Article(id=1322912165409194967, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322912162913596032, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.01.041, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793336438752, onlineDateStr=2026-10-30, pubDate=1736438400000, pubDateStr=2025-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793336438752, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793336438752, creator=13701087609, updateTime=1793336438752, updator=13701087609, issue=Issue{id=1322912162913596032, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='1', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1736438400000', pubDateStr='2025-01-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793336438157, creator='13701087609', updateTime=1793340633627, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929760048906989, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322912162913596032, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929760048906990, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322912162913596032, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=226, endPage=230, ext={EN=ArticleExt(id=1322912169221817304, articleId=1322912165409194967, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Effects of Chaihu Qingshang Decoction(柴胡清上汤)Combined with Gaze Stability Vestibular Rehabilitation Training on Vestibular Function and Oxidative Stress in Patients with Vestibular Neuritis, columnId=1256183365644968140, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Platform of Provincial Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the effectof Chaihu Qingshang Decoction(柴胡清上汤)combined with gaze stability vestibular rehabilitation training on vestibular function and oxidative stress in patients with vestibular neuritis.

Methods

Sixty patients with vestibular neuritis who were diagnosed in the hospital from July 2021 to December 2022 were selected as research objects,and were randomly divided into the experimentgroup and the control group,with 30 patients in each group. The control group was given routine and symptomatic treatment,and the experiment group was given Chaihu Qingshang Decoction combined with gaze stability vestibular rehabilitation training on the basis of the control group. The clinical efficacy,dizziness symptom assessment scale,dizziness disorder scale,specific activity balance confidence scale,vestibular function,serum inflammatory factors,oxidative stress indicators and incidence of adverse reactions were compared between the two groups before and after treatment.

Result

After treatment,compared with the total effective rate(63.33%,19/30)in the control group,the total effective rate(86.67%,26/30)in the experimental group was higher(P<0.05). Compared with those before treatment,the Vertigo Symptom Rating Scale(DARS)and Dizziness Handicap Inventory(DHI)scores of both groups were significantly reduced,while the activities-specific balance confidence scale(ABC)scores were increased(P<0.05). After treatment,compared with the control group,the experimental group had lower DARSand DHIscores,and higher ABC scores(P<0.05). Compared with that before treatment,semicircular canal paresis(CP)value,scanning wave amplitude,spontaneous nystagmus intensity and shaking head nystagmus intensity of semicircular canals paresis patients in the two groups decreased significantly,and semicircular canals gain increased significantly(P<0.05). After treatment,compared with those of the control group,the CP value,scanningwave amplitude,spontaneous nystagmus intensity and shaking head nystagmus intensity of semicircular canals paresis in the experiment group were lower,and the semicircular canals gain was higher(P<0.05). Compared with those before treatment,the serum levels of IL-6 and TNF-αin both groups significantly decreased(P<0.05). And compared with those of the control group,the levels of the experimental group were relatively low(P<0.05). Compared with those before treatment,the levels of SOD in both groups significantly increased,while the levels of MDA decreased(P<0.05). Compared with the control group,the experimental group had higher level of SOD and lower level of MDA(P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).

Conclusion

Chaihu Qingshang Decoction combined with gaze stability vestibular rehabilitation training can effectively improve the overall therapeutic effect of patients with vestibular neuritis,regulate inflammation and oxidative stress in the body,significantly improve vestibular function,alleviate nystagmus and semicircular canals paresis,which is suitable for clinical promotion.

, authors=Deping LI, Zhiguo MIAO, Zhen LI, Xiaoqiang GONG, Bo LIU, authorsList=Deping LI, Zhiguo MIAO, Zhen LI, Xiaoqiang GONG, Bo LIU, authorCompany=null, correspAuthors=Zhiguo MIAO, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322912173835551714, articleId=1322912165409194967, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=柴胡清上汤联合凝视稳定性前庭康复训练对前庭神经炎前庭功能和氧化应激的影响, columnId=1256183369033965799, journalTitle=中华中医药学刊, columnName=省级项目平台, runingTitle=null, highlight=null, articleAbstract=
目的

探讨柴胡清上汤联合凝视稳定性前庭康复训练对前庭神经炎患者前庭功能和氧化应激的影响。

方法

选择2021年7月—2022年12月医院就诊并诊断为前庭神经炎患者60例作为研究对象,随机分为试验组和对照组,各30例。对照组予以常规及对症治疗,试验组在对照组基础上予以柴胡清上汤联合凝视稳定性前庭康复训练。比较治疗前后两组患者临床疗效、眩晕症状评定量表(Vertigo symptom rating scale,DARS)、眩晕障碍量表(Dizziness handicap inventory,DHI)及特异性活动平衡自信量表(Activities-specific balance confidence scale,ABC)、前庭功能、血清炎症因子、氧化应激指标及不良反应发生情况。

