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Article(id=1322922887623082453, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322922680609014711, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.02.045, 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=1793338995127, onlineDateStr=2026-10-30, pubDate=1739116800000, pubDateStr=2025-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793338995127, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793338995127, creator=13701087609, updateTime=1793338995127, updator=13701087609, issue=Issue{id=1322922680609014711, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='2', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1739116800000', pubDateStr='2025-02-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793338945772, creator='13701087609', updateTime=1793340618065, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929694785536732, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322922680609014711, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929694785536733, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322922680609014711, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=220, endPage=224, ext={EN=ArticleExt(id=1322922887845380566, articleId=1322922887623082453, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Clinical Study on Treatment of Lumbar Disc Herniation by Blood Letting Puncture and “Tongji” Electroacupuncture, columnId=1256183365644968140, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Platform of Provincial Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the clinical study of blood letting puncture combined with“Tongji”electroacupuncture in the treatment of lumbar disc herniation.

Methods

From January 2022 to January 2023，88 patients with lumbar disc herniation were selected from the acupuncture and moxibustion department of the hospital. According to the treatment method，the patients were divided into an observation group（48 cases）and a control group（40 cases）. The control group was treated with traditional conventional acupuncture，while the observation group was treated with blood letting puncture and“Tongji”electroacupuncture for lumbar disc herniation. The changes of pain visual analogue score（VAS），Japanese Orthopaedic Association（JOA）score，bradykinin（BK），substance P（SP），Fas-FasL factor in peripheral venous blood，clinical efficacy，and serum inflammatory factor interleukin-6（IL-6），tumor necrosis factor-α（TNF-α），C-reactive protein（CRP）and Oswestry disability index（ODI）before and after treatment between the two groups were observed and compared. There was no obvious difference in the levels of SP，BK or Fas-FasL between two groups before treatment（P>0.05）. After 7 and 14 days of treatment，the levels of SPand BK in the serum of the observation group were obvious lower than those of the control group（P<0.05）. After 7 and 14 days of treatment，there was no obvious difference in Fas-FasL between two groups（P>0.05）. There was no obvious difference in VASbetween two groups before treatment（P>0.05）. After 7 and 14 days of treatment，the VASscore of the observation group was obvious lower than that of the control group（P<0.05）. There was no obvious difference in JOA between two groups before treatment（P>0.05）. After 7 and 14 days of treatment，the JOA score of the observation group was obvious higher than that of the control group（P<0.05）. The total effective rate of the observation group（97.92%，47/48）was higher than that of the control group（82.50%，33/40），and the difference was obvious（P<0.05）. The levels of IL-6 and TNF-αin two groups before treatment. There was no obvious difference in CRP（P>0.05）. The levels of IL-6，TNF-αand CRPof the observation group after treatment were significantly reduced compared to those of the control group（P<0.05）. There was no obvious difference in ODI between two groups before treatment（P>0.05）. After treatment，the ODI score of the observation group was obvious lower than that of the control group（P<0.05）.

Conclusion

Acupuncture and blood letting puncture combined with“Tongji”electroacupuncture significantly improved the patients'quality of life，increased the levels of BK and SP，reduced treatment cycles and significantly lowered the levels of inflammatory factors.

, authors=Weixuan TAN, Daifu YUAN, Yi CHEN, Jiaqi ZHOU-YANG, authorsList=Weixuan TAN, Daifu YUAN, Yi CHEN, Jiaqi ZHOU-YANG, authorCompany=null, correspAuthors=null, 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=1322922890898833894, articleId=1322922887623082453, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=刺络放血联合“通脊”电针治疗腰椎间盘突出症的临床研究, columnId=1256183369033965799, journalTitle=中华中医药学刊, columnName=省级项目平台, runingTitle=null, highlight=null, articleAbstract=
目的

探究刺络放血联合“通脊”电针治疗腰椎间盘突出症的临床研究。

方法

选取医院针灸科2022年1月—2023年1月收治的88例腰椎间盘突出症患者。根据治疗方法将患者分为观察组（48例）与对照组（40例），对照组使用传统的常规针刺治疗，观察组使用刺络放血联合“通脊”电针治疗。观察比较两组患者在疼痛视觉模拟评分（Visual analogue scale，VAS）、日本骨科学会（Japanese Orthopaedic Association，JOA）的评分、外周静脉血中缓激肽（Bradykinin，BK）、SP物质、Fas-FasL因子的含量变化、临床疗效和治疗前后血清炎症因子包括肿瘤坏死因子-α（Tumor necrosis factorα，TNF-α）、白细胞介素-6（Interleukin-6，IL-6）、C-反应蛋白（C-reactive protein，CRP）以及功能障碍指数（Oswestry disability index，ODI）。

