九味羌活通络汤对腰椎间盘摘除术后患者肠道菌群失衡恢复及术后并发症的影响  

Effect of Jiuwei Qianghuo Tongluo decoction on the recovery of intestinal microbiota imbalance and postoperative complications in patients after lumbar discectomy

作　　者：关雨晴 王福育 李德魁[1] 陈江[1] 李遵旺 秦佳齐 杨嘉玉 GUAN Yuqing;WANG Fuyu;LI Dekui;CHEN Jiang;LI Zunwang;QIN Jiaqi;YANG Jiayu(Department of Orthopaedics,Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing 100700,China;Traditional Medical Technology Center,South District of Guang’anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 102618,China)

机构地区：[1]北京中医药大学东直门医院骨科,北京100700 [2]中国中医科学院广安门医院南区传统医疗技术中心,北京102618

出　　处：《陕西中医》2025年第2期182-187,共6页Shaanxi Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金资助项目(82374492)。

摘　　要：目的:探究九味羌活通络汤对腰椎间盘摘除术后患者肠道菌群失衡的恢复及术后并发症的影响。方法:选取接受经皮内镜腰椎间盘切除术(PELD)治疗后发生肠道菌群失衡的90例腰椎间盘突出(LDH)患者作为研究对象,按随机数字表法分为两组,每组各45例。比较两组治疗前后肠道菌群值及双歧杆菌属/肠杆菌科(B/E)值、菌群失衡分级、胃肠功能、生活质量、肠黏膜屏障功能、T淋巴细胞亚群水平、炎症因子水平、疼痛及腰椎功能相关指标及并发症发生率。结果:治疗后,两组的双歧杆菌、类杆菌、小梭菌和乳杆菌数量及B/E值显著增加,而肠杆菌和肠球菌数量显著减少。观察组在这些指标上的改善优于对照组,差异有统计学意义(P<0.05)。治疗后,两组肠道菌群失衡分级Ⅲ级患者数量均较治疗前明显减少,Ⅰ级+正常患者数量均较治疗前明显增加,且观察组的Ⅰ级+正常患者数量明显多于对照组(均P<0.05)。治疗后,观察组的CD4^(+)、CD4^(+)/CD8^(+)较治疗前明显升高,CD8^(+)较治疗前明显降低;对照组的CD4^(+)、CD4^(+)/CD8^(+)较治疗前明显降低,CD8^(+)较治疗前明显升高(均P<0.05),观察组的CD4^(+)、CD4^(+)/CD8^(+)明显高于对照组,CD8^(+)明显低于对照组(均P<0.05)。治疗后,两组胃肠功能各项评分、VAS、ODI评分、D-乳酸、DAO、IL-6、TNF-α水平均较治疗前明显降低,且观察组明显低于对照组(均P<0.05)。治疗后,两组患者的生活质量各维度评分和JOA评分在治疗后显著提高,且观察组的评分明显高于对照组(均P<0.05)。观察组的并发症发生率(6.67%)明显低于对照组(28.89%,P<0.05)。结论:九味羌活通络汤可显著改善腰椎间盘摘除术后患者肠道菌群失衡,有效降低炎症和疼痛反应,提高患者免疫水平,并减少并发症发生。Objective:To investigate the effects of Jiuwei Qianghuo Tongluo decoction on the recovery of intestinal microbiota imbalance and reduction of postoperative complications in patients following lumbar discectomy.Methods:Ninety patients with lumbar disc herniation(LDH)who developed intestinal microbiota imbalance after percutaneous endoscopic lumbar discectomy(PELD)were included in this study.They were randomly allocated to an observation group and a control group,with 45 patients in each group.Pre-and post-treatment comparisons were made for gut microbiota values,bifidobacterium/enterobacteriaceae(B/E)ratios,microbiota imbalance grades,gastrointestinal function,quality of life,intestinal mucosal barrier function,T lymphocyte subsets,inflammatory factor levels,pain-related indicators,and lumbar spine function,as well as the incidence of complications.Results:Post-treatment,the numbers of bifidobacterium,bacteroidetes,clostridium,and lactobacillus,as well as the B/E ratios,significantly increased in both groups compared to pre-treatment levels,while the numbers of escherichia coli and enterococcus significantly decreased.The improvements in these indicators were more pronounced in the observation group compared to the control group(all P<0.05).The number of patients with gradeⅠintestinal microbiota imbalance significantly decreased in both groups after treatment,while the number of patients with gradeⅠor normal balance significantly increased(all P<0.05).The observation group showed a significantly higher proportion of patients with gradeⅠor normal balance compared to the control group(P<0.05).In the observation group,CD4^(+)and CD4^(+)/CD8^(+)levels significantly increased post-treatment,while CD8^(+)levels significantly decreased compared to pre-treatment levels.In contrast,CD4^(+)and CD4^(+)/CD8^(+)levels in the control group were decreased,and CD8^(+)levels was increased(all P<0.05).The observation group showed significantly higher in CD4^(+)and CD4^(+)/CD8^(+)levels and significantly lower in CD8^(+)levels

关 键 词：腰椎间盘摘除术 九味羌活通络汤 肠道菌群失衡 并发症 T淋巴细胞亚群 炎症因子 

分 类 号：R684[医药卫生—骨科学]