结果

治疗后,与对照组总有效率63.33%(19/30)相比,试验组总有效率(86.67%,26/30)较高(P<0.05),与治疗前比较,两组患者DARS、DHI评分均显著降低,ABC评分升高(P<0.05);治疗后与对照组相比,试验组DARS、DHI评分较低,ABC评分较高(P<0.05)。与治疗前比较,两组患者半规管轻瘫(Semicircular canal paraplegia,CP)值、扫视波幅度、自发眼震强度、摇头眼震强度明显下降,半规管增益明显增高(P<0.05);治疗后与对照组相比,试验组半规管轻瘫CP值、扫视波幅度、自发眼震强度、摇头眼震强度较低,半规管增益较高(P<0.05)。与治疗前比较,两组患者血清肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白细胞介素-6(Interleukin-6,IL-6)水平明显下降(P<0.05);且与对照组相比,试验组血清TNF-α、IL-6水平较低(P<0.05)。与治疗前比较,两组患者超氧化物歧化酶(Superoxide dismutase,SOD)水平明显升高,丙二醛(Malondialdehyde,MDA)水平降低(P<0.05);且与对照组相比,试验组SOD水平较高,MDA水平较低(P<0.05)。两组不良反应发生情况相比差异无统计学意义(P>0.05)。

结论

柴胡清上汤联合凝视稳定性前庭康复训练可有效提升前庭神经炎患者整体治疗效果,调节机体内血清炎症、氧化应激水平,显著改善前庭功能,缓解眼震、半规管轻瘫状态,临床适宜推广。

, authors=李得平, 苗治国, 李振, 龚晓强, 刘博, authorsList=李得平, 苗治国, 李振, 龚晓强, 刘博, authorCompany=null, correspAuthors=苗治国, authorNote=

李得平(1986-),女,湖南郴州人,主治中医师,硕士,研究方向:中医临床。

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苗治国(1976-),男,河南郑州人,副主任中医师,博士,研究方向:中医药防治脑病。E-mail:。
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authorNames=OLIVEIRA JE SILVA L, KHOUJAH D, NAPLES JG, journalName=Acad Emerg Med, refType=null, unstructuredReference=OLIVEIRA JE SILVA L,KHOUJAH D,NAPLES JG,et al.Corticosteroids for patientswith vestibular neuritis:an evidence synthesis for guidelines for reasonable and appropriate care in the emergency department[J].Acad Emerg Med,2023,30(5):531-540., articleTitle=Corticosteroids for patientswith vestibular neuritis:an evidence synthesis for guidelines for reasonable and appropriate care in the emergency department, refAbstract=null), Reference(id=1322912702577901952, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322912165409194967, doi=null, pmid=null, pmcid=null, year=2023, volume=62, issue=7, pageStart=743, pageEnd=747, url=null, language=null, rfNumber=[27], rfOrder=26, authorNames=庄建华, journalName=中华内科杂志, refType=null, unstructuredReference=庄建华.前庭神经炎不同时期的临床特征和处理策略[J].中华内科杂志,2023,62(7):743-747., articleTitle=前庭神经炎不同时期的临床特征和处理策略, refAbstract=null), Reference(id=1322912702653399425, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322912165409194967, doi=null, pmid=null, pmcid=null, year=2022, volume=39, issue=11, pageStart=1712, pageEnd=1714, url=null, language=null, rfNumber=[28], rfOrder=27, authorNames=李进, 邹兴菊, journalName=医学临床研究, refType=null, unstructuredReference=李进,邹兴菊.糖皮质激素结合前庭功能训练对前庭神经炎患者平衡功能、炎症因子及氧化应激水平的影响[J].医学临床研究,2022,39(11):1712-1714., articleTitle=糖皮质激素结合前庭功能训练对前庭神经炎患者平衡功能、炎症因子及氧化应激水平的影响, refAbstract=null), Reference(id=1322912702728896898, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322912165409194967, doi=null, pmid=null, pmcid=null, year=2019, volume=14, issue=9, pageStart=69, pageEnd=71, url=null, language=null, rfNumber=[29], rfOrder=28, authorNames=黄瓅, journalName=中国药物经济学, refType=null, unstructuredReference=黄瓅.甲钴胺联合泼尼松对老年前庭神经炎患者前庭功能和炎症介质水平的影响[J].中国药物经济学,2019,14(9):69-71., articleTitle=甲钴胺联合泼尼松对老年前庭神经炎患者前庭功能和炎症介质水平的影响, refAbstract=null), 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of oxidative stress in patientswith peripheral vertigo[J].Eur Arch Otorhinolaryngol,2021,278(10):3773-3776., articleTitle=Serum prolidase,malondialdehyde and catalase levels for the evaluation of oxidative stress in patientswith peripheral vertigo, refAbstract=null), Reference(id=1322912703068635525, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322912165409194967, doi=null, pmid=null, pmcid=null, year=2019, volume=25, issue=10, pageStart=788, pageEnd=791, url=null, language=null, rfNumber=[32], rfOrder=31, authorNames=蔡彬林, 瞿秀, 瞿春林, journalName=海南医学院学报, refType=null, unstructuredReference=蔡彬林,瞿秀,瞿春林.分泌性中耳炎患者关于促炎作用、液体平衡、血管通透性及氧化应激的变化分析[J].海南医学院学报,2019,25(10):788-791., articleTitle=分泌性中耳炎患者关于促炎作用、液体平衡、血管通透性及氧化应激的变化分析, refAbstract=null)], funds=[Fund(id=1322912698907885923, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322912165409194967, awardId=2022ZY2063, language=CN, fundingSource=河南省卫生健康委员会中医药管理局中医药专项(2022ZY2063), fundOrder=null, 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组别例数治愈好转无效总有效
试验组3011(36.67)15(50.00)4(13.33)26(86.67)*
对照组309(30.00)10(33.33)11(36.67)19(63.33)
), ArticleFig(id=1322912698220020058, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322912165409194967, language=CN, label=表1, caption=