结果

治疗前两组病人的SP、BK、Fas-FasL的含量差异无统计学意义（P>0.05）。在治疗7、14 d后，观察组血清中SP与BK的含量显著低于对照组（P<0.05）。而治疗7 d、14 d后，两组患者的Fas-FasL差异无统计学意义（P>0.05）。两组治疗前VAS差异无统计学意义（P>0.05）。在治疗7 d、14 d后，观察组的VAS评分显著低于对照组（P<0.05）。两组治疗前JOA差异无统计学意义（P>0.05）。在治疗7 d、14 d后，观察组的JOA评分显著高于对照组（P<0.05）。观察组的总有效率（97.92%，47/48）高于对照组（82.50%，33/40），差异有统计学意义（P<0.05）。IL-6、TNF-α、CRP的浓度水平方面，两组患者治疗前差异均无统计学意义（P>0.05）。治疗后观察组IL-6、TNF-α、CRP水平较对照组显著降低（P<0.05）。治疗前两组患者ODI差异无统计学意义（P>0.05）。治疗后观察组ODI评分显著低于对照组（P<0.05）。

结论

刺络放血联合“通脊”电针治疗显著改善了患者的生活质量、BK、SP含量得到提升，治疗周期减少，降低患者炎性因子水平效果显著。

, authors=谭维选, 袁代富, 陈艺, 周杨嘉琪, authorsList=谭维选, 袁代富, 陈艺, 周杨嘉琪, authorCompany=null, correspAuthors=null, authorNote=

谭维选（1990-），男（苗族），贵州湄潭人，副主任医师，硕士，研究方向：针灸推拿治疗神经系统疾病及脊柱相关性疾病。

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谭维选（1990-），男（苗族），贵州湄潭人，副主任医师，硕士，研究方向：针灸推拿治疗神经系统疾病及脊柱相关性疾病。

"}, bioImg=null, bioContent=

谭维选（1990-），男（苗族），贵州湄潭人，副主任医师，硕士，研究方向：针灸推拿治疗神经系统疾病及脊柱相关性疾病。

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figs=[ArticleFig(id=1322922895348990473, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922887623082453, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间SP/（μg·mL-1）BK/（μg·L-1）
观察组48治疗前203.53±12.4515.62±3.15
治疗7 d后142.58±10.7812.58±2.78
治疗14 d后120.34±9.378.34±1.82
对照组40治疗前200.87±11.6516.21±3.07
治疗7 d后167.64±9.4614.65±2.90
治疗14 d后145.51±8.9710.91±2.56
两组患者治疗t值11.4933.411
7 d后比较P值<0.05<0.05
两组患者治疗t值12.7925.489
14 d后比较P值<0.05<0.05
), ArticleFig(id=1322922895432876554, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922887623082453, language=CN, label=表1, caption=

两组腰椎间盘突出症患者治疗前与治疗7 d、14 d后血清中SP值、BK含量的比较（±s）

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组别例数时间SP/（μg·mL-1）BK/（μg·L-1）
观察组48治疗前203.53±12.4515.62±3.15
治疗7 d后142.58±10.7812.58±2.78
治疗14 d后120.34±9.378.34±1.82
对照组40治疗前200.87±11.6516.21±3.07
治疗7 d后167.64±9.4614.65±2.90
治疗14 d后145.51±8.9710.91±2.56
两组患者治疗t值11.4933.411
7 d后比较P值<0.05<0.05
两组患者治疗t值12.7925.489
14 d后比较P值<0.05<0.05
), ArticleFig(id=1322922895529345547, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922887623082453, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数FasFasL
治疗前治疗7 d后治疗14 d后治疗前治疗7 d后治疗14 d后
观察组4848.36±4.8951.65±5.0155.12±5.4248.65±4.7850.34±5.1251.65±5.34
对照组4047.65±4.9852.45±5.3254.37±6.1249.24±4.8150.45±5.2352.12±4.96
t值0.6720.7250.6090.5740.0990.424
P值>0.05>0.05>0.05>0.05>0.05>0.05
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两组腰椎间盘突出症患者治疗前与治疗7 d、14 d后血清中Fas-FasL的含量比较（±s）

