独活续断汤对不同类型腰间盘突出症患者临床疗效、生活能力的影响及机制
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摘要
目的:探讨独活续断汤治疗不同证型腰间盘突出症的临床疗效,对生活能力,血清疼痛因子,骨形成蛋白-7(BMP-7),聚集蛋白聚糖(Aggrecan)的影响。方法:将2017年1月至2018年6月天津中医药大学第一附属医院收治的非急症期腰间盘突出症患者121例随机分为观察组(62例)和对照组(59例),两组患者均给予复位手法治疗后绝对卧床休息,观察组给予独活续断汤治疗,150 mL/次,3次/d口服,对照组给予布洛芬300 mg/次、维生素B110 mg/次,2次/d口服,每周服药5 d,停药2 d,两组患者均连续治疗4周,观察两组患者治疗前后视觉模拟评分(VAS),改良Oswestry功能障碍指数变化;酶联免疫吸附测定(ELISA)检测治疗前后血清P物质(SP),多巴胺(DA),五羟色胺(5-HT),BMP-7及Aggrecan含量变化。结果:与本组治疗前比较,两组患者VAS,改良Oswestry功能障碍指数评分均降低(P<0.01),血清BMP-7,Aggrecan含量升高,SP,DA,5-HT含量降低(P<0.01);与对照组治疗后比较,观察组患者VAS,改良Oswestry功能障碍指数评分均降低(P<0.01),临床疗效提高(P<0.01),血清BMP-7,Aggrecan含量更高,SP,DA及5-HT含量更低(P<0.01);在所有证型中肝肾阴虚型患者疗效最佳。结论:独活续断汤对不同类型腰间盘突出症均有一定疗效,但对于肝肾阴虚型患者疗效最佳。
Objective:To investigate clinical efficacy of Duhuo Xuduan Tang in treatment of lumbar disc herniation with different syndrome types and its effect on serum pain factors,bone morphogenetic protein-7(BMP-7) and Aggrecan.Method:A total of 121 patients with non-emergency lumbar disc herniation admitted to the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from January 2017 to June 2018 were randomly divided into observation group(62 cases) and control group(59 cases).The two groups of patients were treated by repositioning maneuver before absolute bed rest.observation group was given Duhuo Xuduan Tang,150 mL·time-1,3 times·d-1 orally,while control group was orally given ibuprofen,300 mg·time-1,vitamin B1,10 mg·time-1,2 times·d-1,drugs were taken for 5 days a week,and then stopped for 2 days.Both groups were treated continuously for 4 weeks.changes in visual analogue score(VAS),modified Oswestry dysfunction index(MODI),serum substance P(SP),dopamine(DA),serotonin(5-HT),BMP-7 and Aggrecan were observed before and after treatment with enzyme-linked immunosandwich assay(ELISA).Result:Compared with before treatment,VAS and modified Oswestry dysfunction index scores were lower in both groups(P<0.05),BMP-7 and Aggrecan contents were higher,while SP,DA and 5-HT contents were lower(P<0.05).Compared with control group,VAS and modified Oswestry dysfunction index scores of observation group were lower(P<0.05),clinical efficacy was improved(P<0.05),levels of BMP-7 and Aggrecan in serum were higher,whereas contents of SP,DA and 5-HT were lower(P<0.05).Conclusion:Duhuo Xuduan Tang has a certain efficacy on different types of lumbar disc herniation,with best efficacy for patients with liver and kidney yin deficiency.
Objective:To investigate clinical efficacy of Duhuo Xuduan Tang in treatment of lumbar disc herniation with different syndrome types and its effect on serum pain factors,bone morphogenetic protein-7(BMP-7) and Aggrecan.Method:A total of 121 patients with non-emergency lumbar disc herniation admitted to the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from January 2017 to June 2018 were randomly divided into observation group(62 cases) and control group(59 cases).The two groups of patients were treated by repositioning maneuver before absolute bed rest.observation group was given Duhuo Xuduan Tang,150 mL·time-1,3 times·d-1 orally,while control group was orally given ibuprofen,300 mg·time-1,vitamin B1,10 mg·time-1,2 times·d-1,drugs were taken for 5 days a week,and then stopped for 2 days.Both groups were treated continuously for 4 weeks.changes in visual analogue score(VAS),modified Oswestry dysfunction index(MODI),serum substance P(SP),dopamine(DA),serotonin(5-HT),BMP-7 and Aggrecan were observed before and after treatment with enzyme-linked immunosandwich assay(ELISA).Result:Compared with before treatment,VAS and modified Oswestry dysfunction index scores were lower in both groups(P<0.05),BMP-7 and Aggrecan contents were higher,while SP,DA and 5-HT contents were lower(P<0.05).Compared with control group,VAS and modified Oswestry dysfunction index scores of observation group were lower(P<0.05),clinical efficacy was improved(P<0.05),levels of BMP-7 and Aggrecan in serum were higher,whereas contents of SP,DA and 5-HT were lower(P<0.05).Conclusion:Duhuo Xuduan Tang has a certain efficacy on different types of lumbar disc herniation,with best efficacy for patients with liver and kidney yin deficiency.
