扎冲十三味丸对肩周炎气滞血瘀证的疗效及血清前列腺素E2(PGE2)和缓激肽水平的影响
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摘要
目的:探讨扎冲十三味丸治疗肩周炎气滞血瘀证的疗效及对血清前列腺素E2(PGE2)和缓激肽水平的影响。方法:选取肩周炎患者140例,按数字表法随机分为对照组例和观察组,每组70例。两组予常规肩部功能康复锻炼,2次/d,20 min/次。对照组口服活血止痛胶囊,3粒/次,2次/d。观察组口服扎冲十三味丸,5～9粒/次,1次/d。两组连续治疗4周。应用McGill疼痛问卷(SF-MPQ)评定两组视觉疼痛评分(VAS)、现在疼痛状况(PPI)及疼痛评级指数(PRI)。比较两组肩关节功能评分和临床疗效。检测两组血清前列腺素E2(PGE2)和缓激肽水平。记录两组不良反应发生情况。结果:与对照组比较,观察组治疗后VAS、PPI及PRI评分降低更明显,而日常生活活动、疼痛、关节活动度以及肌力评分增加更明显(P<0.01)。观察组患者的总有效率为95.71%,显著高于对照组(84.29%)(P<0.05)。与对照组比较,观察组治疗后血清PGE2和缓激肽水平下降更明显(P<0.01)。观察组患者轻度肝肾功能减退2例,胃肠道不良反应7例;对照组肝肾功能减退2例,胃肠道不适反应3例;两组不良反应发生率比较差异无统计学意义(P>0.05)。结论:扎冲十三味丸治疗肩周炎气滞血瘀证的疗效确切,且安全性好,调节患者血清中PGE2和缓激肽水平可能与其疗效有关。
Objective:To investigate the efficacy of Zhachong Shisan Pill in treating periarthritis of shoulder with Qi stagnation and blood stasis syndrome and effect on serum levels of Prostaglandin E2(PGE2) and bradykinin. Method:One hundred and forty cases with periarthritis of shoulder were chosen and randomly divided into control group(70 cases) and observation group(70 cases). Both groups were given shoulder rehabilitation exercise(20 min/time,twice a day). Cases of control group were orally treated with Huoxue Zhitong Capsule(3 grains/time,twice a day). The observtion group was treated with Zhachong Shisan Pill(5-9 grains/time,once a day). The course was for 4 weeks in both groups. SF-MPQ was employed to evaluate visual pain score(VAS),present pain status(PPI) and pain rating Index(PRI). Scores of function of the shoulder joint and efficacy were compared in both groups. Serum levels of PGE2 and bradykinin were detected in both groups. Adverse reactions were recorded in both groups. Results: Compared to control group,scores of VAS,PPI and PRI were evidently decreased after treatment,while scores of daily activities,pain,joint motion and muscle force were obviously increased(P<0.01). The total effective rate for the observation group was 95.71%,which was remarkably higher than that of the control group(84.29%)(P<0.05). Compared to control group,serum levels of PGE2 and bradykinin of observation group were obviously decreased after treatment(P<0.01). Two cases with mild liver and kidney function hypofunction and seven cases with gastrointestinal adverse reaction took place in observation group and those of control group were two cases and three cases respectively and there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion: The efficacy of Zhachong Shisan Pill in treating periarthritis of shoulder with Qi stagnation and blood stasis syndrome is significant and safe,which may be related to regulation of serum levels of PGE2 and bradykinin.
Objective:To investigate the efficacy of Zhachong Shisan Pill in treating periarthritis of shoulder with Qi stagnation and blood stasis syndrome and effect on serum levels of Prostaglandin E2(PGE2) and bradykinin. Method:One hundred and forty cases with periarthritis of shoulder were chosen and randomly divided into control group(70 cases) and observation group(70 cases). Both groups were given shoulder rehabilitation exercise(20 min/time,twice a day). Cases of control group were orally treated with Huoxue Zhitong Capsule(3 grains/time,twice a day). The observtion group was treated with Zhachong Shisan Pill(5-9 grains/time,once a day). The course was for 4 weeks in both groups. SF-MPQ was employed to evaluate visual pain score(VAS),present pain status(PPI) and pain rating Index(PRI). Scores of function of the shoulder joint and efficacy were compared in both groups. Serum levels of PGE2 and bradykinin were detected in both groups. Adverse reactions were recorded in both groups. Results: Compared to control group,scores of VAS,PPI and PRI were evidently decreased after treatment,while scores of daily activities,pain,joint motion and muscle force were obviously increased(P<0.01). The total effective rate for the observation group was 95.71%,which was remarkably higher than that of the control group(84.29%)(P<0.05). Compared to control group,serum levels of PGE2 and bradykinin of observation group were obviously decreased after treatment(P<0.01). Two cases with mild liver and kidney function hypofunction and seven cases with gastrointestinal adverse reaction took place in observation group and those of control group were two cases and three cases respectively and there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion: The efficacy of Zhachong Shisan Pill in treating periarthritis of shoulder with Qi stagnation and blood stasis syndrome is significant and safe,which may be related to regulation of serum levels of PGE2 and bradykinin.