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组别例数FasFasL
治疗前治疗7 d后治疗14 d后治疗前治疗7 d后治疗14 d后
观察组4848.36±4.8951.65±5.0155.12±5.4248.65±4.7850.34±5.1251.65±5.34
对照组4047.65±4.9852.45±5.3254.37±6.1249.24±4.8150.45±5.2352.12±4.96
t值0.6720.7250.6090.5740.0990.424
P值>0.05>0.05>0.05>0.05>0.05>0.05
), ArticleFig(id=1322922895726477837, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922887623082453, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数治疗前治疗7 d后治疗14 d后
观察组488.78±1.213.18±1.131.24±0.87
对照组408.86±1.344.14±1.262.86±0.98
t值0.2943.7658.211
P值>0.05<0.05<0.05
), ArticleFig(id=1322922895822946830, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922887623082453, language=CN, label=表3, caption=

两组腰椎间盘突出症患者治疗前及治疗7 d、14 d后VAS评分比较（±s）

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组别例数治疗前治疗7 d后治疗14 d后
观察组488.78±1.213.18±1.131.24±0.87
对照组408.86±1.344.14±1.262.86±0.98
t值0.2943.7658.211
P值>0.05<0.05<0.05
), ArticleFig(id=1322922895927804431, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922887623082453, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数治疗前治疗7 d后治疗14 d后
观察组488.64±1.3412.78±1.6419.28±2.15
对照组408.54±1.2210.29±1.4215.74±1.87
t值0.3627.5328.154
P值>0.05<0.05<0.05
), ArticleFig(id=1322922895990718992, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922887623082453, language=CN, label=表4, caption=

两组腰椎间盘突出症患者治疗前、治疗7 d后、14 d后JOA评分比较（±s）

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组别例数治疗前治疗7 d后治疗14 d后
观察组488.64±1.3412.78±1.6419.28±2.15
对照组408.54±1.2210.29±1.4215.74±1.87
t值0.3627.5328.154
P值>0.05<0.05<0.05
), ArticleFig(id=1322922896192045585, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922887623082453, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数显效有效无效总有效
观察组4824（50.00）23（47.92）1（2.08）47（97.92）
对照组4015（37.50）18（37.50）7（17.50）33（82.50）
χ2值---4.548
P值---0.033
), ArticleFig(id=1322922896271737362, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922887623082453, language=CN, label=表5, caption=

两组腰椎间盘突出症患者治疗14 d后的疗效比较

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组别例数显效有效无效总有效
观察组4824（50.00）23（47.92）1（2.08）47（97.92）
对照组4015（37.50）18（37.50）7（17.50）33（82.50）
χ2值---4.548
P值---0.033
), ArticleFig(id=1322922896355623443, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922887623082453, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数IL-6/（μg·L-1）TNF-α/（ng·L-1）CRP/（mg·L-1）
治疗前治疗后治疗前治疗后治疗前治疗后
观察组48125.15±8.1491.04±4.252.74±0.651.04±0.2122.52±3.578.65±2.48
对照组40123.56±8.18111.28±5.272.69±0.621.58±0.3823.01±3.4414.28±2.17
t值0.91019.9460.4678.4270.65111.216
P值>0.05<0.05>0.05<0.05>0.05<0.05
), ArticleFig(id=1322922896422732309, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922887623082453, language=CN, label=表6, caption=

两组腰椎间盘突出症患者治疗前后IL-6、TNF-α、CRP水平比较（±s）

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组别例数IL-6/（μg·L-1）TNF-α/（ng·L-1）CRP/（mg·L-1）
治疗前治疗后治疗前治疗后治疗前治疗后
观察组48125.15±8.1491.04±4.252.74±0.651.04±0.2122.52±3.578.65±2.48
对照组40123.56±8.18111.28±5.272.69±0.621.58±0.3823.01±3.4414.28±2.17
t值0.91019.9460.4678.4270.65111.216
P值>0.05<0.05>0.05<0.05>0.05<0.05
), ArticleFig(id=1322922896556950040, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922887623082453, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数治疗前治疗后
观察组4842.56±7.9813.16±6.42
对照组4042.02±7.9324.22±6.44
t值0.3168.035
P值>0.05<0.05
), ArticleFig(id=1322922896619864602, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922887623082453, language=CN, label=表7, caption=

