大补阴丸联合神经节苷脂治疗无骨折脱位型急性颈脊髓损伤疗效及对血液中TNF-α和IL-1β水平影响

张建敏 章国银 林婷婉 潘文俊 徐强 应有荣 郑彬彬

[摘要] 目的 探討大补阴丸联合神经节苷脂治疗无骨折脱位型急性颈脊髓损伤疗效及对血液中TNF-α和IL-1β水平影响。 方法 选择2018年9月～2019年9月台州恩泽医疗中心（集团）台州医院骨科病房100例无骨折脱位型急性颈脊髓损伤患者，按就诊顺序将患者随机分为对照组、观察组1、观察组2和观察组3，每组25例;对照组给予甲泼尼龙琥珀酸钠冲击治疗，观察组1给予甲基强的松龙联合神经节苷脂治疗，观察组2给予甲基强的松龙联合大补阴丸治疗，观察组3给予甲基强的松龙联合神经节苷脂和补阴丸治疗;比较四组JOA评分改善率及血液中TNF-α和IL-1β水平变化。 结果 治疗前后四组JOA评分各项功能障碍的改善率，包括手指运动、下肢运动、上肢感觉、躯体感觉、下肢感觉、膀胱功能，观察组3显著高于观察组1和观察组2及对照组;治疗后四组血液中TNF-α和IL-1β水平观察组3显著低于观察组1和对照组，但与观察组2无显著差异。 结论 大补阴丸联合神经节苷脂可降低血液中TNF-α和IL-1β水平，显著改善无骨折脱位型急性颈脊髓损伤疗效。

[关键词] 无骨折脱位型急性颈脊髓损伤;大补阴丸;神经节苷脂;IL-1β;TNF-α

[中图分类号] R687.3          [文献标识码] B          [文章编号] 1673-9701（2020）17-0072-04

Effect of dabuyin pill combined with ganglioside in the treatment of acute cervical spinal cord injury without fracture and dislocation and its influence on blood TNF-α and IL-1β levels

ZHANG Jianmin1   ZHANG Guoyin1   LIN Tingwan2   PAN Wenjun3   XU Qiang3   YING Yourong4   ZHENG Binbin1

1.Department of Orthopedics， Taizhou Enze Medical Center（Group） Taizhou Hospital in Zhejiang Province， Taizhou 317000， China; 2.Operating Room， Taizhou Enze Medical Center（Group） Taizhou Hospital in Zhejiang Province， Taizhou   317000， China; 3.Department of Orthopedics， Taizhou Enze Medical Center（Group） Enze Hospital in Zhejiang Province， Taizhou   318050， China; 4.Department of Traditional Chinese Medicine， Taizhou Enze Medical Center（Group） Luqiao Hospital in Zhejiang Province， Taizhou   318050， China

[Abstract] Objective To investigate the therapeutic effect of Dabuyin pill combined with ganglioside in the treatment of acute cervical spinal cord injury without fracture and dislocation and its influence on blood levels of TNF-α and IL-1β. Methods 100 acute cervical spinal cord injury patients without fracture and dislocation were selected in Orthopedics ward of Taizhou Enze Medical Center（Group） Taizhou Hospital from September 2018 to September 2019. They were randomly divided into control group， observation group 1， and observation group 2 and observation group 3， with 25 cases in each group. The control group was given methylprednisolone sodium succinate shock treatment， The observation group 1 was given methylprednisolone combined with ganglioside treatment， and the observation group 2 was given methylprednisolone combined with Dabuyin pill， and observation group 3 was given methylprednisolone combined with ganglioside and Dabuyin pill. The JOA score improvement rate and blood TNF-α and IL-1β level changes in four goups were compared. Results The improvement rate of various dysfunctions of JOA scores before and after treatment in observation group 3， including finger movement， lower limb movement， upper limb sensation， somatosensory， lower limb sensation and bladder function，  were significantly higher than those of observation group 1 and observation group 2 and the control group. After treatment， the levels of TNF-α and IL-1β in the blood in the observation group 3 were significantly lower than those in the observation group 1 and control group， but were not significantly different from those of the observation group 2. Conclusion Dabuyin pill combined with ganglioside can reduce the levels of TNF-α and IL-1β in blood， and significantly improve the curative effect of acute cervical spinal cord injury without fracture and dislocation.

[Key words] Acute cervical spinal cord injury without fracture and dislocation; Dabuyin pill; Ganglioside; IL-1β; TNF-α

急性颈髓损伤常见于颈椎外伤，包括原发性损伤（即机械损害、出血等）和继发性损伤（即水肿、炎症反应、缺血、细胞因子、再灌注等对脊髓产生的毒害作用）[1]，严重者常伴发呼吸衰竭，需长时间机械通气[2]。临床研究[3]显示，急性颈髓损伤致残率和病死率均较高。……