| Objective:1.To explore the relationship between the mechanism of Yiqi Huoxue Tongdu Decoction in promoting resorption after ruptured lumbar intervertebral disc herniation and autophagy and apoptosis through human intervertebral disc in vitro experiments.This is the Chinese medicine Yiqi Huoxue Tongdu Decoction for the treatment of ruptured lumbar disc herniation The scientificity and effectiveness of the sci-fi provide experimental basis;2.Based on the clinical randomized controlled trial method,to study the clinical efficacy,changes of imaging indicators before and after treatment and safety of the treatment of ruptured lumbar intervertebral disc herniation,and provide evidence-based medicine for clinical evidence.Methods:1.Experimental study:12 cases of ruptured herniated tissues removed due to lumbar intervertebral disc herniation underwent intervertebral foraminal surgery.After phenotypic identification of nucleus pulposus cells and subculture,the appropriate concentration of H2O2 was used to intervene to produce human ruptured lumbar intervertebral discs.Highlight the tissue oxidative stress model in vitro.The prepared models were divided into the normal saline serum group and the Yiqi Huoxue Tongdu prescription drug-containing serum group,and the active oxygen in the protruding nucleus pulposus cells was detected at 0/12/24/48h after adding the medicated serum or normal saline serum(ROS),Beclin-1,LC3-Ⅰ,LC3-Ⅱ,Caspase-3,Caspase-8,Caspase-9 expression and cell apoptosis.2.Clinical research:The clinical randomized controlled trial method was used to select 60 patients diagnosed as ruptured lumbar disc herniation in the Department of Orthopedics and Traumatology of Suzhou Traditional Chinese Medicine Hospital from September 1,2018 to March 31,2020.According to random number table method,the patients were equally divided into treatment group and control group,30 cases in each group.Both groups of patients were treated with non-steroidal anti-inflammatory drugs and dehydrating drugs for 14 days during the acute pain period.The treatment group was given the traditional Chinese medicine Yiqi Huoxue Tongdu Decoction orally for 8 weeks,and the control group was not given other treatment measures.All patients were followed up for 1 year,and the visual analogue scale(VAS)of lumbar and leg pain before and after treatment,the Japanese Orthopedic Association of Evaluation and Treatment Score(JOA),the size of the protrusion on MRI,the absorption rate,the incidence of resorption,were compared between the two groups before and after treatment."bull"s-eye configuration"parameters,electrocardiogram,blood and urine routine,liver and kidney function,and adverse reactions.Results:1.Experimental study:(1)When the concentration of H2O2 is 10 μ mol/L and the treatment time is 12h,H2O2 has little effect on cell proliferation and has a greater influence on the ability to produce reactive oxygen species.It is the best concentration and treatment time for constructing an oxidative stress model(2)In an in vitro oxidative stress model of human ruptured lumbar disc herniation,compared with the normal saline serum blank control group,the serum of Yiqi Huoxue Tongdu Recipe can obviously cause the increase of intracellular reactive oxygen species,which increases with time This trend is more obvious;(3)The serum of Yiqi Huoxue Tongdu Recipe can significantly up-regulate the expression of apoptosis-related proteins caspase-3,caspase-8,caspase-9 and autophagy markers LC3II and Beclin-1 compared with the blank serum group Level,promote the apoptosis of nucleus pulposus cells,the difference is statistically significant(P<0.05);2.Clinical study:There was no significant difference in the baseline data of 60 patients(P>0.05).During the follow-up,5 patients in the traditional Chinese medicine treatment group fell off,and 13 patients in the western medicine treatment group fell off.The rest of the patients completed treatment and follow-up according to the treatment plan.After treatment,the JO A score and VAS score of the two groups were improved,but the difference in VAS score was not statistically significant(P>0.05);14 days after treatment,the JOA score of the two groups was not statistically significant(P>0.05),but treatment The JOA score of the traditional Chinese medicine treatment group was significantly better than that of the western medicine treatment group in 1 month,2 months,and 1 year(P<0.05).The incidence of resorption in the traditional Chinese medicine treatment group was higher than that in the western medicine treatment group(P<0.05).There was no significant difference in the volume of protrusions between the two groups before and after treatment(P>0.05).There was no significant difference in the incidence of resorption between the two groups at 2 months after treatment(P>0.05),1 year after treatment,the incidence of resorption and the absorption rate of protrusions in the traditional Chinese medicine treatment group were significantly higher than those in the western medicine treatment group(P<0.05).In the bull’s-eye configuration parameter,the maximum thickness of the first ring edge and the degree of enhancement are positively correlated with the absorption rate of protrusions,which can be used to predict the resorption of protrusions to a certain extent.No serious adverse reactions occurred in all patients,and there were no significant changes in safety indicators.Conclusion:1.Yiqi Huoxue Tongdu Recipe can increase the content of reactive oxygen species in cells,while simultaneously inducing autophagic death and apoptosis of intervertebral disc tissue cells,thereby regulating the resorption process of herniated tissues;2.The treatment of ruptured lumbar disc herniation with the method of replenishing qi,activating blood and promoting the supervision can better improve the patient’s lumbar function,promote the resorption of the protrusion,and increase the success rate of conservative treatment;the resorption of the protrusion occurs in 2 months～1 year,patients with ruptured lumbar disc herniation with positive bull’s-eye configuration on enhanced MRI have a higher absorption rate of protrusions.The maximum thickness of the initial ring edge is in direct proportion to the enhancement degree of the ring edge and the absorption rate of the protrusion.These two indexes can predict the absorption degree of the resorption to a certain extent. |
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