两组腰椎间盘突出症患者治疗前后Oswestry腰椎功能评分比较（±s）

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组别例数治疗前治疗后
观察组4842.56±7.9813.16±6.42
对照组4042.02±7.9324.22±6.44
t值0.3168.035
P值>0.05<0.05
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刺络放血联合“通脊”电针治疗腰椎间盘突出症的临床研究
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谭维选 , 袁代富 , 陈艺 , 周杨嘉琪
中华中医药学刊 | 省级项目平台 2025,43(2): 220-224
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中华中医药学刊 |省级项目平台 2025 , 43 (2) : 220 -224
刺络放血联合“通脊”电针治疗腰椎间盘突出症的临床研究
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谭维选, 袁代富, 陈艺, 周杨嘉琪
作者信息
  • 遵义医科大学附属医院，贵州 遵义 563099
作者简介:

谭维选（1990-），男（苗族），贵州湄潭人，副主任医师，硕士，研究方向：针灸推拿治疗神经系统疾病及脊柱相关性疾病。

Clinical Study on Treatment of Lumbar Disc Herniation by Blood Letting Puncture and “Tongji” Electroacupuncture
Weixuan TAN, Daifu YUAN, Yi CHEN, Jiaqi ZHOU-YANG
Affiliations
  • Affiliated Hospital of Zunyi Medical University，Zunyi 563099，Guizhou，China
出版时间: 2025-02-10 doi: 10.13193/j.issn.1673-7717.2025.02.045
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摘要
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目的

探究刺络放血联合“通脊”电针治疗腰椎间盘突出症的临床研究。

方法

选取医院针灸科2022年1月—2023年1月收治的88例腰椎间盘突出症患者。根据治疗方法将患者分为观察组（48例）与对照组（40例），对照组使用传统的常规针刺治疗，观察组使用刺络放血联合“通脊”电针治疗。观察比较两组患者在疼痛视觉模拟评分（Visual analogue scale，VAS）、日本骨科学会（Japanese Orthopaedic Association，JOA）的评分、外周静脉血中缓激肽（Bradykinin，BK）、SP物质、Fas-FasL因子的含量变化、临床疗效和治疗前后血清炎症因子包括肿瘤坏死因子-α（Tumor necrosis factorα，TNF-α）、白细胞介素-6（Interleukin-6，IL-6）、C-反应蛋白（C-reactive protein，CRP）以及功能障碍指数（Oswestry disability index，ODI）。

结果

治疗前两组病人的SP、BK、Fas-FasL的含量差异无统计学意义（P>0.05）。在治疗7、14 d后，观察组血清中SP与BK的含量显著低于对照组（P<0.05）。而治疗7 d、14 d后，两组患者的Fas-FasL差异无统计学意义（P>0.05）。两组治疗前VAS差异无统计学意义（P>0.05）。在治疗7 d、14 d后，观察组的VAS评分显著低于对照组（P<0.05）。两组治疗前JOA差异无统计学意义（P>0.05）。在治疗7 d、14 d后，观察组的JOA评分显著高于对照组（P<0.05）。观察组的总有效率（97.92%，47/48）高于对照组（82.50%，33/40），差异有统计学意义（P<0.05）。IL-6、TNF-α、CRP的浓度水平方面，两组患者治疗前差异均无统计学意义（P>0.05）。治疗后观察组IL-6、TNF-α、CRP水平较对照组显著降低（P<0.05）。治疗前两组患者ODI差异无统计学意义（P>0.05）。治疗后观察组ODI评分显著低于对照组（P<0.05）。

结论

刺络放血联合“通脊”电针治疗显著改善了患者的生活质量、BK、SP含量得到提升，治疗周期减少，降低患者炎性因子水平效果显著。

刺络放血  /  通脊电针  /  腰椎间盘突出症  /  功能障碍指数  /  血清炎症因子
Objective

To explore the clinical study of blood letting puncture combined with“Tongji”electroacupuncture in the treatment of lumbar disc herniation.

