加味葛根汤联合正脊手法治疗颈椎间盘突出症疗效及对患者血清细胞炎性因子、疼痛介质的影响  

Clinical Efficacy of Modified Gegentang Combined with Spinal Manipulation and Its Effect on Inflammatory Factors and Pain Mediators of Cervical Disc Herniation

作　　者：王大力[1] 樊炜骏 杨凤妮 WANG Da-li;FAN Wei-jun;YANG Feng-ni(First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine （TCM）, Tianjin 300193, China;Dongguan Hospital of TCM , Dongguan 523000, China;The Third People＇s Hospital of Shenzhen, Shenzhen 518115, China)

机构地区：[1]天津中医药大学第一附属医院,天津300193 [2]东莞市中医院,广东东莞523000 [3]深圳市第三人民医院,广东深圳518115

出　　处：《中国实验方剂学杂志》2018年第9期179-183,共5页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：天津市卫生局中医、中西医结合科研项目(07061);广东省中医药局科研基金项目(20111079)

摘　　要：目的：探讨加味葛根汤联合正脊手法治疗颈椎间盘突出症（cervical disc herniation,CDH）疗效及对患者血清细胞炎性因子、疼痛介质的影响。方法：2014年3月—2016年12月天津中医药大学第一附属医院共收治157例CDH患者,以该批患者为研究对象,按随机数字表法分为治疗组（78例）和对照组（79例）。对照组患者采用正脊手法进行治疗,治疗组同时加服加味葛根汤,每日1剂,连续服用10 d后,分析两组患者临床疗效,视觉模拟评分法（VAS评分）,血清炎性因子以及疼痛介质的变化情况。结果：治疗组患者总有效率为94.87%,对照组为82.28%,两组差异有统计学意义（P〈0.05）;治疗6,10 d后,两组患者VAS评分均有所降低,治疗组明显低于对照组（P〈0.05）;与治疗前比较,治疗后,两组患者血清中肿瘤坏死因子（tumor necrosis factor,TNF）-α,白细胞介素-1（interleukin-1,IL-1）,白细胞介素-6（interleukin-6,IL-6）水平均明显降低,且治疗组明显低于对照组（P〈0.05）;通过治疗,两组患者血清中5-羟色胺（5-hydroxytryptamine,5-HT）,前列腺素E2（prostaglandin,PEG2）与一氧化氮（nitric oxide,NO）水平均明显降低,且治疗组明显低于对照组（P〈0.05）。结论：加味葛根汤联合正脊手法可以明显提高临床疗效,降低VAS评分与患者疼痛感受,有效抑制细胞炎性反应,减缓颈椎间盘退变进程,因此对CDH具有积极的治疗效果,值得临床推广应用。Objective：To study the clinical efficacy of modified Gegentang combined with spinal manipulation and its effect on inflammatory factors and pain mediators of cervical disc herniation（CDH）.Method：Totally 157 cases of CDH patients treated in our hospital from March 2014 to December 2016 were selected and divided into two groups according to the admitted order,with 78 cases in clinical group and 79 in control group.Patients in control group were treated with spinal manipulation; in addition,the clinical group was also given modified Gegentang.Then the clinical efficacy,visual analogue scale/score（VAS） scores,inflammatory factors and pain mediators were compared.Result：Compared with 82.28% in the control group,the total effective rate of the clinical group was 94.87%,with significant differences（P 〈 0.05）.After the treatment for 6 d and 10 d,VAS scores of the two groups decreased,the experimental group was inferior to the control group（P 〈 0.05）.Compared with before treatment,tumor necrosis factor（TNF）-α,interleukin（IL）-1 and IL-6 of the two groups decreased after treatment（P 〈 0.05）.Compared with control group,the levels of TNF-α,IL-1 and IL-6 in patients of clinical group were lower after treatment（P 〈 0.05）.Compared with before treatment,5-hydroxytryptamine（5-HT）,prostaglandin（PEG2） and nitric oxide（NO） of the two groups decreased after treatment（P 〈 0.05）.Compared with control group,the levels of 5-HT,PEG2 and NO in patients of the clinical group were lower after treatment（P 〈 0.05）.Conclusion：Modified Gegentang combined with spinal manipulation can significantly enhance the therapeutic efficiency,lower VAS scores and the perception of pain,effectively inhibit inflammatory reaction and slow down the progress of cervical intervertebral disc degeneration.Therefore,it has a better effect on CDH and is worth clinical promotion and application.

关 键 词：加味葛根汤 正脊手法 椎间盘突出症 疗效 炎性因子 疼痛介质 

分 类 号：R22[医药卫生—中医基础理论] R24[医药卫生—中医学]