(P <0. 01);观察组患者JOA量表评分高于对照组(P <0. 01),寒湿瘀阻证评分和ODI量表评分均低于对照组(P <0. 01);观察组患者TNF-α,IL-1β,TXB2水平均低于对照组(P <0. 01),6-Keto-PGFla高于对照组(P <0. 01),TXB2/6-Keto-PGFla低于对照组(P <0. 01)。结论:在针刺和运动疗法的基础上,采用加味乌附麻辛桂姜汤治疗慢性NLBP,近期能改善疼痛等症状,促进患者功能恢复,提高日常生活能力,远期能稳定病情,减少复发,并具有一定抗炎、镇痛作用。
Objective: To observe the short-term and long-term clinical effect of modified Wufu Maxin Guijiang decoction treatment to chronic nonspecific low back pain( NLBP) with syndrome of cold dampness and stasis,and to investigate the mechanism of anti-inflammatory and analgesia. Method: One hundred and nineteen eligible patients were randomly divided into control group( 59 cases) and observation group( 60 cases) by random number table. Patients in control group got acupuncture treatment and pilates. Based on the treatment in control group,patients in observation received additional modified Wufu Maxin Guijiang decoction,1 dose/day. The course of treatment was 6 weeks in both groups. Before and after treatment,scores of short-form McGill pain questionnaire( SF-MPQ), Oswestry disability index( ODI), Japanese orthopaedic association( JOA) and syndrome of cold dampness were graded. After treatment,the patients made self efficacy assessment. Levels of thromboxane 2( TXB2),6-Keto-PGFla,tumor necrosis factor-α( TNF-α) and interleukins-1β( IL-1β) were detected both before and after treatment. Result: After treatment,the rank sum test showed that the clinical efficacy in observation group was better than that in control group( Z = 2. 226,P < 0. 05),and the self efficacy assessment showed the efficacy in observation group was also better than that in control group( Z = 2. 104,P <0. 05). Scores of SF-MPQ,PRI,VAS,PPI,ODI and syndrome of cold dampness and stasis in observation group were all lower than those in control group( P < 0. 01),and score of JOA was higher than that in control group( P < 0. 01). Levels of TXB2,TNF-α and IL-1β and TXB2/6-Keto-PGFlawere lower than those in control group( P < 0. 01),and the level of 6-Keto-PGFlawas higher than that in control group( P < 0. 01). Conclusion: Based on the acupuncture treatment and pilates,modified Wufu Maxin Guijiang decoction in the treatment of chronic NLBP can ameliorate symptoms of pain,promote the recovery of function,and enhance activity of daily living in a short term,reduce the recurrence and stabilize the disease condition in a long term,with certain effects of antiinflammatory and analgesia.
Objective: To observe the short-term and long-term clinical effect of modified Wufu Maxin Guijiang decoction treatment to chronic nonspecific low back pain( NLBP) with syndrome of cold dampness and stasis,and to investigate the mechanism of anti-inflammatory and analgesia. Method: One hundred and nineteen eligible patients were randomly divided into control group( 59 cases) and observation group( 60 cases) by random number table. Patients in control group got acupuncture treatment and pilates. Based on the treatment in control group,patients in observation received additional modified Wufu Maxin Guijiang decoction,1 dose/day. The course of treatment was 6 weeks in both groups. Before and after treatment,scores of short-form McGill pain questionnaire( SF-MPQ), Oswestry disability index( ODI), Japanese orthopaedic association( JOA) and syndrome of cold dampness were graded. After treatment,the patients made self efficacy assessment. Levels of thromboxane 2( TXB2),6-Keto-PGFla,tumor necrosis factor-α( TNF-α) and interleukins-1β( IL-1β) were detected both before and after treatment. Result: After treatment,the rank sum test showed that the clinical efficacy in observation group was better than that in control group( Z = 2. 226,P < 0. 05),and the self efficacy assessment showed the efficacy in observation group was also better than that in control group( Z = 2. 104,P <0. 05). Scores of SF-MPQ,PRI,VAS,PPI,ODI and syndrome of cold dampness and stasis in observation group were all lower than those in control group( P < 0. 01),and score of JOA was higher than that in control group( P < 0. 01). Levels of TXB2,TNF-α and IL-1β and TXB2/6-Keto-PGFlawere lower than those in control group( P < 0. 01),and the level of 6-Keto-PGFlawas higher than that in control group( P < 0. 01). Conclusion: Based on the acupuncture treatment and pilates,modified Wufu Maxin Guijiang decoction in the treatment of chronic NLBP can ameliorate symptoms of pain,promote the recovery of function,and enhance activity of daily living in a short term,reduce the recurrence and stabilize the disease condition in a long term,with certain effects of antiinflammatory and analgesia.