Methods

From January 2022 to January 2023，88 patients with lumbar disc herniation were selected from the acupuncture and moxibustion department of the hospital. According to the treatment method，the patients were divided into an observation group（48 cases）and a control group（40 cases）. The control group was treated with traditional conventional acupuncture，while the observation group was treated with blood letting puncture and“Tongji”electroacupuncture for lumbar disc herniation. The changes of pain visual analogue score（VAS），Japanese Orthopaedic Association（JOA）score，bradykinin（BK），substance P（SP），Fas-FasL factor in peripheral venous blood，clinical efficacy，and serum inflammatory factor interleukin-6（IL-6），tumor necrosis factor-α（TNF-α），C-reactive protein（CRP）and Oswestry disability index（ODI）before and after treatment between the two groups were observed and compared. There was no obvious difference in the levels of SP，BK or Fas-FasL between two groups before treatment（P>0.05）. After 7 and 14 days of treatment，the levels of SPand BK in the serum of the observation group were obvious lower than those of the control group（P<0.05）. After 7 and 14 days of treatment，there was no obvious difference in Fas-FasL between two groups（P>0.05）. There was no obvious difference in VASbetween two groups before treatment（P>0.05）. After 7 and 14 days of treatment，the VASscore of the observation group was obvious lower than that of the control group（P<0.05）. There was no obvious difference in JOA between two groups before treatment（P>0.05）. After 7 and 14 days of treatment，the JOA score of the observation group was obvious higher than that of the control group（P<0.05）. The total effective rate of the observation group（97.92%，47/48）was higher than that of the control group（82.50%，33/40），and the difference was obvious（P<0.05）. The levels of IL-6 and TNF-αin two groups before treatment. There was no obvious difference in CRP（P>0.05）. The levels of IL-6，TNF-αand CRPof the observation group after treatment were significantly reduced compared to those of the control group（P<0.05）. There was no obvious difference in ODI between two groups before treatment（P>0.05）. After treatment，the ODI score of the observation group was obvious lower than that of the control group（P<0.05）.

Conclusion

Acupuncture and blood letting puncture combined with“Tongji”electroacupuncture significantly improved the patients'quality of life，increased the levels of BK and SP，reduced treatment cycles and significantly lowered the levels of inflammatory factors.

