腰痹康颗粒联合塞来昔布对腰椎间盘突出症椎间孔镜术后残余症及椎间盘退变的影响  

Effect of Yaobikang Granule Combined with Celecoxib on Lumbar Disc Degeneration and Residual Symptoms after Transforaminal Endoscopic Discectomy for Lumbar Disc Herniation

作　　者：牛永涛 樊新甫[1] 蒋伟 薛娣 NIU Yongtao;FAN Xinfu;JIANG Wei;XUE Di(The Affiliated Hospital of Anhui College of Traditional Chinese Medicine,Anhui Wuhu 241000,China)

机构地区：[1]安徽中医药高等专科学校附属医院,安徽芜湖241000

出　　处：《安徽中医药大学学报》2024年第4期25-29,共5页Journal of Anhui University of Chinese Medicine

基　　金：安徽省卫生健康科研项目(AHWJ2023A20338);安徽高校自然科学研究重点项目(KJ2021A1278)。

摘　　要：目的探讨腰痹康颗粒对腰椎间盘突出症椎间孔镜术后残余症以及腰椎间盘退变的影响。方法将76例腰椎间盘突出症椎间孔镜术后残余症患者随机分为中药组38例和对照组38例,最终中药组35例、对照组34例完成随访。对照组给予塞来昔布胶囊口服,中药组在对照组基础上给予腰痹康颗粒口服,疗程均为1个月。比较两组患者治疗前后疼痛视觉模拟量表(visual analogue scale,VAS)评分,日本骨科协会(Japanese orthopaedic association,JOA)评分,血清细胞凋亡相关指标[B淋巴细胞瘤-2(B-cell lymphoma 2,Bcl-2)、Bcl-2相关的X蛋白(Bcl-2-associated X protein,Bax)、半胱氨酸蛋白酶-3(caspase-3,CASP3)]水平,两组患者髓核(nucleus pulposus,NP)区、纤维环(annulus fibrosus,AF)区MRI T2值。结果与术后1 d比较,术后1周两组患者VAS评分显著降低,JOA评分显著升高,差异均有统计学意义(P<0.05),且中药组比对照组降低或升高程度更显著(P<0.05);与术后1周比较,术后1个月两组患者VAS评分显著降低,JOA评分显著升高,差异均有统计学意义(P<0.05),且中药组比对照组降低或升高程度更显著(P<0.05)。与术后1 d比较,术后1个月两组患者血清Bcl-2水平均显著升高(P<0.05),且中药组血清Bcl-2水平显著高于对照组(P<0.05),两组患者血清Bax、CASP3水平显著降低(P<0.05),且中药组血清Bax、CASP3水平显著低于对照组(P<0.05)。术后3个月,两组患者NP区、AF区MRI T2值较术前显著降低(P<0.05),但中药组患者NP区、AF区MRI T2值显著高于对照组(P<0.05)。结论腰痹康颗粒能有效改善腰椎间盘突出症椎间孔镜术后残余症,其作用机制可能是提高血清Bcl-2水平,降低血清Bax、CASP3水平。Objective To investigate the effect of Yaobikang Granule combined with celecoxib on lumbar disc degeneration and residual symptoms after transforaminal endoscopic discectomy for lumbar disc herniation.Methods A total of 76 patients with residual symptoms after transforaminal endoscopic discectomy for lumbar disc herniation were randomly divided into traditional Chinese medicine(TCM)group and control group,with 38 patients in each group,and finally,69 patients completed follow-up,with 35 patients in the TCM group and 34 in the control group.The patients in the control group were given oral administration of celecoxib capsules,while those in the TCM group were given oral administration of Yaobikang Granule in addition to the treatment in the control group;the course of treatment was 1 month for both groups.The two groups were compared in terms of Visual Analogue Scale(VAS)score,Japanese Orthopaedic Association(JOA)score,the serum levels of cell apoptosis-related indicators[B-cell lymphoma 2(Bcl-2),Bcl-2-associated X protein(Bax),and caspase-3(CASP3)],and MRI T2 value of the nucleus pulposus(NP)and annulus fibrosus(AF)regions before and after treatment.Results Both groups had a significant reduction in VAS score and a significant increase in JOA score from 1 day to 1 week after surgery(P<0.05),and the TCM group had greater changes than the control group(P<0.05).Both groups had a significant reduction in VAS score and a significant increase in JOA score from 1 week to 1 month after surgery(P<0.05),and the TCM group had greater changes than the control group(P<0.05).From 1 day to 1 month after surgery,both groups had a significant increase in the serum level of Bcl-2(P<0.05),and the TCM group had a significantly higher serum level of Bcl-2 than the control group(P<0.05);both groups had significant reductions in the serum levels of Bax and CASP3(P<0.05),and the TCM group had significantly lower serum levels of Bax and CASP3 than the control group(P<0.05).At 3 months after surgery,both groups had a significant reduction

关 键 词：腰痹康颗粒 腰椎间盘突出症 椎间孔镜术后 术后残余症 腰椎间盘退变 

分 类 号：R681.53[医药卫生—骨科学]