加味阳和汤治疗脊柱结核临床研究
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摘要
目的:观察加味阳和汤治疗脊柱结核的临床疗效。方法:选取2015年4月至2018年4月在本院治疗的脊柱结核患者60例,按照随机数字表法分为治疗组和常规组,每组30例。常规组给予常规抗结核西药治疗,治疗组在常规组治疗的基础上给予加味阳和汤加减治疗。观察两组患者治疗前后疼痛视觉模拟量表评分(visual analogue scale,VAS)变化情况,采用酶联免疫吸附试验测定两组患者白细胞介素-1β(interleukin-1β,IL-1β)、白细胞介素-17(interleukin-17,IL-17)及肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平进行测定。结果:治疗组有效率93. 33%,常规组有效率70. 00%,治疗组有效率高于常规组,差异有统计学意义(P <0. 05);治疗组治疗后疼痛VAS评分明显低于常规组,差异有统计学意义(P <0. 05);治疗组治疗后IL-1β、IL-17及TNF-α水平均低于常规组,差异有统计学意义(P <0. 05);治疗组治疗后基质金属蛋白酶-1(matrix metalloproteinase-1,MMP-1)、基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)及单核细胞趋化因子-1(monocyte chemokine-1,MCP-1)水平均低于常规组,差异有统计学意义(P <0. 05)。结论:加味阳和汤联合常规西药抗结核药物治疗脊柱结核能够提高疗效,有助于改善患者疼痛症状,降低炎症因子水平,安全性较高,减少手术治疗概率。
Objective: To observe the clinical curative effect of Supplemented Harmonious Yang Decoction on spinal tuberculosis.Methods: Sixty patients with spinal tuberculosis treated in our hospital from April 2015 to April 2018 were divided into the treatment group and the routine group according to random number table method,with 30 cases in each group. The routine group was treated with conventional anti-tuberculosis Western medicine,while the treatment group was treated with Supplemented Harmonious Yang Decoction on the basis of the routine treatment. The changes of pain visual analogue scale( VAS) before and after the treatment were observed. The levels of interleukin-1β( IL-1β),interleukin-17( IL-17) and tumor necrosis factor-α( TNF-α) were measured by enzyme-linked immunosorbent assay( ELISA). Results: The effective rate was 93. 33% in the treatment group and70. 00% in the routine group,the treatment group was higher than the routine group and the difference was statistically significant( P < 0. 05). The VAS score of pain in the treatment group was significantly lower than that in the conventional group,and the difference was statistically significant( P < 0. 05). The levels of IL-1β,IL-17 and TNF-α in the treatment group were lower than those in the conventional group,and all the differences were statistically significant( P < 0. 05). The levels of matrix metalloproteinase-1,matrix metalloproteinase-9 and monocyte chemokine-1 in the treatment group after the treatment were significantly lower than those in the conventional group and all the differences were statistically significant( P < 0. 05). Conclusion: Supplemented Harmonious Yang Decoction combined with conventional Western medicine in the treatment of spinal tuberculosis can improve the curative effect,help to improve the pain symptoms of patients,reduce the level of inflammatory factors with high safety,and reduce the probability of surgical treatment.
Objective: To observe the clinical curative effect of Supplemented Harmonious Yang Decoction on spinal tuberculosis.Methods: Sixty patients with spinal tuberculosis treated in our hospital from April 2015 to April 2018 were divided into the treatment group and the routine group according to random number table method,with 30 cases in each group. The routine group was treated with conventional anti-tuberculosis Western medicine,while the treatment group was treated with Supplemented Harmonious Yang Decoction on the basis of the routine treatment. The changes of pain visual analogue scale( VAS) before and after the treatment were observed. The levels of interleukin-1β( IL-1β),interleukin-17( IL-17) and tumor necrosis factor-α( TNF-α) were measured by enzyme-linked immunosorbent assay( ELISA). Results: The effective rate was 93. 33% in the treatment group and70. 00% in the routine group,the treatment group was higher than the routine group and the difference was statistically significant( P < 0. 05). The VAS score of pain in the treatment group was significantly lower than that in the conventional group,and the difference was statistically significant( P < 0. 05). The levels of IL-1β,IL-17 and TNF-α in the treatment group were lower than those in the conventional group,and all the differences were statistically significant( P < 0. 05). The levels of matrix metalloproteinase-1,matrix metalloproteinase-9 and monocyte chemokine-1 in the treatment group after the treatment were significantly lower than those in the conventional group and all the differences were statistically significant( P < 0. 05). Conclusion: Supplemented Harmonious Yang Decoction combined with conventional Western medicine in the treatment of spinal tuberculosis can improve the curative effect,help to improve the pain symptoms of patients,reduce the level of inflammatory factors with high safety,and reduce the probability of surgical treatment.
引文
[1]蒋之,屈满英,万轲.耐药脊柱结核的临床分析及疗效研究[J].中国现代医学杂志,2016,26(11):132-136.
[2]侯煜,杨雯,杨帆,等.钴合金椎弓根螺钉植入修复脊柱结核重度后凸畸形:自身对照临床试验方案[J].中国组织工程研究,2016,20(44):6661-6666.
[3]LIU J M,CHEN X Y,ZHOU Y,et al.Is nonstructural bone graft useful in surgical treatment of lumbar spinal tuberculosis?:A retrospective case-control study[J].Medicine,2016,95(35):e4677.
[4]耿同宇,陈盈君,张雷,等.药物治疗在脊柱结核患者中的应用效果与对血液指标影响研究[J].中华医院感染学杂志,2016,26(12):2794-2796.
[5]肖运祥,陈海丹,刘杨.后路与前路病灶清除减压植骨融合内固定术治疗腰椎结核临床效果比较[J].山东医药,2017,57(16):49-51.