两组前庭神经炎患者临床疗效比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数治愈好转无效总有效
试验组3011(36.67)15(50.00)4(13.33)26(86.67)*
对照组309(30.00)10(33.33)11(36.67)19(63.33)
), ArticleFig(id=1322912698287128923, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322912165409194967, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间DARSDHIABC
试验组30治疗前59.25±6.3364.52±6.9360.55±6.52
治疗后35.24±3.77*#22.10±2.54*#75.36±8.02*#
对照组30治疗前59.02±6.2964.50±6.8960.79±6.57
治疗后44.53±4.83*31.34±3.51*65.33±6.84*
), ArticleFig(id=1322912698354237788, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322912165409194967, language=CN, label=表2, caption=

两组前庭神经炎患者DARS、DHI、ABC评分比较(±s)

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间DARSDHIABC
试验组30治疗前59.25±6.3364.52±6.9360.55±6.52
治疗后35.24±3.77*#22.10±2.54*#75.36±8.02*#
对照组30治疗前59.02±6.2964.50±6.8960.79±6.57
治疗后44.53±4.83*31.34±3.51*65.33±6.84*
), ArticleFig(id=1322912698412958045, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322912165409194967, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间半规管轻瘫CP值/(%)半规管增益扫视波幅度/(°/s)自发眼震强度/(°/s)摇头眼震强度/(°/s)
试验组30治疗前35.45±3.770.43±0.08203.54±22.546.56±0.789.35±1.55
治疗后15.24±1.94*#0.91±0.05*#98.12±10.43*#1.58±0.22*#1.64±0.22*#
对照组30治疗前35.44±3.800.44±0.09203.88±22.606.50±0.799.40±1.57
治疗后22.43±2.65*0.69±0.11*153.45±18.23*2.56±0.34*2.90±0.32*
), ArticleFig(id=1322912698484261214, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322912165409194967, language=CN, label=表3, caption=

两组前庭神经炎患者前庭功能比较(±s)

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间半规管轻瘫CP值/(%)半规管增益扫视波幅度/(°/s)自发眼震强度/(°/s)摇头眼震强度/(°/s)
试验组30治疗前35.45±3.770.43±0.08203.54±22.546.56±0.789.35±1.55
治疗后15.24±1.94*#0.91±0.05*#98.12±10.43*#1.58±0.22*#1.64±0.22*#
对照组30治疗前35.44±3.800.44±0.09203.88±22.606.50±0.799.40±1.57
治疗后22.43±2.65*0.69±0.11*153.45±18.23*2.56±0.34*2.90±0.32*
), ArticleFig(id=1322912698555564383, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322912165409194967, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间TNF-αIL-6
试验组30治疗前26.46±2.8918.35±1.97
治疗后13.52±1.76*#9.13±1.32*#
对照组30治疗前26.50±2.8018.60±1.98
治疗后20.33±2.14*13.20±1.77*
), ArticleFig(id=1322912698618478944, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322912165409194967, language=CN, label=表4, caption=

两组前庭神经炎患者血清炎症因子指标比较(±s)