引文
[1]黄墩兵,周凡萍,黄赛娥.悬吊运动疗法治疗慢性非特异性腰痛疗效的Meta分析[J].中国康复理论与实践,2017,23(12):1435-1442.
[2]岳寿伟.腰痛的评估与康复治疗进展[J].中国康复医学杂志,2017,32(2):136-139.
[3]刘宜军,杨勇,孙丽敏.附子汤合芍药甘草汤加味离子导入治疗寒湿瘀阻证非特异性下腰痛[J].中国实验方剂学杂志,2017,23(20):195-200.
[4]张继伟,陈东煜.非特异性下腰痛的保守治疗现状[J].中医药临床杂志,2015,27(12):1668-1670.
[5]付传国.应用“乌附麻辛桂姜汤”治疗痹证的体会[J].成都中医学院学报,1982,6(2):50-52.
[6]李泰标,谢洪武,吴伟,等.乌附麻辛桂姜汤加减治疗非特异性下腰痛的临床疗效观察[J].世界科学技术—中医药现代化,2014,16(10):2153-2156.
[7]赵海博,翟明玉,白玉,等.乌附麻辛桂姜汤加减治疗寒湿型腰椎间盘突出症46例[J].现代中医药,2014,34(3):29-30.
[8]宋恩峰,孙文连.乌附麻辛桂姜汤加味治疗类风湿性关节炎临床研究[J].湖北中医药大学学报,2012,14(4):48-49.
[9]中国康复医学会脊柱脊髓专业委员会专家组.中国急/慢性非特异性腰背痛诊疗专家共识[J].中国脊柱脊髓杂志,2016,26(12):1134-1138.
[10]中华人民共和国中医药行业标准.中医骨伤科病证诊断疗效标准[M].北京:人民卫生出版社,1994:197.
[11]肖军章.疼痛评估方法的优与劣[J].中国临床医药研究杂志,2007,177:39-40.
[12] Zigler J E,Delamarter R B. Oswestry disability index[J]. J Neurosurg Spine,2014,20(2):241-242.
[13]梁育磊,高谦.非特异性腰痛诊疗进展[J].颈腰痛杂志,2017,38(4):376-379.
[14]张浩,梁潇,徐浩,等.非特异性腰痛的研究概况[J].中国民族民间医药,2017,26(7):59-61.
[15]李松.温经通督药熥法配合艾灸治疗寒湿闭阻型腰痛临床研究[J].中医学报,2017,32(4):677-682.
[16]朱华,秦丽,杜沛霖,等.桂枝药理活性及其临床应用研究进展[J].中国民族民间医药,2017,26(22):61-65.
[17]崔虹,朱佳茜,冯秋芳,等.中药白芍化学成分及生物活性研究进展[J].海峡药学,2017,29(9):1-5.
[18]张翠英,章洪,戚琼华.川芎的有效成分及药理研究进展[J].辽宁中医杂志,2014,41(10):2264-2266.
[19] MAI X,SHI Y,XU Y,et al. Acupuncture for chronic low back pain in long-term follow-up:a meta-analysis of13 randomized controlled trials[J]. Am J Chin Med,2013,41(1):1-19.