引文
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[16]张其镇,苗雨,王大力,等.独活寄生汤配合温针灸治疗风寒湿痹型膝骨关节炎患者的疗效及对血清疼痛介质、炎症介质、白三烯的影响[J].中国实验方剂学杂志,2018,24(18):153-158.
[17]张婧娴,芮俊乾,陈逸凡,等.四逆散有效成分对内脏高敏感大鼠5-HT信号通路的多靶点协同调控[J].中国实验方剂学杂志,2018,24(16):115-123.
[18]Odabas S,Feichtinger G A,Korkusuz P,et al.Auricular cartilage repair using cryogel scaffolds loaded with BMP-7-expressing primary chondrocytes[J].J Tissue Eng Regen Med,2013,7(10):831-840.
[19]Gavenis K,Heussen N,Hofman M,et al.Cell-free repair of small cartilage defects in the Goettinger minipig:the effects of BMP-7 continuously released by poly(lacticco-glycolid acid)microspheres[J].J Biomater Appl,2014,27(7):1008-1015.
[20]李涛,刘强.IL-17与BMP-7在退变腰椎间盘髓核组织中的表达及其意义[J].中国现代医生,2011,49(6):1-2,10.
[21]Nia H T,Han L,Bozchalooi I S,et al.Aggrecan nanoscale solid-fluid interactions are a primary determinant of cartilage dynamic mechanical properties[J].ACS Nano,2015,9(3):2614-2625.
[2]张云,黎波.身痛逐瘀汤加减内服治疗腰椎间盘突出症90例疗效观察[J].中医临床研究,2018,10(16):99-100.
[3]郭振江.自制外贴内服方药治疗腰间盘突出症的远期疗效观察[J].中华中医药学刊,2009,27(5):1108-1110.
[4]朱海丰,陈福初.按摩加牵引点压复位法治疗腰间盘突出的临床观察[J].现代诊断与治疗,2015,26(6):1251,1299.
[5]匡尧,李正飞,孙鹏,等.独活寄生汤配合膝四针治疗风寒湿痹型膝骨关节炎的临床观察[J].中国实验方剂学杂志,2018,24(18):147-152.
[6]李育刚.腰椎间盘突出患者血清疼痛物质及炎性应激指标的变化研究[J].中国骨与关节外科,2014,7(6):472-474.
[7]舒剑臣,唐小穗.P物质、白介素6与腰椎键盘所致腰腿疼痛的相关性研究[J].中国骨与关节损伤杂志,2013,28(9):825-827.
[8]解纪惠,刘梅珍,崔丽芹.清痹汤治疗膝骨关节炎的VAS评分WOMAC骨关节炎指数的变化[J].河北中医药学报,2011,26(1):16,31.
[9]厉强,刘文东,于鹏飞.舒筋健腰丸治疗腰间盘突出所致坐骨神经痛(肝肾亏虚证)的临床研究[J].中药材,2018,41(3):747-749.
[10]中华医学会.临床诊疗指南·骨科分册[M].北京:人民卫生出版社,2009:97-98.
[11]国家中医药管理局.中医病证诊断疗效标准[M].北京:中国中医药出版社,2014:214.
[12]Knop C,Oeser M,Bastian L,et al.Development and validation of the visual analogue scale(VAS)spine score[J].Unfallchirurg,2001,104(6):488-497.
[13]张斌.右归丸治疗腰间盘突出症随机平行对照研究[J].光明中医,2017,32(6):775-777.
[14]Kato K,Sekiguchi M,Kikuchi S,et al.The effect of a5-HT2A receptor antagonist on pain-relate behavior,endgenous 5-hydroxytryptamine production,and the expression 5-HT2A receptors in dorsal root ganglia in a rat lumbar disc herniation model[J].Spine,2015,40(6):357-362.
[15]刘家远,闫安.中频电疗结合循经点穴推拿治疗腰椎间盘突出症的疗效及对血浆NGF、SP水平的影响研究[J].浙江中医杂志,2015,50(10):749-750.
[16]张其镇,苗雨,王大力,等.独活寄生汤配合温针灸治疗风寒湿痹型膝骨关节炎患者的疗效及对血清疼痛介质、炎症介质、白三烯的影响[J].中国实验方剂学杂志,2018,24(18):153-158.
[17]张婧娴,芮俊乾,陈逸凡,等.四逆散有效成分对内脏高敏感大鼠5-HT信号通路的多靶点协同调控[J].中国实验方剂学杂志,2018,24(16):115-123.
[18]Odabas S,Feichtinger G A,Korkusuz P,et al.Auricular cartilage repair using cryogel scaffolds loaded with BMP-7-expressing primary chondrocytes[J].J Tissue Eng Regen Med,2013,7(10):831-840.
[19]Gavenis K,Heussen N,Hofman M,et al.Cell-free repair of small cartilage defects in the Goettinger minipig:the effects of BMP-7 continuously released by poly(lacticco-glycolid acid)microspheres[J].J Biomater Appl,2014,27(7):1008-1015.
[20]李涛,刘强.IL-17与BMP-7在退变腰椎间盘髓核组织中的表达及其意义[J].中国现代医生,2011,49(6):1-2,10.
[21]Nia H T,Han L,Bozchalooi I S,et al.Aggrecan nanoscale solid-fluid interactions are a primary determinant of cartilage dynamic mechanical properties[J].ACS Nano,2015,9(3):2614-2625.