blood letting puncture  /  Tongji electroacupuncture  /  lumbar disc herniation  /  Oswestry disability Index  /  serum inflammatory factors
谭维选, 袁代富, 陈艺, 周杨嘉琪. 刺络放血联合“通脊”电针治疗腰椎间盘突出症的临床研究. 中华中医药学刊, 2025 , 43 (2) : 220 -224 . DOI: 10.13193/j.issn.1673-7717.2025.02.045
Weixuan TAN, Daifu YUAN, Yi CHEN, Jiaqi ZHOU-YANG. Clinical Study on Treatment of Lumbar Disc Herniation by Blood Letting Puncture and “Tongji” Electroacupuncture[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (2) : 220 -224 . DOI: 10.13193/j.issn.1673-7717.2025.02.045
正文
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腰椎间盘突出症（lumbar disc herniation，LDH）主要是腰椎间盘发生变性、纤维环破裂，髓核突出对神经产生压迫从而表现出疼痛的疾病[1]。在我们日常的生活中，腰腿疼痛最为常见的原因之一就有LDH。LDH主要和椎间盘的退变、损伤、遗传、发育异常等因素相关[2]。常用治疗方法可以分为手术与非手术治疗。大多数的患者可以得到有效地缓解治愈[3]。由于人们对手术的恐惧与预后担忧，大多数人选择保守治疗。传统的中医在保守治疗这方面有绝对的优势，针灸、刺络放血等是治疗LDH患者的有效方法[4]。本次研究使用刺络放血联合“通脊”电针观察并探讨对LDH患者的疗效。
1　资料与方法
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1.1　一般资料
挑选我院针灸科2022年1月—2023年1月治疗的腰椎间盘突出症患者88例。根据治疗方法将患者分为观察组（48例）与对照组（40例），对照组使用传统的常规针刺治疗，观察组使用刺络放血联合“通脊”电针治疗。观察组男女比例为30∶18；年龄30～60岁，平均（45.29±3.54）岁；病程1～15 d，平均（10.12±2.13）d。对照组男女比例为26∶14；年龄30～65岁，平均（50.23±2.54）岁；病程1～15 d，平均（10.23±1.89）d。一般资料差异无统计学意义（P>0.05）。本研究经本院医学伦理委员会批准。
1.2　诊断标准、纳入标准和排除标准
1.2.1　西医诊断标准
①符合《实用骨科学》[5]的相关诊断。②腰臀部或者下肢有放射痛，直腿抬高试验、挺腹试验阳性。③DR照片上显示脊柱的侧弯与腰椎生理前凸消失。
1.2.2　中医诊断标准
符合《中医骨病学》[6]关于气滞血瘀型腰痛病的诊断标准，主症：腰腿疼痛，白天轻晚上重、腰部坚硬、俯仰旋转受限，痛处拒按。次症：舌质黯，脉弦紧。满足以上2个以上主症和次症即可诊断为气滞血瘀型腰椎间盘突出症。
1.2.3　纳入标准
①患者及其家属知情同意。②符合腰椎间盘突出中西医诊断标准。
1.2.4　排除标准
①无下肢及坐骨神经放射痛的患者。②合并有严重的糖尿病、心脏病等疾病的患者。③患者具有精神病，无法正常沟通。④晕针患者。⑤椎间盘脱出或游离，或腰椎滑脱Ⅱ°及以上患者。⑥年龄在25岁以下及70岁以上者。⑦腰椎骨折、结核、脓肿或其他占位性病变。
1.3　治疗方法
对照组进行常规的针刺治疗，患者采取俯卧位暴露疼痛部位，进行常规消毒，针具：φ0.35 mm×75 mm贵州安迪牌一次性无菌针灸针。选取第一、二、四腰椎棘突下的穴位悬枢、命门、腰阳关，向上斜刺进针0.5～1寸。选取骶管裂孔处的腰俞向上斜刺0.5～1寸。取腰眼，第四腰椎棘突下，旁开3～4寸的凹陷中，直刺1～1.5寸。肾俞位于第二腰椎棘突下旁开1.5寸，直刺0.5～1寸。使用由汕头市医用设备有限公司生产的电针仪，使用疏密波，根据患者耐受度来调整波段，范围在15～100 Hz。强度在1～2 mA，1次持续治疗30 min。观察组取穴：在病变节段及病变椎体上下节段旁开1寸处，左右对称。每次选取2～3个穴位。操作手法：局部消毒后，用采血针在相应治疗部位快速疾刺10～15次，尽量捏起局部皮肤，以减轻患者疼痛。针具为荣飞牌一次性使用医用采血针，规格23 G，0.60 mm。刺络后用3号玻璃罐在刺络部位拔罐，留罐6 min后取罐。刺络后进行“通脊”电针治疗，取穴水平后正中线旁开1寸，在病变椎体的上下节段各取穴，左右对称。操作手法：夹脊透刺法：采取俯卧位，平补平泻法捻转斜刺入皮下1.0～1.5寸，针刺时尽量透刺至椎板，刺中神经干，针感沿相应脊神经分布区域放射；根据病人胖瘦和肌肉丰厚程度进行针刺；并将同侧L3、L5针柄处分别连接穴位神经刺激仪，疏密波，刺激频波为20/100 Hz，强度1～2 mA，持续30 min。针具：φ0.35 mm×75 mm贵州安迪牌一次性无菌针灸针。
