课题背景：非单纯机械压迫作为腰椎间盘突出症的病因已经存在，化学炎性学说和自身免疫性学说为其发病机制提供更为全面的解释，也为非手术治疗提供了思路和依据。课题拟以此为依据探讨腰椎间盘突出症的免疫学机制和中药治则的作用机制。

应用要点：实验在腰椎间盘突出症患者腰腿痛与血清白细胞介素1β、肿瘤坏死因子α数值上成线性关系的理论基础上，拟探讨中药治则的免疫干预作用与途径。

同行评价：文章探讨了渗湿通络法治疗腰椎间盘突出症对患者血清细胞因子的干预效应，证实渗湿通络法能降低腰椎间盘突出症患者异常升高的血清白细胞介素1β、白细胞介素6、肿瘤坏死因子α的水平，对临床实践有指导意义。

摘要
目的：观察腰椎间盘突出症患者血清细胞因子应用渗湿通络法治疗后的变化。
方法：①对象：选择2005-02/12中国中医科学院望京医院收治的寒湿痹阻型腰椎间盘突出症患者43例，随机分成试验组22例和对照组21例，患者对治疗知情同意。另选择志愿参加试验的健康成年人30人为正常组。②干预：试验组患者给予渗湿通络法则下的薏苡仁汤加减（薏苡仁、杜仲、川断、木防己、威灵仙、鸡血藤、独活、牛膝、白芍等）口服，1剂/d，早晚分服，连服4周。对照组患者给予腰痛宁胶囊口服，4粒/次，1次/d，连服4周。③评估：于治疗前和4周治疗后分别应用放免法测定患者血清白细胞介素1β、白细胞介素6、肿瘤坏死因子α水平；采用目测类比评分法测定患者疼痛；根据日本整形外科学会（JOA）腰痛疾患疗效评定标准判定临床疗效。
结果：①43例患者血清白细胞介素１β、白细胞介素6、肿瘤坏死因子α较健康人有异常升高（P < 0.01）；治疗后试验组患者血清白细胞介素1β、肿瘤坏死因子α含量下降（P < 0.05、P < 0.01），对照组患者血清肿瘤坏死因子α含量下降（P < 0.05）。②试验组、对照组治疗前后症状体征积分、疼痛评分均有明显改善（P < 0.01），试验组治疗前后症状体征积分、疼痛评分差值均优于对照组（P < 0.05）。
结论：应用渗湿通络法治疗后患者血清中异常升高的白细胞介素1β、白细胞介素6、肿瘤坏死因子α水平降低，疼痛症状改善明显。
关键词：椎间盘移位；白细胞介素1β；白细胞介素6；肿瘤坏死因子α；中药疗法；组织构建

于杰，朱立国，高景华，王尚全.腰椎间盘突出症患者血清白细胞介素1β及白细胞介素６和肿瘤坏死因子α变化与渗湿通络法治疗的影响：随机对照[J].中国组织工程研究与临床康复，2008，12(7):1221-1224
[www.zglckf.com/zglckf/ejournal/upfiles/08-7/7k-1221(ps).pdf]

Changes in serum interleukin-1 beta, interleukin-6, and tumor necrosis factor alpha in patients with lumbar disc herniation after Shenshi Tongluo therapy: Randomized controlled study

Abstract

AIM：To observe the changes in serum cytokines in patients with lumbar disc herniation (LDH) following Shenshi Tongluo therapy (discharging damp and dredging collaterals).
METHODS：①Forty-three patients with LDH (cold-damp arthralgia type) were selected from Wangjing Hospital, China Academy of Chinese Medical Sciences from February to December 2005, and randomly divided into experimental group (n =22) and control group (n =21). The informed consent was obtained from all subjects. Meanwhile, 30 healthy volunteers were selected as controls. ②The patients in the experimental group orally took modified Semen Coicis decoction (Semen Coicis, eucommia bark, Radix dipsaci, cocculi, Chinese clematis root, caulis millettiae, angelica root, achyranthis, and paeoniae radix) according to Shenshi Tongluo therapy, one dose daily for 4 weeks. The patients in control group took Yaotong Ning capsule, 4 pills per day, once daily for 4 weeks. ③Contents of serum interleukin-1 β (IL-1β), IL-6, tumor necrosis factor-α (TNF-α) in patients were detected using radioimmunoassay before and after treatment. Clinical outcome was evaluated using visual analog scale (VAS) and assessment criteria for low lumbar pain of Japanese Orthopedic Association (JOA).
RESULTS：①Contents of serum IL-1β, IL-6, and TNF-α in patients were higher than healthy people (P < 0.01). Contents of IL-1β and TNF-α were decreased in patients after treatment (P < 0.05, P < 0.01). TNF-α content was decreased in control group (P < 0.05). ②The pain, ability, symptoms and sign of patients were improved significantly in both experimental group and control group after treatment (P < 0.01). The score differences of JOA and VAS in the experimental group were better than control group before and after treatment (P < 0.05).
CONCLUSION：Shenshi Tongluo therapy can reduce serum IL-1β, IL-6, and TNF-α contents and improve symptoms and signs in LDH patients.

Yu J, Zhu LG, Gao JH, Wang SQ.Changes in serum interleukin-1 beta, interleukin-6, and tumor necrosis factor alpha in patients with lumbar disc herniation after Shenshi Tongluo therapy: Randomized controlled study.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(7):1221-1224(China) [www.zglckf.com/zglckf/ejournal/upfiles/08-7/7k-1221(ps).pdf]