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间TNF-αIL-6
试验组30治疗前26.46±2.8918.35±1.97
治疗后13.52±1.76*#9.13±1.32*#
对照组30治疗前26.50±2.8018.60±1.98
治疗后20.33±2.14*13.20±1.77*
), ArticleFig(id=1322912698698170721, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322912165409194967, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间SOD/(U/mL)MDA/(nmol/L)
试验组30治疗前60.35±6.555.35±0.65
治疗后93.42±10.24*#3.21±0.44*#
对照组30治疗前60.82±6.705.39±0.64
治疗后78.34±8.94*4.55±0.56*
), ArticleFig(id=1322912698777862498, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322912165409194967, language=CN, label=表5, caption=

两组前庭神经炎患者氧化应激指标比较(±s)

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间SOD/(U/mL)MDA/(nmol/L)
试验组30治疗前60.35±6.555.35±0.65
治疗后93.42±10.24*#3.21±0.44*#
对照组30治疗前60.82±6.705.39±0.64
治疗后78.34±8.94*4.55±0.56*
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柴胡清上汤联合凝视稳定性前庭康复训练对前庭神经炎前庭功能和氧化应激的影响
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李得平 , 苗治国 , 李振 , 龚晓强 , 刘博
中华中医药学刊 | 省级项目平台 2025,43(1): 226-230
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中华中医药学刊 |省级项目平台 2025 , 43 (1) : 226 -230
柴胡清上汤联合凝视稳定性前庭康复训练对前庭神经炎前庭功能和氧化应激的影响
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李得平, 苗治国 , 李振, 龚晓强, 刘博
作者信息
  • 郑州市中医院,河南 郑州 450007
通讯作者:
苗治国(1976-),男,河南郑州人,副主任中医师,博士,研究方向:中医药防治脑病。E-mail:。
作者简介:

李得平(1986-),女,湖南郴州人,主治中医师,硕士,研究方向:中医临床。

Effects of Chaihu Qingshang Decoction(柴胡清上汤)Combined with Gaze Stability Vestibular Rehabilitation Training on Vestibular Function and Oxidative Stress in Patients with Vestibular Neuritis
Deping LI, Zhiguo MIAO , Zhen LI, Xiaoqiang GONG, Bo LIU
Affiliations
  • Zhengzhou Traditional Chinese Medicine Hospital, Zhengzhou 450007, Henan, China
出版时间: 2025-01-10 doi: 10.13193/j.issn.1673-7717.2025.01.041
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目的

探讨柴胡清上汤联合凝视稳定性前庭康复训练对前庭神经炎患者前庭功能和氧化应激的影响。

方法

选择2021年7月—2022年12月医院就诊并诊断为前庭神经炎患者60例作为研究对象,随机分为试验组和对照组,各30例。对照组予以常规及对症治疗,试验组在对照组基础上予以柴胡清上汤联合凝视稳定性前庭康复训练。比较治疗前后两组患者临床疗效、眩晕症状评定量表(Vertigo symptom rating scale,DARS)、眩晕障碍量表(Dizziness handicap inventory,DHI)及特异性活动平衡自信量表(Activities-specific balance confidence scale,ABC)、前庭功能、血清炎症因子、氧化应激指标及不良反应发生情况。

结果

治疗后,与对照组总有效率63.33%(19/30)相比,试验组总有效率(86.67%,26/30)较高(P<0.05),与治疗前比较,两组患者DARS、DHI评分均显著降低,ABC评分升高(P<0.05);治疗后与对照组相比,试验组DARS、DHI评分较低,ABC评分较高(P<0.05)。与治疗前比较,两组患者半规管轻瘫(Semicircular canal paraplegia,CP)值、扫视波幅度、自发眼震强度、摇头眼震强度明显下降,半规管增益明显增高(P<0.05);治疗后与对照组相比,试验组半规管轻瘫CP值、扫视波幅度、自发眼震强度、摇头眼震强度较低,半规管增益较高(P<0.05)。与治疗前比较,两组患者血清肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白细胞介素-6(Interleukin-6,IL-6)水平明显下降(P<0.05);且与对照组相比,试验组血清TNF-α、IL-6水平较低(P<0.05)。与治疗前比较,两组患者超氧化物歧化酶(Superoxide dismutase,SOD)水平明显升高,丙二醛(Malondialdehyde,MDA)水平降低(P<0.05);且与对照组相比,试验组SOD水平较高,MDA水平较低(P<0.05)。两组不良反应发生情况相比差异无统计学意义(P>0.05)。

结论

柴胡清上汤联合凝视稳定性前庭康复训练可有效提升前庭神经炎患者整体治疗效果,调节机体内血清炎症、氧化应激水平,显著改善前庭功能,缓解眼震、半规管轻瘫状态,临床适宜推广。

柴胡清上汤  /  凝视稳定性前庭康复训练  /  前庭神经炎  /  前庭功能  /  氧化应激
Objective

To explore the effectof Chaihu Qingshang Decoction(柴胡清上汤)combined with gaze stability vestibular rehabilitation training on vestibular function and oxidative stress in patients with vestibular neuritis.