引文
[1] 娄飞,蒋翠蕾, 张建东,等.桂枝附子汤加减联合中频导入治疗寒湿痹阻型肩周炎对功能康复的影响[J].中国实验方剂学杂志,2017,23(3):178-182.
[2] 王春成,李明哲,彭晓松.颈舒颗粒联合铍针治疗慢性肩周炎76例近期临床疗效分析[J].重庆医学,2017,46(7):950-953.
[3] 马思瑶,张建福,张董喆.中药联合中频导入治疗血瘀气滞型肩周炎对功能活动的影响[J].风湿病与关节炎,2017,6(12):24-26.
[4] 韩春平,席海山,李江.GC-MS法同时测定扎冲十三味丸中麝香酮和丁香酚含量[J].中国民族医药杂志,2017,(1):46-48.
[5] 刘月英,宝鲁尔,宋葆华,等.扎冲十三味丸抗栓作用及溶栓机制[J].中国实验方剂学杂志, 2015,21(6):127-130.
[6] 中华中医药学会.肩关节周围炎[J].风湿病与关节,2013,2(2):73-75.
[7] 李君,冯艺,韩济生,等.中文版简版McGill疼痛问卷-2的制定与多中心验证[J].中国疼痛医学杂志,2013,19(1):42-46.
[8] Constant CR,Murley AG.A clinical method of functional assessment of the shoulder[J].Clin Orthopaedics Related Research,1987,214:160.
[9] 中国中医药管理局.中医病症诊断疗效标准[S].南京:南京大学出版社,1994:199-201.
[10] 李伟,徐洪亮,王慧芳,等.100例肩周炎的中医证型规律分析[J].中国中医骨伤科杂志,2017,25(9):58-59,64.
[11] 姜寿山,王力国,孙立山,等.从“瘀”论治肩关节周围炎临床疗效观察[J].中国中医骨伤科杂志,2013,21(2):45-46.
[12] 贾汉超.针灸治疗肩周炎研究进展[J].西藏医药,2017,38(5):91-93.
[13] 明兰.关于针灸推拿治疗肩周炎研究进展[J].临床医药文献杂志,2016,56(3):11115.
[14] 高东梅,郝龙,田雪.肩三针注射术配合中药熏蒸、推拿等治疗肩周炎136例[J].陕西中医,2017,38(7):965-966.
[15] 刘月英,包宏,宝鲁尔,等.扎冲十三味丸的溶栓作用机制及对凝血系统的影响[J].中国医院药学杂志,2015,35(1):23-27.
[16] 张亮,潘卫东,吴晓华,等.蒙药珍宝丸与扎冲十三味丸治疗脑梗死后遗症的临床疗效[J].中西医结合心脑血管病杂志,2015,13(7):874-877.
[17] 徐俊,陈立峰,杜毅,等.肩关节腔扩张联合扳动手法治疗老年肩周炎的临床疗效[J].中国老年学杂志,2017,37(8):1982-1984.
[18] Eijkelkamp N,Wang H, Garza-Carbajal A, et al.Low nociceptor GRK2 prolongs prostaglandin E2 hyperalgesia via biased cAMP signaling to Epac/Rap1,protein kinase Cepsilon,and MEK/ERK[J].J Neurosci,2010,30(38):12806-12815.
[19] 黄丽密,王凯,梁雅琴,等.鱼油脂肪乳剂对脂多糖诱导急性肺损伤大鼠肝脏的保护作用研究[J].浙江医学,2017,39(16):1316-1319.
[20] Yoshino O,Yamada-Nomoto K,Kobayashi M,et al.Bradykinin system is involved in endometriosis-related pain through endothelin-1 production[J].Eur J Pain,2018,22(3):501-510.
[21] Falsetta ML,Foster DC,Woeller CF,et al.A Role for Bradykinin Signaling in Chronic Vulvar Pain[J].J Pain,2016,17(11):1183-1197.
[22] 高曦,王金铎,任聪林,等.骨科中药洗剂配合针灸治疗肩周炎临床观察[J].辽宁中医药大学学报,2018,20(7):15-17.
