补气通络法对脊髓型颈椎病术后Aβ蛋白、血浆内皮素、一氧化氮表达的影响

发布时间：2018-03-02 05:15

本文关键词： 脊髓型颈椎病补阳还五汤血浆内皮素一氧化氮 Aβ蛋白　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过探讨补气通络法对脊髓型颈椎病术后血浆内皮素、一氧化氮、Aβ蛋白表达的影响来研究人体脊髓型颈椎病脊髓损伤病理变化及术后中医药对脊髓型颈椎病脊髓损伤修复的干预机制。方法:选择深圳平乐骨伤科医院自2016年03月至2017年02月,确诊的60例脊髓型颈椎病患者,经过随机化分组,分为A组(对照组)30例及B组(治疗组)30例。两组患者全部采用手术治疗,A组:术后常规治疗;B组:术后第2天予补阳还五汤口服+术后常规治疗。检测并记录术前、术后第1天、术后1周、术后4周不同时间点血液中血浆内皮素、一氧化氮、Aβ蛋白相关指标;颈椎JOA评分;术前与术后4周肌电图检测神经根损伤情况;比较治疗组和对照组间治疗前后不同时间节点各个指标变化情况。结果:1.一般资料方面:治疗组(B组)与对照组(A组)相比,性别、年龄,病程、责任椎体数、手术时间、术中出血量差异、手术方式无统计学意义(P0.05)。2.两组患者术前血浆内皮素(ET)、一氧化氮(NO)、Aβ蛋白含量无统计学意义(P0.05)。3.生化指标方面:治疗组和对照组间患者在术后1天血液中血浆内皮素(ET)、一氧化氮(NO)、Aβ蛋白含量对比,差异均无统计学意义(P0.05);治疗组比较对照组,在术后1周、术后4周血液中血浆内皮素(ET)、一氧化氮(NO)降低,且差异有统计学意义(P0.05);术后1周,血液中Aβ蛋白变化,差异无统计学意义(P0.05);术后4周,血液中血浆中Aβ蛋白降低,差异有统计学意义(P0.05)。4.临床疗效评价方面,治疗组与对照组比较,术后第1天颈椎JOA评分无显著性差异(P0.05);术后1周、术后4周颈椎JOA评分有显著性差异(P0.05);治疗组与对照组相比,术后4周肌电图检测神经根损伤情况,治疗组阳性患者3例,对照组阳性患者10例,有显著性差异(P0.05)。结论:脊髓型颈椎病患者术后神经损伤处于一个再生和修复的过程,采用中医补气通络法,口服补阳还五汤能够使术后患者血浆内皮素(ET)降低;对术前脊髓型颈椎病患者血液中高浓度的一氧化氮(NO)指标具有调节作用;术后4周,Aβ蛋白降低;术后1周、术后4周的颈椎神经功能JOA评分上升。说明补阳还五汤可以促进患者术后神经功能恢复,对脊髓型颈椎病术后神经功能恢复具有临床疗效。
[Abstract]:Objective: to study the effect of tonifying qi and dredging collaterals on plasma endothelin in patients with cervical Spondylotic myelopathy after operation. Effects of nitric oxide A 尾 protein expression on spinal cord injury in patients with cervical Spondylotic myelopathy (cervical Spondylotic myelopathy) and the intervention mechanism of traditional Chinese medicine on the repair of cervical Spondylotic Spondylotic Spondylotic Myelopathy (CSM) after operation. From March 2016 to February 2017, Sixty patients with cervical Spondylotic myelopathy were randomly divided into two groups. Group A (30 cases in control group) and group B (30 cases in treatment group). All patients in two groups were treated by operation. Group A: routine treatment after operation: group B: oral routine therapy of Buyang Huanwu decoction on the second day after operation. Plasma endothelin, nitric oxide A 尾 protein, cervical JOA score, nerve root injury were detected by electromyography before and 4 weeks after operation at different time points after operation, 1 day after operation, 1 week after operation and 4 weeks after operation. Results: 1. General data: treatment group (group B) and control group (group A), sex, age, course of disease, number of responsible vertebrae, time of operation, Intraoperative bleeding volume difference, There was no significant difference in the operation methods between the two groups. There was no significant difference between the two groups in plasma endothelin A 尾 protein content and plasma endothelin A 尾 protein content before operation. The biochemical indexes were as follows: the plasma endothelin (et) in the blood of the patients in the treatment group and the control group was in the blood on the first day after operation, and no significant difference was found in the content of plasma endothelin A 尾 protein between the treatment group and the control group. Comparison of A 尾 protein content in nitric oxide. In the treatment group, the plasma endothelin (et), nitric oxide (no) in the blood decreased at 1 week and 4 weeks after operation, and the difference was statistically significant (P 0.05), and the A 尾 protein in the blood of the treatment group was changed 1 week after operation. There was no significant difference (P 0.05) between the treatment group and the control group, but there was no significant difference between the treatment group and the control group on the first day after operation (P 0.05), and at 1 week after operation, there was no significant difference between the treatment group and the control group in the JOA score of cervical vertebrae (P 0.05), the difference was statistically significant in the plasma A 尾 protein at the 4th week after operation, and the difference was statistically significant (P 0.05). There was significant difference in cervical JOA score at 4 weeks after operation (P 0.05). Compared with the control group, the nerve root injury was detected by electromyography 4 weeks after operation in the treatment group (3 cases) and the control group (10 cases). Conclusion: the nerve injury of patients with cervical Spondylotic myelopathy after operation is in a process of regeneration and repair. The method of tonifying qi and dredging collaterals of traditional Chinese medicine and oral buyang Huanwu decoction can make the plasma endothelin et (ETT) of postoperative patients lower than that of patients with cervical Spondylotic myelopathy. It can regulate the high concentration of nitric oxide (no) in the blood of patients with cervical Spondylotic myelopathy before operation, decrease the protein of A 尾 at 4 weeks after operation, and 1 week after operation. The JOA score of cervical vertebra nerve function increased 4 weeks after operation, which indicated that Buyang Huanwu decoction could promote the recovery of postoperative nerve function in patients with cervical Spondylotic myelopathy, and had clinical effect on the recovery of nerve function after operation of cervical Spondylotic myelopathy.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R274.9

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