葛根素介入配合针刺治疗血瘀型腰椎间盘突出症临床研究

[目的]观察针刺郄穴为主配合中药介入治疗血瘀型腰椎间盘突出症的临床疗效.[方法]以计算器数字随机法将入选病例60例随机分为治疗组（30例）和对照组（30例）.治疗组给予针刺L4-S1夹脊穴和外丘、委中、侠溪等特定穴,配合葛根素注射液介入病变腰椎间盘椎间孔附近治疗;对照组针刺治疗同治疗组,配合常规穴位注射葛根素注射液.治疗30d后观察两组临床疗效,并检测2组治疗前、后外周血白细胞介素6（IL-6）及血液流变学指标的变化,以探讨其作用机理.[结果]治疗1个疗程后,根据症状体征量化评分及疼痛视觉模拟评分法（VAS法）评价疗效,治疗组疗效优于对照组（Z=2.525,P=0.012）,且治疗组的平均疗程比对照组为短（P＜0.001）.治疗后两组的症状体征总评分、疼痛评分和直腿抬高试验评分均有明显降低（P＜0.05或P＜0.01）,且治疗组的降低作用更为明显（P＜0.05或P＜0.01）.治疗后两组的IL-6含量均下降,而治疗组的降低作用优于对照组（P＜0.01）.治疗后治疗组的各项血液流变学指标均有改善（P＜0.05或P＜0.01）,而对照组的各项血液流变学指标均无明显改善（P＞0.05）.[结论]对于血瘀型腰椎间盘突出症的治疗,葛根素注射液的介入治疗与针剌的协同作用优于葛根素的穴位注射合常规针刺.这可能与介入治疗能使药物直达病所,更有利于外周血IL-6及血液流变学指标的改善,从而消除神经根炎症有关.

Therapeutic Effect of Puerarin Intervention Combined with Acupuncture for Prolapse of Lumbar Intervertebral Disc with Blood Stasis

[ Objective ] To observe the therapeutic effect of acupuncture on cleft acupoints combined with puerarin intervention for the treatment of prolapse of lumbar intervertebral disc with blood stasis. [ Methods ] Sixty cases were divided into two groups by using random number: group A (n = 30) was treated by acupuncturing the Jiaji points from 4th lumbar vertebrae to 1st sacral vertebrae and specific points such as Waiqiu (GB36), Weizhong (BL40) and Xiaxi (GB43), and with intervention of puerarin Injection into the region of affected lumbar intervertebral foramen; group B (n = 30) was treated by acupuncturing the same acupoints as group A and with routine acupoint injection of puerarin Injection. After a 30-day treatment , the therapeutic effect in the two groups was evaluated by symptoms and signs scoring and pain visual stimulation scoring method. Peripheral blood interleukin 6 (IL-6) and blood rheology parameters before and after treatment were also observed to investigate the therapeutic mechanism. [Results] After one treatment course, the therapeutic effect in group A was better than that in group B (Z = 2.525, P = 0.012) and the mean treatment course was shorter (P < 0.001). The total scores of symptoms and signs, score of pain and score of straight leg raising test were much reduced in the two groups after treatment (P < 0.05 or P<0.01 compared with those before treatment), the decrease being obvious in group A (P < 0.05 or P<0.01). Peripheral blood IL-6 level decreased in the two groups, particularly in group A (P <0.01 compared with group B) . Blood rheology parameters were improved in group A after treatment as compared with those before treatment (P < 0.05 or P < 0.01) while the changes of blood rheology parameters were not obvious in group B (P > 0.05). [Conclusion] The synergistic action of acupuncture combined with puerarin intervention for the treatment of prolapse of lumbar intervertebral disc with blood stasis is better than that of routine acupoint injection of puerarin Injection. The mechanism may be related to the fact that intervention treatment can introduce the drug to the affected area, which benefits the improvement of peripheral blood IL-6 and blood rheology parameters, and thus relieve radiculitis.