黄芪桂枝五物汤联合单唾液酸四己糖神经节苷脂治疗脊髓损伤的疗效及对神经突起因子、神经丝轻链蛋白的影响  

Therapeutic Efficacy of Huangqi Guizhi Wuwu Decoction Combined with Monosialotetrahexosyl Ganglioside in the Treatment of Spinal Cord Injury and Its Effect on Neuritin and Neurofilament Light Chain Protein

作　　者：张宁[1] 赵新 洪叶 李青 ZHANG Ning;ZHAO Xin;HONG Ye;LI Qing(Baoji Hospital of Traditional Chinese Medicine,Baoji 721000 Shaanxi,China;Dept.of Rehabilitation,Baoji People's Hospital,Baoji 721000 Shaanxi,China)

机构地区：[1]陕西省宝鸡市中医医院,陕西宝鸡721000 [2]陕西省宝鸡市人民医院康复医学科,陕西宝鸡721000

出　　处：《广州中医药大学学报》2025年第3期606-613,共8页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家自然科学基金资助项目(编号:81960234)。

摘　　要：【目的】探讨黄芪桂枝五物汤联合单唾液酸四己糖神经节苷脂(GM1)治疗脊髓损伤(SCI)患者的疗效及对神经突起因子(Neuritin)、神经丝轻链蛋白(NFL)的影响。【方法】采用回顾性研究方法,根据治疗方法的不同,将2022年2月至2024年5月陕西省宝鸡市中医医院和陕西省宝鸡市人民医院收治的100例SCI患者分为对照组和研究组,每组各50例。对照组给予GM1联合甲泼尼龙治疗,研究组给予GM1联合黄芪桂枝五物汤治疗,疗程为3周。观察2组患者治疗前后中医证候积分、脊髓损伤程度美国脊髓损伤协会(ASIA)评分、肌张力和肌力评估[改良Ashworth痉挛量表(MASS)、徒手肌力测定(MMT)]、下肢运动功能[功能性步行能力量表(FAC)、美国脊柱损伤协会的下肢运动子量表(LEMS)]评分及血清神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)、神经生长因子(NGF)、S100B蛋白(S100B)、Neuritin、NFL水平的变化情况,比较2组患者的临床疗效和并发症发生率。【结果】(1)疗效方面,治疗3周后,研究组的总有效率为90.00%(45/50),对照组为74.00%(37/50),组间比较(χ^(2)检验),研究组的临床疗效明显优于对照组(P<0.05)。(2)中医证候积分方面,治疗后,2组患者的肢体麻木、肢体不遂、小便不利、大便不调、面色淡白、伤处肿痛、心悸自汗、气短乏力等中医证候积分均较治疗前降低(P<0.05),且研究组的降低幅度均明显优于对照组(P<0.01)。(3)脊髓损伤程度方面,治疗后,2组患者脊髓损伤程度ASIA评分的运动功能、触觉、痛觉评分均较治疗前升高(P<0.05),且研究组的升高幅度均明显优于对照组(P<0.01)。(4)肌张力和肌力方面,治疗后,2组患者的MASS、MMT评分均较治疗前升高(P<0.05),且研究组的升高幅度均明显优于对照组(P<0.01)。(5)下肢运动功能方面,治疗后,2组患者的FAC评分和LEMS评分均较治疗前升高(P<0.05),且研究组的升高幅度均明显优于Objective To investigate the therapeutic efficacy of Huangqi Guizhi Wuwu Decoction combined with monosialotetrahexosyl ganglioside(GM1)in the treatment of spinal cord injury(SCI)and to observe its effect on neuritin and neurofilament light chain protein(NFL).Methods A retrospective study was carried out in 100 cases of SCI patients.The patients admitted to Baoji Hospital of Traditional Chinese Medicine and Baoji People's Hospital from February 2022 to May 2024 were divided into a control group and a study group according to the treatment method,with 50 patients in each group.The control group was given GM1 combined with methylprednisolone,and the study group was given Huangqi Guizhi Wuwu Decoction combined with GM1.The course of treatment covered three weeks.Before and after the treatment,the two groups were observed in the changes of traditional Chinese medicine(TCM)syndrome scores,American Spinal Injury Association(ASIA)scores for evaluating the degree of spinal cord injury,Modified Ashworth Spasticity Scale(MASS)and Manual Muscle Testing(MMT)scores for assessing muscle tone and muscle strength,scores of Functional Ambulation Category Scale(FAC)and Lower-Extremity Motor Subscale(LEMS)of ASIA for assessing lower extremity motor function,and serum levels of neuron-specific enolase(NSE),glial fibrillary acidic protein(GFAP),nerve growth factor(NGF),S100B protein(S100B),Neuritin,and NFL.After treatment,the clinical efficacy and the incidence of complications in the two groups were compared.Results(1)After three weeks of treatment,the total effective rate of the study group was 90.00%(45/50)and that of the control group was 74.00%(37/50),and the intergroup comparison(tested by chi-square test)showed that the clinical efficacy of the study group was significantly superior to that of the control group(P<0.05).(2)After treatment,the two groups presented a decrease in the scores of TCM symptoms of limb numbness,limb paralysis,dysuria,irregular defecation,pale complexion,swelling and pain at injured spot,palpitation and

关 键 词：黄芪桂枝五物汤 单唾液酸四己糖神经节苷脂 GM1 脊髓损伤 下肢运动功能 肌力 肌张力 神经突起因子 神经丝轻链蛋白 NFL 

分 类 号：R274.9[医药卫生—中西医结合]