两组患者一共治疗2个疗程，1个疗程为7 d，每周共治疗5 d，共治疗14 d。
1.4　观察指标
1.4.1　蛋白变化
在两组患者治疗前、治疗后7 d、治疗后14 d，分别抽取晨起两组患者10 mL静脉血，3000 r/min，留取血清，使用由上海酶联生物科技有限公司提供的免疫检测试剂盒检测血清中的SP物质、外周静脉血中缓激肽（Bradykinin，BK）、Fas-FasL蛋白（分为4级，I级色浅、颗粒稀疏；Ⅱ级：色黄棕、颗粒较细密；Ⅲ级：棕黄颗粒细密；Ⅳ级：色棕黑、颗粒密布）的含量变化。
1.4.2　视觉模拟疼痛评分
使用疼痛视觉模拟量表（Visual analogue scale，VAS）对两组患者治疗前及治疗后7 d、14 d的评分比较，满分为10分，0分为无痛，无任何症状，1～3分为轻度疼痛，4～6分为中度疼痛，7～10分为重度疼痛[5]。
1.4.3　日本骨科评定标准
使用日本骨科协会评估治疗分数（Japanese Orthopaedic Association，JOA）评分，观察比较两组治疗前、治疗后7 d、治疗后14 d的JOA评分，满分为29分，正常为2分，轻度为1分，受限为0分。分数与患者症状呈反相关。
1.4.4　临床有效率
两组患者治疗14 d后，评估两组患者的疗效，疗效分为3类，显效、有效、无效。总有效率＝（显效+有效）例数/总数×100%。
1.4.5　血清炎症因子
观察两组患者治疗前后肿瘤坏死因子-α（Tumor necrosis factor，TNF-α）、白介素-6（Interleukin-6，IL-6）、C-反应蛋白（C-reactive protein，CRP）水平变化。两组患者均采集治疗前与治疗后晨起空腹静脉血5 mL，使用上海精密仪器仪表公司提供的GL-25MS高速冷冻离心机，3000 r/min，离心15 min，留取血清，采用由上海酶联生物科技有限公司提供的IL-6、TNF-α、CRP（固相夹心法酶联吸附实验）检测试剂盒，检测IL-6与TNF-α、CRP水平。
1.4.6　Oswestry腰椎功能评分
采用Oswestry腰椎功能障碍指数（ODI）评分[6]。通过对生活能力、行走、站立、睡眠、提物等进行评估。ODI问卷表满分为50分，分值越高表明患者的功能障碍越严重。观察两组患者治疗前后ODI分数。
1.5　统计学方法
SPSS 23.0软件统计包予以相应的处理，以格式代表计量资料，两组间均数用独立样本t检验，治疗前后用配对t检验，用例格式代表计数资料，两组间用χ2检验，以P<0.05为差异有统计学意义。
2　结果
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2.1　治疗前、治疗7 d、14 d后的SP、BK、Fas-FasL的含量比较
治疗前两组患者的SP、BK、Fas-FasL的含量差异无统计学意义（P>0.05）。在治疗7 d、14 d后，观察组血清中SP与BK的含量显著高于对照组（P<0.05）。而治疗7 d、14 d后，两组患者的Fas-FasL差异无统计学意义（P>0.05）。见表1、表2。
2.2　使用VAS对治疗前及治疗7 d、14 d后的评分比较
两组治疗前VAS差异无统计学意义（P>0.05）。在治疗7 d、14 d后，观察组的VAS评分显著低于对照组（P<0.05）。见表3。
2.3　治疗前、治疗7 d后、14 d后的JOA评分比较
两组治疗前JOA差异无统计学意义（P>0.05）。在治疗7 d、14 d后，观察组的JOA评分显著高于对照组（P<0.05）。见表4。
2.4　治疗14 d后的疗效评估
总有效率方面，观察组（97.92%）较对照组（82.50%）高，差异有统计学意义（P<0.05）。见表5。
2.5　血清炎症因子比较
IL-6、TNF-α、CRP浓度水平方面，治疗前两组患者差异均无统计学意义（P>0.05）。治疗后观察组均较对照组降低（P<0.05）。见表6。
2.6　Oswestry腰椎功能评分
治疗前两组患者ODI差异无统计学意义（P>0.05）。治疗后观察组ODI评分显著低于对照组（P<0.05）。见表7。
3　讨论
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椎间盘突出症中，腰椎间盘突出症是最为常见的疾病之一[7]。据有关调查资料表明，腰椎间盘突出症占了90%左右。病患的年龄大多数在20～50岁，约占人数的80%，20岁以下的发病患者仅有6%[8]。且据统计500例腰腿痛的患者中，腰椎间盘突出症占18.6%。由于现在年轻人忙于工作，缺乏锻炼，LDH逐渐年轻化，且多见于男性，男女发病比例10∶1[9]。过于肥胖或者过于瘦弱的人容易导致腰椎间盘突出。长时间的工作或者是工作姿势不良的患者，长期弯腰的患者更容易导致腰椎间盘突出[10-12]。“通脊”电针运用夹脊穴（Ex-B2），亦称华佗夹脊穴，中医理论认为夹脊穴与督脉循行部位一致，电针夹脊穴可联络沟通督脉和足太阳膀胱经以扶助阳气，在治疗LDH方面有显著的效果。
