短刺针法对神经根型颈椎病患者血清IL-1β、TNF-α作用效能的临床研究

发布时间：2018-09-10 09:46

【摘要】：目的：本研究旨在通过短刺针法治疗神经根型颈椎病(CSR)的理论研究和临床观察,探讨炎性细胞因子IL-1β、TNF-α在CSR I临床症状发生发展中的作用及作用机理;观察短刺针法治疗CSR的临床疗效；分析疗效的取得与血清IL-1β、TNF-α等炎性细胞因子的相关性及其作用效能；同时为短刺针法的临床普及提供具体操作步骤和一些技术参数,从而为CSR的治疗和疗效评定提供科学方法。方法：通过理论研究和临床研究两部分来阐述短刺针法对CSR患者血清炎性细胞因子的作用效能。理论研究部分通过图书馆查阅书籍、知网数据库检索等方式收集相关文献资料,从古今中外医家和学者对CSR的疾病认识出发,以现代医学对CSR发生发展过程的研究为重点,深入探析和阐述其发病原因和机制,并对近年来治疗CSR的常用中西医方法进行系统归纳和总结,同时介绍了短刺针法的作用原理和现代临床应用。临床研究部分通过完全随机方法设置治疗组和对照组进行观察研究,治疗组33例使用短刺针法治疗,对照组31例使用常规针刺疗法治疗,均隔日治疗1次,每周3次,4周为1个疗程。连续治疗2个疗程后比较两组治疗前后血清IL-1β、TNF-α浓度,评价比较治疗前后视觉模拟评分量表(VAS)评分、颈部残障指数量表(NDI)评分和SF-36健康调查量表(SF-36)评分,并进行疗效评定。结果：①两组治疗后VAS和NDI评分与治疗前比较均有极显著降低(PO.01),且治疗组治疗后VAS和NDI评分均显著低于对照组治疗后评分(P0.05);②两组治疗后SF-36的生理功能(PF)、生理职能(RP)、躯体疼痛(BP)、总体健康(GH)、活力(VT)、社会功能(SF)、情感职能(RE)、精神健康(MH)8个维度评分与治疗前比较均显著提高(P0.05),治疗组治疗后BP与SF评分均显著优于对照组治疗后评分(P0.05),而其他6个维度评分均无统计学差异(PO.05);③64例入组病例血清IL-1β、TNF-α浓度均明显高于体检健康成年人浓度(P0.01);④两组治疗后均能显著降低患者血清IL-1β、TNF-α浓度(P0.01)，且治疗组治疗后浓度均显著低于对照组治疗后浓度(P,0.05);⑤治疗组总有效率90.9%,对照组80.6%,差异具有统计学意义(PO.05);⑥CSR患者治疗前后血清IL-1β、TNF-α浓度与NDI评分均有明显相关性(P0.01),呈正相关。结论：①)CSR的发生发展与炎性细胞因子IL-1β、TNF-α存在密切关联，，其作用机制之一是IL-1β、TNF-α等炎性细胞因子参与了CSR的炎性反应过程;②病情的严重程度与血清IL-1β、TNF-α浓度有关,浓度越高症状越严重，说明炎性细胞因子的存在是CSR临床症状加重的主要原因之一③短刺针法能够显著缓解患者的临床症状,具有良好的临床疗效,并能够显著降低患者血清IL-1 β、TNF-α浓度,临床疗效的取得与炎性细胞因子含量的减少密切相关;④短刺针法可以作为临床治疗CSR的常用方法之一,向广大CSR患者和临床医生推广。
[Abstract]:Objective: to investigate the role and mechanism of inflammatory cytokine IL-1 尾 -TNF- 伪 in the occurrence and development of (CSR) in patients with cervical Spondylotic radiculopathy (CSR I). To observe the clinical effect of short needling method in treating CSR, to analyze the relationship between the curative effect and the inflammatory cytokines such as serum IL-1 尾 -TNF- 伪, and to provide specific operation steps and some technical parameters for the clinical popularization of short needling method. So as to provide a scientific method for the treatment and evaluation of the efficacy of CSR. Methods: the effect of short acupuncture on serum inflammatory cytokines in patients with CSR was discussed through theoretical and clinical studies. In the part of theoretical research, the author collects the relevant documents by consulting books in the library and searching the database of knowledge network, starting from the understanding of the disease of CSR by doctors and scholars in ancient and modern China and abroad, and focusing on the research on the process of occurrence and development of CSR in modern medicine. The causes and mechanisms of the disease were analyzed and explained, and the common methods of traditional Chinese and western medicine in the treatment of CSR in recent years were systematically summarized and summarized. At the same time, the action principle and modern clinical application of the short needling method were introduced. In the clinical research part, 33 cases of treatment group were treated with short needling method and 31 cases of control group were treated with routine acupuncture therapy, all of which were treated once every other day. Three times a week for 4 weeks as a course of treatment. After two consecutive courses of treatment, the serum IL-1 尾 -TNF- 伪 levels were compared before and after treatment. The visual analogue scale (VAS), cervical disability index scale (NDI) and SF-36 health survey scale (SF-36) were evaluated before and after treatment. Results the scores of VAS and NDI were significantly decreased (PO.01) after treatment in both groups, and the scores of VAS and NDI in the treatment group were significantly lower than those in the control group (P0.05). The physiological function of SF-36 in the treatment group was significantly lower than that in the control group (P0.05). (RP), somatic pain (BP), overall healthy (GH), vigor (VT), social function (SF), affective function (RE), mental health (MH) scores were significantly improved compared with those before treatment (P0.05). BP and SF scores in the treatment group were significantly better than those in the control group after treatment (P0.05). Scores (P0.05), and no significant difference (PO.05) in the other six dimensions (PO.05). The serum IL-1 尾 -TNF- 伪 concentrations in 364 patients were significantly higher than those in healthy adults (P0.01), and the serum IL-1 尾 -TNF- 伪 levels in the treatment group were significantly lower than those in the healthy adults group (P0.01), and the serum IL-1 尾 -TNF- 伪 concentration in the treatment group was significantly lower than that in the control group (P0.01). The total effective rate of the treatment group was significantly lower than that of the control group (P0. 05). The total effective rate of the control group was 80. 6. The difference was statistically significant (PO.05). There was a significant correlation between the serum IL-1 尾-TNF- 伪 level and the NDI score before and after treatment (P0. 01), and there was a positive correlation between the serum IL-1 尾-TNF- 伪 concentration and the NDI score (P0. 01). ConclusionThe occurrence and development of CSR is closely related to the inflammatory cytokine IL-1 尾 -TNF- 伪. One of its mechanisms is that IL-1 尾 -TNF- 伪 and other inflammatory cytokines participate in the inflammatory reaction process of CSR. The severity of the disease is related to the concentration of serum IL-1 尾 -TNF- 伪. The higher the concentration, the more serious the symptoms, indicating that the presence of inflammatory cytokines is one of the main causes of exacerbation of CSR clinical symptoms. 3 short needling method can significantly alleviate the clinical symptoms of patients, and has a good clinical effect. It can significantly reduce the concentration of serum IL-1 尾 -TNF- 伪 in patients. The clinical curative effect is closely related to the decrease of inflammatory cytokines content. The short needling acupuncture method can be used as one of the common methods for the treatment of CSR, and it can be popularized to the majority of CSR patients and clinicians.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.9

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