[6]黄正辉,刘炜,王静丽.脂肪间充质干细胞复合利福平缓释微球在脊柱结核动物模型中的应用[J].中国组织工程研究,2017,21(26):4192-4198.
[7]崔旭,马远征,陈兴,等.脊柱结核术后复治的原因分析和手术治疗策略[J].中华骨科杂志,2017,37(2):65-73.
[8]HU X,ZHANG H,YIN X,et al.One-stage posterior focus debridement,fusion,and instrumentation in the surgical treatment of lumbar spinal tuberculosis with kyphosis in children[J].Childs Nervous System,2016,32(3):535-539.
[9]姜力元,胡建中,陈静,等.一期后路单侧椎板开窗、经椎间隙病灶清除植骨融合内固定治疗胸腰段脊柱结核[J].中国矫形外科杂志,2016,24(11):990-994.
[10]王栋,赵波,李锋涛,等.一期病灶清除固定融合治疗腰骶段脊柱结核的临床观察[J].中国矫形外科杂志,2016,24(23):2144-2147.
[11]买尔旦·买买提,牙克甫·阿不力孜,盛伟斌,等.后路经椎间孔入路病灶清除、椎体间融合内固定治疗胸腰段脊柱结核[J].中华骨科杂志,2016,36(11):672-680.
[12]李建华,陈非凡,罗飞,等.49例耐药脊柱结核的耐药表型及个体化治疗的回顾性分析[J].中华骨科杂志,2016,36(11):699-708.
[13]ABULIZI Y,LIANG W D,MAIMAITI M,et al.Smith-Petersen osteotomy combined with anterior debridement and allografting for active thoracic and lumbar spinal tuberculosis with kyphotic deformity in young children:A prospective study and literature review[J].Medicine,2017,96(32):e7614.
[14]张正平,王凯军,王小明,等.经皮椎间孔入路内镜下病灶清除、植骨联合后路经皮内固定治疗胸、腰椎结核[J].中华骨科杂志,2018,38(8):468-476.
[15]高永建,欧云生,邓乾兴,等.钛笼与髂骨块植骨修复椎骨缺损治疗胸腰椎结核的疗效比较[J].中国矫形外科杂志,2017,25(5):404-409.
[16]任忠明,张远,张翊,等.一期前路病灶清除植骨联合前路或后路内固定重建术治疗胸腰椎结核[J].中国矫形外科杂志,2016,24(19):1774-1779.
[2]侯煜,杨雯,杨帆,等.钴合金椎弓根螺钉植入修复脊柱结核重度后凸畸形:自身对照临床试验方案[J].中国组织工程研究,2016,20(44):6661-6666.
[3]LIU J M,CHEN X Y,ZHOU Y,et al.Is nonstructural bone graft useful in surgical treatment of lumbar spinal tuberculosis?:A retrospective case-control study[J].Medicine,2016,95(35):e4677.
[4]耿同宇,陈盈君,张雷,等.药物治疗在脊柱结核患者中的应用效果与对血液指标影响研究[J].中华医院感染学杂志,2016,26(12):2794-2796.
[5]肖运祥,陈海丹,刘杨.后路与前路病灶清除减压植骨融合内固定术治疗腰椎结核临床效果比较[J].山东医药,2017,57(16):49-51.
[6]黄正辉,刘炜,王静丽.脂肪间充质干细胞复合利福平缓释微球在脊柱结核动物模型中的应用[J].中国组织工程研究,2017,21(26):4192-4198.
[7]崔旭,马远征,陈兴,等.脊柱结核术后复治的原因分析和手术治疗策略[J].中华骨科杂志,2017,37(2):65-73.
[8]HU X,ZHANG H,YIN X,et al.One-stage posterior focus debridement,fusion,and instrumentation in the surgical treatment of lumbar spinal tuberculosis with kyphosis in children[J].Childs Nervous System,2016,32(3):535-539.
[9]姜力元,胡建中,陈静,等.一期后路单侧椎板开窗、经椎间隙病灶清除植骨融合内固定治疗胸腰段脊柱结核[J].中国矫形外科杂志,2016,24(11):990-994.
[10]王栋,赵波,李锋涛,等.一期病灶清除固定融合治疗腰骶段脊柱结核的临床观察[J].中国矫形外科杂志,2016,24(23):2144-2147.
[11]买尔旦·买买提,牙克甫·阿不力孜,盛伟斌,等.后路经椎间孔入路病灶清除、椎体间融合内固定治疗胸腰段脊柱结核[J].中华骨科杂志,2016,36(11):672-680.
[12]李建华,陈非凡,罗飞,等.49例耐药脊柱结核的耐药表型及个体化治疗的回顾性分析[J].中华骨科杂志,2016,36(11):699-708.
[13]ABULIZI Y,LIANG W D,MAIMAITI M,et al.Smith-Petersen osteotomy combined with anterior debridement and allografting for active thoracic and lumbar spinal tuberculosis with kyphotic deformity in young children:A prospective study and literature review[J].Medicine,2017,96(32):e7614.
[14]张正平,王凯军,王小明,等.经皮椎间孔入路内镜下病灶清除、植骨联合后路经皮内固定治疗胸、腰椎结核[J].中华骨科杂志,2018,38(8):468-476.
[15]高永建,欧云生,邓乾兴,等.钛笼与髂骨块植骨修复椎骨缺损治疗胸腰椎结核的疗效比较[J].中国矫形外科杂志,2017,25(5):404-409.
[16]任忠明,张远,张翊,等.一期前路病灶清除植骨联合前路或后路内固定重建术治疗胸腰椎结核[J].中国矫形外科杂志,2016,24(19):1774-1779.