Methods

Sixty patients with vestibular neuritis who were diagnosed in the hospital from July 2021 to December 2022 were selected as research objects,and were randomly divided into the experimentgroup and the control group,with 30 patients in each group. The control group was given routine and symptomatic treatment,and the experiment group was given Chaihu Qingshang Decoction combined with gaze stability vestibular rehabilitation training on the basis of the control group. The clinical efficacy,dizziness symptom assessment scale,dizziness disorder scale,specific activity balance confidence scale,vestibular function,serum inflammatory factors,oxidative stress indicators and incidence of adverse reactions were compared between the two groups before and after treatment.

Result

After treatment,compared with the total effective rate(63.33%,19/30)in the control group,the total effective rate(86.67%,26/30)in the experimental group was higher(P<0.05). Compared with those before treatment,the Vertigo Symptom Rating Scale(DARS)and Dizziness Handicap Inventory(DHI)scores of both groups were significantly reduced,while the activities-specific balance confidence scale(ABC)scores were increased(P<0.05). After treatment,compared with the control group,the experimental group had lower DARSand DHIscores,and higher ABC scores(P<0.05). Compared with that before treatment,semicircular canal paresis(CP)value,scanning wave amplitude,spontaneous nystagmus intensity and shaking head nystagmus intensity of semicircular canals paresis patients in the two groups decreased significantly,and semicircular canals gain increased significantly(P<0.05). After treatment,compared with those of the control group,the CP value,scanningwave amplitude,spontaneous nystagmus intensity and shaking head nystagmus intensity of semicircular canals paresis in the experiment group were lower,and the semicircular canals gain was higher(P<0.05). Compared with those before treatment,the serum levels of IL-6 and TNF-αin both groups significantly decreased(P<0.05). And compared with those of the control group,the levels of the experimental group were relatively low(P<0.05). Compared with those before treatment,the levels of SOD in both groups significantly increased,while the levels of MDA decreased(P<0.05). Compared with the control group,the experimental group had higher level of SOD and lower level of MDA(P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).

Conclusion

Chaihu Qingshang Decoction combined with gaze stability vestibular rehabilitation training can effectively improve the overall therapeutic effect of patients with vestibular neuritis,regulate inflammation and oxidative stress in the body,significantly improve vestibular function,alleviate nystagmus and semicircular canals paresis,which is suitable for clinical promotion.

