活血舒筋汤联合循经点揉推拿法治疗血瘀型腰椎间盘突出症的疗效及对p38MAPK信号通路的影响  

Clinical Effect of Huoxue Shujin Decoction Combined with Point-pressing Massage along the Meridians in Treatment of Blood Stasis-type Lumbar Disc Herniation and Its Impact on the p38MAPK Signaling Pathway

作　　者：汪荣贵 何康乐 WANG Ronggui;HE Kangle(Department of Traditional Chinese Medicine Orthopedics,Anqing 116 Hospital,Anhui Anqing 246000,China)

机构地区：[1]安庆一一六医院中医骨伤科,安徽安庆246000

出　　处：《安徽中医药大学学报》2025年第2期29-33,共5页Journal of Anhui University of Chinese Medicine

基　　金：安徽省中医药传承创新科研项目(2022ZYYD16)。

摘　　要：目的探讨活血舒筋汤联合循经点揉推拿法治疗血瘀型腰椎间盘突出症(lumbar disc herniation,LDH)的疗效及其可能的作用机制。方法将108例血瘀型LDH患者随机分为治疗组和对照组,每组54例;对照组采取循经点揉推拿法,治疗组在对照组治疗同时予活血舒筋汤口服,两组均连续治疗4周;比较两组治疗前后腰腿疼痛视觉模拟量表(visual analogue scale,VAS)评分,腰椎功能日本骨科协会(Japanese orthopaedic association,JOA)评分,血瘀证证候评分,血清磷酸化细胞外信号调节激酶(phosphorylated extracellular signal-regulated kinase,p-ERK)、磷酸化p38丝裂原活化蛋白激酶(phosphorylated p38 mitogen-activated protein kinase,p-p38MAPK)、磷酸化c-Jun氨基端激酶(phosphorylated c-Jun N-terminal kinase,p-JNK)表达水平,肿瘤坏死因子(tumor necrosis factor,TNF)-α、白细胞介素(interleukin,IL)-1β、IL-6水平以及临床疗效。结果与治疗前比较,治疗后两组患者腰腿疼痛VAS评分,血瘀证证候评分,p-ERK、p-p38、p-JNK蛋白表达水平,TNF-α、IL-1β、IL-6水平均显著降低(P<0.05),JOA评分均显著升高(P<0.05),且治疗组上述指标降低或升高程度均显著大于对照组(P<0.05)。治疗组临床疗效显著优于对照组(P<0.05)。结论活血舒筋汤联合循经点揉推拿法治疗血瘀型LDH疗效显著,可有效改善患者临床症状,其作用机制可能与激活p38MAPK信号通路,减轻炎症反应有关。Objective To investigate the clinical effect of Huoxue Shujin Decoction combined with point-pressing massage along the meridians in the treatment of blood stasis-type lumbar disc herniation(LDH)and its possible mechanism of action.Methods A total of 108 patients with blood stasis-type LDH were randomly divided into treatment group and control group,with 54 patients in each group.The patients in the control group received point-pressing massage along the meridians,while those in the treatment group received oral administration of Huoxue Shujin Decoction in addition to the treatment in the control group;the course of treatment was 4 consecutive weeks for both groups.The two groups were compared in terms of Visual Analogue Scale(VAS)score of low back and leg pain,Japanese Orthopaedic Association(JOA)score of lumbar vertebral function,blood stasis syndrome score,the expression levels of serum phosphorylated extracellular signal-regulated kinase(p-ERK),phosphorylated p38 mitogen-activated protein kinase(p-p38MAPK),and phosphorylated c-Jun N-terminal kinase(p-JNK),the levels of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),and interleukin-6(IL-6),and clinical outcome before and after treatment.Results After treatment,both groups had significant reductions in VAS score of low back and leg pain,blood stasis syndrome score,the protein expression levels of p-ERK,p-38,and p-JNK,and the levels of TNF-α,IL-1β,and IL-6(P<0.05)and a significant increase in JOA score(P<0.05),and compared with the control group,the treatment group had significantly greater changes in the above indicators(P<0.05).The treatment group had a significantly better clinical outcome than the control group(P<0.05).Conclusion Huoxue Shujin Decoction combined with point-pressing massage along the meridians has a marked clinical effect in the treatment of blood stasis-type LDH and can effectively improve the clinical symptoms of patients,possibly by activating the p38MAPK signaling pathway and alleviating inflammatory response.

关 键 词：腰椎间盘突出症 活血舒筋汤 循经点揉推拿法 P38MAPK信号通路 

分 类 号：R274.2[医药卫生—中医骨伤科学]