| The First Part:Study on the correlation between low back pain and degeneration of lumbar endplateObjective:To explore the correlation between the degree of low back pain and the change of Modic in lumbar endplate degeneration,and to study the difference of expression of inflammatory cytokines in the change of Modic in lumbar endplate degeneration.Methods:From January to August 2018,30 patients with degenerative lumbar disc diseases who underwent surgical nucleus pulpotomy or lumbar interbody fusion were selected as the subjects.Combining with the Modic changes of lumbar endplate degeneration in preoperative lumbar MRI,the patients were divided into non-Modic change type(group A),Modic change type I(group B)and Modic change type Ⅱ(group C),10 cases each.Modic changes in type III are rare and not included in this study.Visual analogue scale(VAS)was recorded before operation.Enzyme-linked immunosorbent assay(ELISA)was used to quantify the concentration of inflammatory factors Interleukin-1β(IL-1β)Interleukin-6(IL-6)、Tumor necrosis factor-a(TNF-α)in the samples.The histopathological changes of some endplates were observed.SPSS 19.0 statistical software was used for data analysis.Result:1.The VAS scores of each group before operation were:group A(3.10±0.73),group B(4.90±1.20)and group C(4.60±1.07).There were differences among the three groups.The VAS score of lower back pain in group B and C was significantly higher than that in group A(P<0.01),and that in group B was higher than that in group C(4.90±1.20 VS 4.60±1.07)·2.The results of ELISA showed that the concentration of IL-1β in group A(82.30±18.24),group B(166.21±34.38),group C(128.01±23.09);IL-6:group A(65.42±14.91),group B(142.80±30.16),group C(101.30±20.27);TNF-a:group A(200.10±21.17),group B(320.06±32.65),and group C(256.50±1.04).There were differences in the concentration of inflammatory factors between group A,group B and group C.The levels of IL-1β、IL-6 and TNF-a were all P<0.01.Specifically,inflammatory factors in group B and C were significantly higher than those in group A(P<0.01),and those in group B were higher than those in group C(P<0.01).3.After HE staining,the observation results showed that there was no change in group A;there were vascularized fibrous tissue in group B and its inferior area,and there were different degrees of cracks or ruptures in the related cartilage;there were adipose tissue in group C and its inferior area instead of normal cartilage or bone tissue.4.Pearson analysis showed that the concentrations of inflammatory factors IL-1β、IL-6 and TNF-a in each group were positively correlated with VAS score of low back pain(P<0.05/P<0.01)Conclusion:Inflammatory factors IL-1β、IL-6 and TNF-a expressed differently in different Modic alteration types of endplate..HE staining of endplate and expression of inflammatory factors showed that Modic alteration was a continuous and aggravating process,not a relatively independent pathological type.Inflammatory reaction may be closely related to lumbar endplate degeneration and discogenic low back pain.The Second Part:Effect of ZhiKeGancao Decoction on Lumbar Intervertebral Disc Herniation with Modic Ⅰ DegenerationObjective:To observe and evaluate the clinical efficacy of ZhiKeGancao Decoction in the treatment of lumbar disc herniation with Modic Ⅰ degeneration.Methods:From January 2018 to May 2018 30 cases diagnosed as Lumbar disc herniation with Cartilage Bone Modic Ⅰ type complying with the inclusion criteria were selected as the research subjects,randomly divided into Control group、Western Medicine group and traditional Chinese medicine group,10 cases in each group.Control group was treated with health education and Massage necessary;The Western Medicine group was treated with MeiLuoXiKang capsules;The traditional Chinese medicine group was oral ZhiKeGanCao Decotion and the western medicine;14 days was a treatment course.Before and 1 treatment course(14 days)later observed and recorded the VAS score、ODI scores and IL-1β、IL-6、TNF-a levels in serum of three groupsResult:1.Before treatment,the VAS scores of the three groups were as follows:control group(5,10±1.29),western medicine group(5.30±1.42),traditional Chinese medicine group(5.50±1.08);ODI scores were as follows:control group(27.70±5.21),western medicine group(26.90±5.08)traditional Chinese medicine group(28.30±4.19).After treatment,the VAS scores of the three groups were as follows:control group(2.70±0.82),western medicine group(1.90±0.74),traditional Chinese medicine group(1.30+0.48);ODI scores were as follows:control group(19.70±3.81),western medicine group(16.40±3.06),traditional Chinese medicine group(13.30±2.67).Before treatment,there was no difference in VAS and ODI scores among the three groups,P>0.05;after treatment,VAS and ODI scores of the three groups decreased in varying degrees compared with before treatment,and VAS pain scores and ODI scores of the western medicine group and the traditional Chinese medicine group decreased significantly compared with the control group,P<0.05/P<0.01;and the traditional Chinese medicine group was better than the western medicine group,P<0.052.Before treatment,the serum levels of IL-1β、IL-6 and TNF-α in the three groups were as follows:IL-1β:control group(14.52±4.36),western medicine group(14.64±4.59),traditional Chinese medicine group(14.19±4.47);IL-6:control group(15.74±5.95),western medicine group(16.90±5.12),traditional Chinese medicine group(16.11±5.86);TNF-a:control group(22.58±5.11),western medicine group(22.14±4.86),traditional Chinese medicine group(22.41±4.78).There was no difference in scores between groups(P>0.05).After treatment,they were IL-1β:control group(8.99±3.26),western medicine group(5.28±3.43),traditional Chinese medicine group(4.14±3.01);IL-6:control group(12.40±4.02),western medicine group(9.01±3.84),traditional Chinese medicine group(7.14±3.01);TNF-a:control group(19.31+3.94),western medicine group(10.30±4.01),traditional Chinese medicine group(8.35±3.21).After treatment,the levels of inflammatory factors in the three groups decreased in varying degrees compared with those before treatment;the levels of serum IL-1β、IL-6 and TNF-α,in the western medicine group and the traditional Chinese medicine group were significantly lower than those in the control group(P<0.05/P<0.01);compared with the western medicine group,the levels of IL-1β、IL-6 and TNF-a,in the traditional Chinese medicine group were not significantly lower,P>0.05.Conclusion:Compared with the simple usage of MeiLuoXiKang Capsules the ZhiKeGanCao Decoction change formula not might relieve the pains and ameliorate the lumbar function for Lumbar disc herniation diagnosed as stagnation and blood stasis. |
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