LDH最先引发的症状为腰痛，而且是多见的症状，发生率为91%[13]。腰痛主要发病部位在下腰背部或腰骶部[14]。LDH患者L4-L5及L5-S1间隙发病，容易发生坐骨神经痛。坐骨神经痛是随着病情发展而逐渐发生的，初期为钝痛，随着病情的发展加重，呈现放射性的疼痛，从臀部、大腿后侧、小腿外侧再到跟部或足背[15]。
LDH在中医上属于“痹证”等范畴，病机大多是肾阳气不足、正气出现虚亏，或者是感受风寒湿邪，跌打损伤，导致腰腹的气滞血瘀，瘀血阻滞腰腹经络，致不通则痛[16]。中医在治疗腰椎间盘突出症这一疾病的方法多样，最常见的有针灸、正骨、拔罐等，并多嘱咐患者予以如热毛巾湿敷、打拳等锻炼辅助治疗。与西医相比，中医治疗具体的疗程差不多，但有效率方面更高、改善的效果更为明显、病情稳定，对机体无侵入性损伤、不良反应不大等优势，因此受到多数腰椎间盘突出症患者的青睐[17]。临床治疗中，虽然西医手术治疗很重要，但是属于对机体的侵入性治疗手段，患者伤口明显、复发风险较高，因此存在一定的风险，推荐将中医疗法作为首选治疗方案[18]。中医古籍中腰腿痛患者的症状体现为腰腿疼痛、活动不利、肌体麻木，腰痛患者多表现为肝肾两亏，风湿外邪入体，气血瘀堵，下肢疼痛。针对此证，中医多采取补气通经，疏肝补阳，利用刺络放血、“通脊”电针等方式活通经络，减轻患者痛苦[19]。其中刺络放血疗法是用针刺穴位或体表小静脉而放出少量血液的治疗方法，通过针刺放血将瘀滞的气血放出，由此经络可通畅，气可运行，血随气行，痛则可以消除[20]。针刺可以刺激神经及血管壁的感受器，引起血管的收缩、扩张改善血液的流变性、降低循环阻力。血液的流动可以改善血管局部病变的病灶，改善局部的微循环[21]。电针对穴位的刺激可以改变血液的循环、抑制炎症[22-23]。腰椎棘突下缘旁开0.3寸进行针刺，可刺激脊神经后内侧支浅支；0.5寸可缓解深层肌肉的痉挛状态；1寸可解除或减轻神经卡压状态[24]。本课题组前期研究发现，电针脊穴（后正中线旁开1寸、病变椎体上下节段处）可明显减轻腰痛。
机体受到创伤时，自身的生理机制遭到破坏，进而导致机体处于应激状态，并进一步引发炎症反应的发生，相关研究亦发现炎症因子水平升高被视为引起腰椎间盘突出症患者腰部疼痛的关键因素，当神经根受压时，局部供血障碍导致缺血缺氧，可引起炎症因子水平升高[25]。目前，临床常用来反映炎症水平的指标主要有IL-1、IL-6、TNF-α以及CRP等，其中IL-6是一种多效应的细胞因子，可刺激炎性细胞聚集、激活和炎性递质的释放，促进腰椎间盘退行性变的炎症过程；IL-1作为重要的炎性介质之一，在炎症介导和细胞免疫中发挥重要作用；CRP是一种因组织损伤后产生的反应蛋白，参与了多种病理反应；而TNF-α是导致椎间盘突出症的一个重要致炎因子，由吞噬细胞释放后，具有促进浸润而引起炎症和组织损伤，诱导神经痛觉过敏作用[26-27]。
SP是疼痛递质因子之一，能有效反映疼痛水平，疼痛程度与SP水平呈现正相关。Fas-FasL能引起细胞的凋亡、降低炎症因子水平。本试验中观察组SP、BK的含量均低于对照组，总有效率也高于对照组。刺络放血联合“通脊”电针治疗的患者VAS、JOA评分及治疗有效率均好于常规的针刺治疗，Oswestry功能障碍指数也低于对照组，同时也降低了LDH患者的炎症因子水平，使得疼痛递质因子水平降低，缓解患者疼痛。
综上所述，刺络放血联合“通脊”电针治疗腰椎间盘突出症患者有显著的疗效，能显著降低患者疼痛、提高患者生活水平，但本试验存在样本数量偏少等缺点，具体结果有待进一步探讨。
基金
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  • 贵州省科学技术厅项目(黔科合成果-LC〔2021〕033)
文献
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2025年第43卷第2期
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doi: 10.13193/j.issn.1673-7717.2025.02.045
  • 首发时间：2026-10-30
  • 出版时间：2025-02-10
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    遵义医科大学附属医院，贵州 遵义 563099
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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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