基于Zelen's设计桂葛灵仙汤联合颈夹脊穴透灸法治疗神经根型颈椎病风寒湿痹证  

Effect of Zelen's Guige Lingxian Decoction Combined with Moxibustion at Neck Jiaji Acupoint in Treatment of Cervical Spondylotic radiculopathy of Wind-cold-dampness Arthralgia Syndrome

作　　者：孙鹏[1] 李建[1] 樊炜骏 唐宁[1] 沙明波[1] 鲁育 李华南[1] 王舒[1] SUN Peng;LI Jian;FAN Wei-jun;TANG Ning;SHA Ming-bo;LU Yu;LI Hua-nan;WANG Shu(The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300193,China)

机构地区：[1]天津中医药大学第一附属医院,天津300193

出　　处：《中国实验方剂学杂志》2020年第9期58-63,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金项目(81603711)。

摘　　要：目的:基于Zelen's设计,探讨桂葛灵仙汤联合夹脊穴透灸法治疗神经根型颈椎病(CSR)风寒湿痹证临床疗效及作用机制。方法:将120例CSR风寒湿痹证患者随机分为中药组和联合组,均60例,拟入中药组直接进入中药组,拟入联合组知情同意则进入联合组,不同意则进入中药组。中药组给予桂葛灵仙汤150 mL/次,2次/d口服,联合组患者在中药组治疗基础上给予颈部夹脊穴透灸治疗,30 min/次,1次/d,两组患者均治疗8周。记录入组患者CSR 20分量表评分,SF-36量表评分及典型症状体征缓解时间,治疗结束后统计总有效率和治愈率;酶联免疫夹心法检测治疗前后患者血清白三烯B4(LTB4),白三烯C4(LTC4),白三烯D4(LTD4),甲壳质酶蛋白-40(YKL-40),白细胞介素-1β(IL-1β)及肿瘤坏死因子-α(TNF-α)含量。结果:联合组总有效率为98.11%(52/53),治愈率为43.39%(23/52),优于中药组总有效率91.04%(61/69),治愈率20.89%(14/67)(P<0.05);与中药组比较,联合组患者CSR 20分量表,SF-36量表评分升高(P<0.05),典型症状体征缓解时间缩短(P<0.05);血清中LTB4,LTC4,LTD4,YKL-40,IL-1β及TNF-α含量降低(P<0.05)。结论:Zelen's设计结果显示桂葛灵仙汤联合夹脊穴透灸法治疗CSR风寒湿痹证临床疗效确切,值得临床推广,其机制可能与抑制LT表达,减少IL-1β及TNF-α含量在血清中含量,从而促进颈椎软骨修复和提高疼痛阈值有关。Objective:To investigate the clinical efficacy and mechanism of Guige Lingxian decoction combined with moxibustion at neck Jiaji acupoint on cervical spondylotic radiculopathy(CSR)of wind-colddampness arthralgia syndrome.Method:Totally 120 cases of cervical spondylotic radiculopathy with wind-colddampness syndrome were randomly divided into two groups:traditional Chinese medicine(TCM)group and combination group,with 60 cases in each group.The TCM group was treated with Guige Lingxian Tang 150 mL/time,twice a day.The combination group was treated with moxibustion at neck Jiaji acupoint in addition to the therapy of the TCM group,30 minutes/time,once a day.Both groups were treated for 8 weeks.CSR 20 subscale score,SF-36 scale score,typical symptoms and signs remission time were recorded.The total effective rate and the cure rate were recorded after treatment.Serum levels of leukotriene B4(LTB4),leukotriene C4(LTC4),leukotriene D4(LTD4),chitinase protein 40(YKL-40),interleukin-1β(IL-1β)and tumor necrosis factor-α(TNF-α)were measured by enzyme linked immunosorbent assay(ELISA)before and after treatment.Result:The total effective rate was 98.11%(52/53),and the cure rate was 43.39%(23/53)in the combination group,which were higher than 91.04%(61/67)and 20.89%(14/67)in the TCM group(P<0.05).Compared with the TCM group,the scores of CSR 20 subscale and SF-36 scale in combination group were increased(P<0.05),and the remission time of typical symptoms and signs was shortened.Serum levels of LTB4,LTC4,LTD4,YKL-40,IL-1βand TNF-αwere decreased(P<0.05).Conclusion:Moxibustion at neck Jiaji acupoint combined with Guige Lingxian decoction is effective in treating CSR of wind-cold-dampness arthralgia syndrome,which is worthy of clinical promotion.Its mechanism may be related to the inhibition of the expression of LT,and the reduction of the content of IL-1βand TNF-αin serum,thus promoting the repair of cervical cartilage and increasing the pain threshold.

关 键 词：桂葛灵仙汤 神经根型颈椎病 透灸法 白三烯 炎症 桂枝加葛根汤 

分 类 号：R22[医药卫生—中医基础理论] R242[医药卫生—中医学]