Clinical Efficacy And Serum Metabolomics Study Of Zhengqing Fengtongning Triple Therapy In The Treatment Of LDH Wind-cold-warm Arthralgia Patient

Objective:To observe the effects of Zhengqing FengTongNing triple therapy and celecoxib capsules on the pain and physical activity function in LDH(wind-cold-dampness type),and evaluate the clinical efficacy and difference of the two treatments.To explore the difference of serum metabolites and metabolic pathway of Zhengqing Fengtongning triple therapy in the treatment of lumbar disc herniation(wind-cold-dampness type)by using serum metabonomics technology,to explore its mechanism from the perspective of metabonomics.Methods:1.68 patients with lumbar disc herniation(wind-cold-dampness type)were randomly divided into test group(Zhengqing triple group)and control group(Celecoxib group)by using randomized and controlled clinical research method.The test group was treated with Zhengqing Fengtongning triple therapy,and the control group was treated with Celecoxib capsule orally.Traditional Chinese Medicine Syndrome Points、VAS pain score and JOA score were used as the efficacy evaluation indicators,and blood routine,liver and kidney function routine,stool routine and adverse reaction record were used as the safety evaluation indicators.The clinical efficacy of the two therapies in the treatment of lumbar disc herniation(wind-cold-dampness type)was evaluated at four stages before treatment,on the 10th day of treatment,on the 20th day of treatment,and one month after treatment.2.The serum samples of the patients in the Zhengqing triple group and Celecoxib group were collected at the time of enrollment and 20 days after treatment,and the serum metabolites were detected by gas chromatography-mass spectrometry(GC-MS);At the same time,carry out multivariate statistical analysis on the data,use the database to compare the potential different metabolites between the two groups before and after treatment,and analyze the metabolic pathways that may be involved.Result:(1)This study included a total of 68 cases,with 8 cases experiencing dropout during the treatment process.In fact,60 cases were included in the statistical analysis,including 30 cases in the control group and 30 cases in the experimental group.There was no statistically significant difference in gender,age,traditional Chinese medicine syndrome score,VAS score,and JOA score between the two groups before treatment(P>0.05);(2)The TCM syndrome scores,VAS,and JOA scores of the two groups of patients were better than before treatment on the 10th,20th,and 1-month follow-up(P<0.05),and the VAS and JOA scores of the experimental group were better than the control group at all stages(P<0.05).The total effective rate of the experimental group was 93.33%,while the total effective rate of the control group was 80.0%,with a statistically significant difference(P<0.05);(3)During the treatment process,both groups of patients had mild adverse reactions.The incidence of adverse reactions in the experimental group was 13.33%,while the incidence of adverse reactions in the control group was 16.67%,with no statistically significant difference(P>0.05);(4)LC-MS technology was used to detect the difference metabolites in the test group after treatment compared with that before treatment:lysine,glutamic acid,glycine,pyruvate,xylose 5 phosphate,N-hydroxy arachidonic acid amine,etc;The metabolic pathways involved include pentose and glucuronic acid conversion,pentose phosphate pathway,pyruvate metabolism,glycolysis or gluconeogenesis,glycerol phospholipid metabolism,tryptophan metabolism,and aminoacyl tRNA biosynthesis.Conclusion:1.Both Zhengqing Fengtongning triple therapy and Celecoxib capsules can improve limb pain and dysfunction in patients with lumbar disc herniation caused by wind cold dampness;The therapeutic effect of Zhengqing Fengtongning triple therapy on lumbar disc herniation of wind cold dampness type was better than that of celecoxib capsules on the 10th,20th,and 1-month follow-up,and there was no difference in safety.The combination therapy of Zheng Qing Feng Tong Ning has significant therapeutic effect and high safety in the treatment of wind cold dampness type LDH,which is worthy of clinical promotion and application.2.Zhengqing Fengtongning triple therapy has a significant effect on the levels of serum lysine,glutamic acid,glycine,pyruvate,xylose-5-phosphate,arachidonic acid and other compounds in patients with LDH of wind cold dampness syndrome type.The mechanism of this therapy in treating LDH may be related to the regulation of amino acid metabolism and sugar metabolism in the body.