[20]宋斌,宋红,王鸿儒,等.腰宁汤联合麝香止痛贴膏治疗寒湿瘀阻型慢性腰肌劳损的临床评价[J].中国实验方剂学杂志,2016,22(18):159-163.
[21]樊国峰,刘创建,王丹,等.白细胞介素-1,肿瘤坏死因子-α与腰椎间盘退变的研究进展[J].河北医科大学学报,2008,29(4):624-627.
[2]岳寿伟.腰痛的评估与康复治疗进展[J].中国康复医学杂志,2017,32(2):136-139.
[3]刘宜军,杨勇,孙丽敏.附子汤合芍药甘草汤加味离子导入治疗寒湿瘀阻证非特异性下腰痛[J].中国实验方剂学杂志,2017,23(20):195-200.
[4]张继伟,陈东煜.非特异性下腰痛的保守治疗现状[J].中医药临床杂志,2015,27(12):1668-1670.
[5]付传国.应用“乌附麻辛桂姜汤”治疗痹证的体会[J].成都中医学院学报,1982,6(2):50-52.
[6]李泰标,谢洪武,吴伟,等.乌附麻辛桂姜汤加减治疗非特异性下腰痛的临床疗效观察[J].世界科学技术—中医药现代化,2014,16(10):2153-2156.
[7]赵海博,翟明玉,白玉,等.乌附麻辛桂姜汤加减治疗寒湿型腰椎间盘突出症46例[J].现代中医药,2014,34(3):29-30.
[8]宋恩峰,孙文连.乌附麻辛桂姜汤加味治疗类风湿性关节炎临床研究[J].湖北中医药大学学报,2012,14(4):48-49.
[9]中国康复医学会脊柱脊髓专业委员会专家组.中国急/慢性非特异性腰背痛诊疗专家共识[J].中国脊柱脊髓杂志,2016,26(12):1134-1138.
[10]中华人民共和国中医药行业标准.中医骨伤科病证诊断疗效标准[M].北京:人民卫生出版社,1994:197.
[11]肖军章.疼痛评估方法的优与劣[J].中国临床医药研究杂志,2007,177:39-40.
[12] Zigler J E,Delamarter R B. Oswestry disability index[J]. J Neurosurg Spine,2014,20(2):241-242.
[13]梁育磊,高谦.非特异性腰痛诊疗进展[J].颈腰痛杂志,2017,38(4):376-379.
[14]张浩,梁潇,徐浩,等.非特异性腰痛的研究概况[J].中国民族民间医药,2017,26(7):59-61.
[15]李松.温经通督药熥法配合艾灸治疗寒湿闭阻型腰痛临床研究[J].中医学报,2017,32(4):677-682.
[16]朱华,秦丽,杜沛霖,等.桂枝药理活性及其临床应用研究进展[J].中国民族民间医药,2017,26(22):61-65.
[17]崔虹,朱佳茜,冯秋芳,等.中药白芍化学成分及生物活性研究进展[J].海峡药学,2017,29(9):1-5.
[18]张翠英,章洪,戚琼华.川芎的有效成分及药理研究进展[J].辽宁中医杂志,2014,41(10):2264-2266.
[19] MAI X,SHI Y,XU Y,et al. Acupuncture for chronic low back pain in long-term follow-up:a meta-analysis of13 randomized controlled trials[J]. Am J Chin Med,2013,41(1):1-19.
[20]宋斌,宋红,王鸿儒,等.腰宁汤联合麝香止痛贴膏治疗寒湿瘀阻型慢性腰肌劳损的临床评价[J].中国实验方剂学杂志,2016,22(18):159-163.
[21]樊国峰,刘创建,王丹,等.白细胞介素-1,肿瘤坏死因子-α与腰椎间盘退变的研究进展[J].河北医科大学学报,2008,29(4):624-627.