Chaihu Qingshang Decoction(柴胡清上汤)  /  gazing stability vestibular rehabilitation training  /  vestibular neuritis  /  vestibular function  /  oxidative stress
李得平, 苗治国, 李振, 龚晓强, 刘博. 柴胡清上汤联合凝视稳定性前庭康复训练对前庭神经炎前庭功能和氧化应激的影响. 中华中医药学刊, 2025 , 43 (1) : 226 -230 . DOI: 10.13193/j.issn.1673-7717.2025.01.041
Deping LI, Zhiguo MIAO, Zhen LI, Xiaoqiang GONG, Bo LIU. Effects of Chaihu Qingshang Decoction(柴胡清上汤)Combined with Gaze Stability Vestibular Rehabilitation Training on Vestibular Function and Oxidative Stress in Patients with Vestibular Neuritis[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (1) : 226 -230 . DOI: 10.13193/j.issn.1673-7717.2025.01.041
前庭神经炎(vestibularneuritis,VN)是一种急性外周性前庭综合征[1],临床可见突发性持续头晕、恶心呕吐、视物旋转、严重不平衡感,未存在听力受损、耳鸣等耳蜗症状或合并中枢病变[2]。目前相关研究表明,本病在临床上的患病率为3.5/10万左右,常处于20~60岁人群中[3],患病人数增多,对居民日常生活与身心健康产生恶劣影响。目前临床治疗一般选择激素类药物、改善微循环,并应用营养神经药物,辅以前庭康复训练[4]。凝视稳定性前庭康复训练是前庭神经炎患者一类有效的干预措施,能促进各类感觉系统发挥出整合作用,从而替代前庭功能缺损[5],该类康复训练方式能有效弥补[6],以往卧床休息及药物治疗期间的不足,但当前临床暂无凝视稳定性前庭康复训练应用于前庭神经炎患者的相关研究。此外中医在眩晕治疗上具有显著优势。其中中药汤剂是临床应用有效且不良反应较小的治疗方法。本实验观察柴胡清上汤联合凝视稳定性前庭康复训练治疗前后的临床效果,观察患者前庭功能和氧化应激等指标变化,就联合干预手段治疗前庭神经炎患者的相关机制进行研究。
选择2021年7月—2022年12月在我院就诊并诊断为前庭神经炎患者60例作为研究对象,随机分为试验组和对照组,各30例。试验组患者男17例,女13例,年龄22~67岁,平均(41.53±4.81)岁,病程1.2~14 d,平均(5.62±0.64)h;对照组患者男18例,女12例,年龄21~64岁,平均(40.92±4.90)岁,病程1.5~13 d,平均(5.70±0.62)h。两组平均年龄、性别比例、平均病程等基本资料经统计学进行对比发现差异无统计学意义(P>0.05)。
(1)西医诊断参考《前庭神经炎诊治多学科专家共识》[7]中的诊断标准。(2)中医诊断参考《中医耳鼻咽喉科学》[8],患者存在旋转性眩晕,常存在突发性发作眩晕,天旋地转,站立不稳,多合并恶心呕吐,出冷汗,神志清楚。恶心呕吐,可伴发热恶风,鼻塞流涕,咳嗽,舌质红,苔薄黄,脉浮数。(3)年龄为18~60岁。(4)发病至就诊于14 d内,或床旁检查仍存在向健侧的自发性眼震。(5)能配合相关量表。(6)本试验经伦理委员会批准,患者家属签署知情同意书。
(1)既往患前庭相关疾病,或其他类型耳蜗或前庭疾病;(2)存在头部中枢病变;(3)存在消化道疾病、骨质疏松、糖尿病等激素禁忌证者;(4)无法完成全部检查及填写量表者。
予以常规及对症治疗,维生素B1片(规格:5 mg,国药准字H44021852,广东邦民制药厂有限公司)口服,10 mg/次,3次/d;甲钴胺片(规格:0.5 mg,国药准字H20041229,沈阳澳华制药有限公司)口服,500 μg/次,3次/d;醋酸泼尼松片(规格:5 mg,国药准字H33021207,浙江仙琚制药股份有限公司),口服,30 mg/次,1次/d,服用5 d后停药;甲磺酸倍他司汀片[规格:6 mg,国药准字H20180334,卫材(中国)药业有限公司]口服,12 mg/次,3次/d。
在对照组基础上予以柴胡清上汤联合凝视稳定性前庭康复训练。
(1)柴胡清上汤:待患者恶心呕吐症状缓解后,予中药汤剂柴胡清上汤100 mL日3次口服(组成:柴胡30 g,栀子12 g,桔梗12 g,甘草9 g,薄荷30 g,连翘15 g,香附9 g),院内统一代煎,每剂煎取300 mL。