[23] 宿小满,连树林.艾灸联合米乐祛痛贴治疗肩周炎对患者疼痛感受、关节功能评分的影响[J].辽宁中医杂志,2018,45(9):1938-1940.
[24] 黄健琳,辜孔进.导引配合温针灸治疗肩周炎疼痛和活动受限的临床研究[J].辽宁中医杂志,2018,45(4):801-804.
[2] 王春成,李明哲,彭晓松.颈舒颗粒联合铍针治疗慢性肩周炎76例近期临床疗效分析[J].重庆医学,2017,46(7):950-953.
[3] 马思瑶,张建福,张董喆.中药联合中频导入治疗血瘀气滞型肩周炎对功能活动的影响[J].风湿病与关节炎,2017,6(12):24-26.
[4] 韩春平,席海山,李江.GC-MS法同时测定扎冲十三味丸中麝香酮和丁香酚含量[J].中国民族医药杂志,2017,(1):46-48.
[5] 刘月英,宝鲁尔,宋葆华,等.扎冲十三味丸抗栓作用及溶栓机制[J].中国实验方剂学杂志, 2015,21(6):127-130.
[6] 中华中医药学会.肩关节周围炎[J].风湿病与关节,2013,2(2):73-75.
[7] 李君,冯艺,韩济生,等.中文版简版McGill疼痛问卷-2的制定与多中心验证[J].中国疼痛医学杂志,2013,19(1):42-46.
[8] Constant CR,Murley AG.A clinical method of functional assessment of the shoulder[J].Clin Orthopaedics Related Research,1987,214:160.
[9] 中国中医药管理局.中医病症诊断疗效标准[S].南京:南京大学出版社,1994:199-201.
[10] 李伟,徐洪亮,王慧芳,等.100例肩周炎的中医证型规律分析[J].中国中医骨伤科杂志,2017,25(9):58-59,64.
[11] 姜寿山,王力国,孙立山,等.从“瘀”论治肩关节周围炎临床疗效观察[J].中国中医骨伤科杂志,2013,21(2):45-46.
[12] 贾汉超.针灸治疗肩周炎研究进展[J].西藏医药,2017,38(5):91-93.
[13] 明兰.关于针灸推拿治疗肩周炎研究进展[J].临床医药文献杂志,2016,56(3):11115.
[14] 高东梅,郝龙,田雪.肩三针注射术配合中药熏蒸、推拿等治疗肩周炎136例[J].陕西中医,2017,38(7):965-966.
[15] 刘月英,包宏,宝鲁尔,等.扎冲十三味丸的溶栓作用机制及对凝血系统的影响[J].中国医院药学杂志,2015,35(1):23-27.
[16] 张亮,潘卫东,吴晓华,等.蒙药珍宝丸与扎冲十三味丸治疗脑梗死后遗症的临床疗效[J].中西医结合心脑血管病杂志,2015,13(7):874-877.
[17] 徐俊,陈立峰,杜毅,等.肩关节腔扩张联合扳动手法治疗老年肩周炎的临床疗效[J].中国老年学杂志,2017,37(8):1982-1984.
[18] Eijkelkamp N,Wang H, Garza-Carbajal A, et al.Low nociceptor GRK2 prolongs prostaglandin E2 hyperalgesia via biased cAMP signaling to Epac/Rap1,protein kinase Cepsilon,and MEK/ERK[J].J Neurosci,2010,30(38):12806-12815.
[19] 黄丽密,王凯,梁雅琴,等.鱼油脂肪乳剂对脂多糖诱导急性肺损伤大鼠肝脏的保护作用研究[J].浙江医学,2017,39(16):1316-1319.
[20] Yoshino O,Yamada-Nomoto K,Kobayashi M,et al.Bradykinin system is involved in endometriosis-related pain through endothelin-1 production[J].Eur J Pain,2018,22(3):501-510.
[21] Falsetta ML,Foster DC,Woeller CF,et al.A Role for Bradykinin Signaling in Chronic Vulvar Pain[J].J Pain,2016,17(11):1183-1197.
[22] 高曦,王金铎,任聪林,等.骨科中药洗剂配合针灸治疗肩周炎临床观察[J].辽宁中医药大学学报,2018,20(7):15-17.
[23] 宿小满,连树林.艾灸联合米乐祛痛贴治疗肩周炎对患者疼痛感受、关节功能评分的影响[J].辽宁中医杂志,2018,45(9):1938-1940.
[24] 黄健琳,辜孔进.导引配合温针灸治疗肩周炎疼痛和活动受限的临床研究[J].辽宁中医杂志,2018,45(4):801-804.