【摘要】：目的：本研究旨在通過短刺針法治療神經(jīng)根型頸椎病(CSR)的理論研究和臨床觀察,探討炎性細胞因子IL-1β、TNF-α在CSR I臨床癥狀發(fā)生發(fā)展中的作用及作用機理;觀察短刺針法治療CSR的臨床療效；分析療效的取得與血清IL-1β、TNF-α等炎性細胞因子的相關性及其作用效能；同時為短刺針法的臨床普及提供具體操作步驟和一些技術參數(shù),從而為CSR的治療和療效評定提供科學方法。方法：通過理論研究和臨床研究兩部分來闡述短刺針法對CSR患者血清炎性細胞因子的作用效能。理論研究部分通過圖書館查閱書籍、知網(wǎng)數(shù)據(jù)庫檢索等方式收集相關文獻資料,從古今中外醫(yī)家和學者對CSR的疾病認識出發(fā),以現(xiàn)代醫(yī)學對CSR發(fā)生發(fā)展過程的研究為重點,深入探析和闡述其發(fā)病原因和機制,并對近年來治療CSR的常用中西醫(yī)方法進行系統(tǒng)歸納和總結(jié),同時介紹了短刺針法的作用原理和現(xiàn)代臨床應用。臨床研究部分通過完全隨機方法設置治療組和對照組進行觀察研究,治療組33例使用短刺針法治療,對照組31例使用常規(guī)針刺療法治療,均隔日治療1次,每周3次,4周為1個療程。連續(xù)治療2個療程后比較兩組治療前后血清IL-1β、TNF-α濃度,評價比較治療前后視覺模擬評分量表(VAS)評分、頸部殘障指數(shù)量表(NDI)評分和SF-36健康調(diào)查量表(SF-36)評分,并進行療效評定。結(jié)果：①兩組治療后VAS和NDI評分與治療前比較均有極顯著降低(PO.01),且治療組治療后VAS和NDI評分均顯著低于對照組治療后評分(P0.05);②兩組治療后SF-36的生理功能(PF)、生理職能(RP)、軀體疼痛(BP)、總體健康(GH)、活力(VT)、社會功能(SF)、情感職能(RE)、精神健康(MH)8個維度評分與治療前比較均顯著提高(P0.05),治療組治療后BP與SF評分均顯著優(yōu)于對照組治療后評分(P0.05),而其他6個維度評分均無統(tǒng)計學差異(PO.05);③64例入組病例血清IL-1β、TNF-α濃度均明顯高于體檢健康成年人濃度(P0.01);④兩組治療后均能顯著降低患者血清IL-1β、TNF-α濃度(P0.01)，且治療組治療后濃度均顯著低于對照組治療后濃度(P,0.05);⑤治療組總有效率90.9%,對照組80.6%,差異具有統(tǒng)計學意義(PO.05);⑥CSR患者治療前后血清IL-1β、TNF-α濃度與NDI評分均有明顯相關性(P0.01),呈正相關。結(jié)論：①)CSR的發(fā)生發(fā)展與炎性細胞因子IL-1β、TNF-α存在密切關聯(lián)，，其作用機制之一是IL-1β、TNF-α等炎性細胞因子參與了CSR的炎性反應過程;②病情的嚴重程度與血清IL-1β、TNF-α濃度有關,濃度越高癥狀越嚴重，說明炎性細胞因子的存在是CSR臨床癥狀加重的主要原因之一③短刺針法能夠顯著緩解患者的臨床癥狀,具有良好的臨床療效,并能夠顯著降低患者血清IL-1 β、TNF-α濃度,臨床療效的取得與炎性細胞因子含量的減少密切相關;④短刺針法可以作為臨床治療CSR的常用方法之一,向廣大CSR患者和臨床醫(yī)生推廣。
[Abstract]:Objective: to investigate the role and mechanism of inflammatory cytokine IL-1 尾 -TNF- 偽 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- 偽, 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- 偽 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- 偽 concentrations in 364 patients were significantly higher than those in healthy adults (P0.01), and the serum IL-1 尾 -TNF- 偽 levels in the treatment group were significantly lower than those in the healthy adults group (P0.01), and the serum IL-1 尾 -TNF- 偽 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- 偽 level and the NDI score before and after treatment (P0. 01), and there was a positive correlation between the serum IL-1 尾-TNF- 偽 concentration and the NDI score (P0. 01). ConclusionThe occurrence and development of CSR is closely related to the inflammatory cytokine IL-1 尾 -TNF- 偽. One of its mechanisms is that IL-1 尾 -TNF- 偽 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- 偽. 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- 偽 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.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R246.9

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