(2)凝视稳定性前庭康复训练操作如下:①训练(摇头固视):右手持视靶放于眼部正前方盯住视靶左右进行5个来回45°转头、上下进行5个来回45°抬头低头为1个训练,每次进行5个循环,3次/d。②训练(反向固视):手持视靶放于眼部正前方,手向一侧移动。集中盯住视靶头往另外一侧转动左右、上下各5个,来回代表1个循环,每次进行5个循环,3次/d。③交替固视:手握两个视靶,先放于眼睛的正前方,两个视靶间隔50 cm头、眼同步在两个视靶之间来回固视,进行5个来回。后上下放置两个视靶于面前间隔50 cm头、眼在两个视靶之间同步来回固视,进行5个来回。上下、左右各5个来回代表1个循环,每次进行5个循环,3次/d。④分离固视:双手握两个视靶先放于眼睛的正前方,相距眼睛50 cm,先看往一侧视靶,后头转向视靶,需眼睛始终盯紧视靶;眼睛再看往另外一侧视靶,头部紧随其后转动,进行5个来回。左右、上下各5个来回代表1个循环,每次进行5个循环,3次/d。
治愈为强烈旋转性眩晕症状完全消失,头位发生改变时不会诱发头晕、眼震等症状,可进行正常生活与工作;好转为眩晕症状好转,但合并头晕不平衡感,头位发生变化时可诱发头晕症状,对正常生活及工作略有影响;无效为强烈旋转性眩晕等临床症状、体征无明显好转,可对正常生活及工作造成严重影响。总有效率为治愈率和好转率之和。
观察两组治疗前后眩晕症状评定量表(Vertigo symptom rating scale,DARS)、眩晕障碍量表(Vertigo disorder scale,DHI)及特异性活动平衡自信量表(Specific activity balance confidence scale,ABC)评分情况,其中DARS、DHI评分越高,说明眩晕症状越严重;ABC评分越高,说明平衡能力越理想。
在治疗前后对双温试验中半规管轻瘫(Semicircular canal paraplegia,CP)值、头脉冲试验中受累水平半规管增益、扫视波幅度、自发及摇头眼震强度进行监测,其中半规管轻瘫CP值越高、受累水平半规管增益越低、自发及摇头眼震强度和扫视波幅度越高,提示前庭功能越差。
于治疗前后,清晨8时采空腹左肘静脉血5 mL置入抗凝管内,静置后2500 r·min-1离心15 min,取上清液收集于-70℃冰箱保存;于晨起第1次尿液中段取8 mL,静置后以2500 r·min-1离心15 min,离心完成后取上层清洁尿液装入EP管;血样以及尿样收集完整后转交至专业人员根据试剂盒说明书步骤进行操作。采用酶联免疫分析法检测血清肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白细胞介素-6(Interleukin-6,IL-6)水平。
应用硫代巴比妥酸(Thiobarbituric acid,TBA)法对血清超氧化物歧化酶(Superoxide dismutase,SOD)水平进行监测;应用黄嘌呤氧化酶法对丙二醛(Malondialdehyde,MDA)进行检测。
记录患者不良反应发生情况。
采用SPSS 24.0统计进行统计学分析,计量资料应用t检验,均数±标准差表示,临床有效率及不良反应发生率等计数资料应用率(%)表示,采用卡方法检验,统计值P<0.05为差异具有统计学意义。
治疗后,与对照组总有效率(63.33%)相比,试验组总有效率(86.67%)较高,差异具有统计学意义(P<0.05)。如表1。
与治疗前比较,两组患者DARS、DHI评分均显著降低,ABC评分升高(P<0.05);治疗后与对照组相比,试验组DARS、DHI评分较低,ABC评分较高(P<0.05)。见表2。
与治疗前比较,两组患者半规管轻瘫CP值、扫视波幅度、自发眼震强度、摇头眼震强度明显下降,半规管增益明显增高(P<0.05);治疗后与对照组相比,试验组半规管轻瘫CP值、扫视波幅度、自发眼震强度、摇头眼震强度较低,半规管增益较高(P<0.05)。如表3。
与治疗前比较,两组患者血清TNF-α、IL-6水平明显下降(P<0.05);且与对照组相比,试验组血清TNF-α、IL-6水平较低(P<0.05)。如表4。
与治疗前比较,两组患者SOD水平明显升高,MDA水平降低(P<0.05);且与对照组相比,试验组SOD水平较高,MDA水平较低(P<0.05)。如表5。
试验组出现2例头晕目眩,1例胃肠道不适,总不良反应发生率为10.00%(3/30);对照组出现2例轻微腹泻,2例头晕目眩,总不良反应发生率为13.33%(4/30);两组不良反应发生情况相比,差异无统计学意义(P>0.05)。
前庭神经炎是由于前庭神经元受累诱发突发性眩晕症状所致的非特异性前庭神经节或前庭通路病变[9],疾病前期会诱发呼吸道病毒感染的症状[10]。部分患者临床症状持续时间较短,会在2周内可完全恢复[11],但是存在少量患者会残留不同程度的头晕以及平衡障碍,会诱发临床症状加重[12]。部分患者还可合并咽痛、流涕、发热、耳痛、发热等症状,对生活质量产生恶劣影响[13]。本病经药物及对症治疗后,患者眩晕、平衡功能及前庭功能会有一定好转,但长期使用易产生依赖性[14],此外部分动态前庭功能损伤患者因持续伴随眩晕症状而害怕运动,诱发恶性循环,药物治疗效果较差[15]。KABIŞ B等[16]对比前庭康复训练与仪器训练对前庭功能障碍的疗效,结果显示,两种疗法均能改善患者的平衡功能与日常活动。徐金凤等[17]对58例前庭神经炎患者开展研究,一组予以常规治疗归为参考组,一组加以前庭康复训练归为训练组,结果显示,训练组治疗后的DHI评分低于参考组。