陈莉 叶亚云 叶世伟 金丽仙 丁晓媚 陈阳阳

[摘要] 目的 探讨中西医结合治疗肝肾亏虚型腰椎间盘突出症患者的疗效及对血清炎症因子水平的影响。 方法 选取2015年1月～2017年9月中西医结合门诊就诊的肝肾亏虚型LDH患者80例，采用抛硬币法分为观察组和对照组。两组均给予卧硬板床、避免腰部剧烈活动等治疗。对照组在此基础上加用塞来昔布胶囊治疗，0.2 g/次，1次/d，口服；观察组在对照组基础上再加独活寄生汤加减口服，两组均连用4周。观察并记录两组治疗前后血清超敏C反应蛋白（hs-CRP）、肿瘤坏死因子（TNF-α）和白介素-6（IL-6）水平变化，并评估疗效。 结果 治疗4周后，两组血清hs-CRP、TNF-α和IL-6水平均较前不同程度下降（P<0.05或P<0.01），且观察组下降值较对照组更显著（P<0.05）；同时观察组临床总有效率较对照组更佳（χ2=4.11，P<0.05）。 结论 塞来昔布胶囊联合独活寄生汤中西医结合治疗肝肾亏虚型LDH的效果明显优于单纯的塞来昔布胶囊，机制与其能降低血清hs-CRP、TNF-α和IL-6水平，抑制炎症反应密切相关。

[关键词] 腰椎间盘突出症；肝肾亏虚型；塞来昔布胶囊；独活寄生汤；炎症因子

[中图分类号] R285.6 [文献标识码] A [文章编号] 1673-9701（2018）30-0024-04

[Abstract] Objective To investigate the curative effect of the combination of traditional Chinese and western medicine on the patients with lumbar disc herniation（liver and kidney deficiency type） and its influence on the serum level of inflammatory cytokines. Methods From January 2015 to September 2017， 80 cases of LDH with hepatorenal deficiencies were treated in Integrative Medicine Clinic. The patients were divided into observation group and control group by flipping coin method. Two groups were given treatment such as sleeping on hard bed and avoiding the intense waist activity. On this basis， the control group was taken celecoxib capsule treatment， 0.2 g/time， 1 time/d， orally. The observation group was given Duhuo Jisheng decoction orally on the basis of the control group. Both groups were given 4 weeks. The changes of serum hs-CRP， TNF-α and interleukin-6 before and after treatment were observed and recorded. The curative effect was evaluated. Results The levels of serum hs-CRP， TNF-α and IL-6 in the two groups were all decreased to different degrees after 4 weeks treatment（P<0.05 or P<0.01）， and the decrease in the observation group was more significant than that in the control group（P<0.05）. At the same time， the clinical total effective rate in the observation group was better than that in the control group（χ2=4.11， P<0.05）. Conclusion The effect celecoxib capsules combined with traditional Chinese medicine Duhuo Jisheng decoction in treating idiopathic liver and kidney deficiency type LDH is better than that of celecoxib capsules alone. The mechanism is that it can reduce the serum levels of hs-CRP， TNF-α and IL-6 Level， inhibit inflammation.

[Key words] Lumbar disc herniation； Liver and kidney deficiency type； Celecoxib capsules； Duhuo Jisheng decoction； Inflammatory factor

腰椎間盘突出症（lumbar disc herniation，LDH）是常见疾病，好发于中老年人，主要是由于各种原因导致的腰椎间盘发生退行性变，使髓核等椎间盘组织后突刺激或压迫神经根而引起腰腿痛，严重影响患者的日常生活，需予以积极的干预治疗[1，2]。LDH的发病机制较复杂，近年来研究发现炎症因子水平异常在其发病过程中起重要作用，其中超敏C反应蛋白（hs-CRP）、肿瘤坏死因子（TNF-α）和白介素-6（IL-6）研究较多[3，4]。LDH临床上多采用非甾体类抗炎药进行治疗，短期内虽有一定的效果，但远期效果较差，且长期使用药物副作用明显[5]。中医认为LDH属“痹证” 范畴，与肝肾亏虚密切相关，治疗宜补肾强筋。独活寄生汤具有祛风止痛、益肾补血的作用，联合西药治疗取得了较好的效果，但其对炎症因子的影响国内外报道较少[6，7]。……