凝视稳定性前庭康复训练是前庭神经炎患者一类有效的干预措施,能促进各类感觉系统发挥出整合作用,替代前庭功能缺损[18]。该类康复训练方式能有效弥补以往卧床休息及药物治疗期间的不足,具有内容简单,易被患者理解、学习及接受,不易使其生成厌倦感等优势[19],训练方法针对性较强,能较快收获一定的康复效果,提升患者的康复自信心,依从性佳[20]。但当前临床有关凝视稳定性前庭康复训练用于前庭神经炎患者的临床研究较少。此外中医治疗本病近年来获得显著优势。本病在中医学研究中隶属“耳眩晕”范畴,在前人治疗眩晕的经验理论基础之上,选方柴胡清上汤以发挥疏风散邪、清利头目,同时养血治风的功效。方中柴胡具有解表散热,疏肝和胃的功效;栀子能清热,泻火,凉血;桔梗具有开宣肺气,祛痰排脓功效;甘草具有和中缓急,润肺,解毒,调和诸药的功效;薄荷能疏风散热、辟秽解毒;连翘善于清热解毒、散结消肿;香附能理气解郁,止痛调经。前期研究将柴胡清上汤应用于前庭神经炎患者的治疗中,科室内获得满意的临床疗效。目前暂无柴胡清上汤与凝视稳定性前庭康复训练联合应用的相关研究,基于此本项目就柴胡清上汤联合凝视稳定性前庭康复训练对前庭神经炎患者前庭功能和氧化应激的影响进行分析,结果显示与对照组相比,试验组总有效率、ABC评分、半规管增益较高,DARS、DHI评分、半规管轻瘫CP值、扫视波幅度、自发眼震强度、摇头眼震强度较低,提示经联合干预后患者眩晕症状及平衡功能。考虑原因是凝视稳定性前庭康复训练从摇头固视、反向固视、交替固视、分离固视几方面开展前庭康复训练,训练期间除充分考虑到患者视觉输入,还需维持机体及头部运动一致性及协调性,确保机体运动平衡性,对机体中多个部位发挥良好协同作用,缓解患者的眩晕程度,加快其平衡能力恢复[21]。辅助中药治疗在提高患者免疫力的同时,符合耳眩晕外邪侵袭证的治疗,方中柴胡可参与细胞外的免疫应答,截断病毒侵入机体的途径[22];连翘中有效成分能起到抗炎作用,还具有抗菌、抗肿瘤、抗氧化等作用[23];甘草中的甘草次酸等成分也具有抗炎作用,能够发挥类似于糖皮质激素的作用,还具有抗肿瘤、抗病毒等药理学作用[24]。
本病发病后可使受累前庭神经功能丧失,存在炎症细胞浸润、水肿现象,进而诱发局部神经组织缺血致使水平半规管、上半规管功能麻痹,前庭终器丧失支配作用[10,25-27]。TNF-α以及IL-6均为重要炎症介质[28],其水平升高能够使机体炎症反应增强,进而导致病情加重,是评估患者机体炎症反应状态及病情严重程度的关键标志物[29]。我们研究显示,经联合干预方案后可通过下调机体TNF-α、IL-6等炎性因子水平进而提升治疗效果,加快前庭神经功能恢复。
前庭神经炎患者存在前庭神经节突触密度减少、前庭感觉上皮萎缩、神经组织缺血缺氧现象[30],机体SOD、MDA等氧化应激指标多为不平衡状态,使神经细胞轴索分解变性,产生功能障碍[31]。因此选择氧化应激水平作为观察指标,血清SOD水平可反映机体对氧自由基的清除能力,MDA反映机体脂质过氧化程度[32]。我们研究显示,与对照组相比,试验组血清SOD、MDA等氧化应激指标水平显著调节,提示联合干预手段可有效提升机体清除自由基及抗氧化能力,改善神经组织局部微循环状态,并进一步修复神经细胞功能,从而达到治疗目标。
本研究通过对我院收治的前庭神经炎患者60例的临床疗效、眩晕症状评定量表、眩晕障碍量表、特异性活动平衡自信量表、前庭功能、血清炎症因子、氧化应激指标及不良反应发生情况进行研究,证实了柴胡清上汤联合凝视稳定性前庭康复训练可有效提升前庭神经炎患者整体治疗效果,调节机体内血清炎症、氧化应激水平,显著改善前庭功能,缓解眼震、半规管轻瘫状态,临床适宜推广。
  • 河南省卫生健康委员会中医药管理局中医药专项(2022ZY2063)
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2025年第43卷第1期
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doi: 10.13193/j.issn.1673-7717.2025.01.041
  • 首发时间:2026-10-30
  • 出版时间:2025-01-10
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河南省卫生健康委员会中医药管理局中医药专项(2022ZY2063)
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    郑州市中医院,河南 郑州 450007

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苗治国(1976-),男,河南郑州人,副主任中医师,博士,研究方向:中医药防治脑病。E-mail:。
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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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