葛根汤配合夹脊穴针刺对慢性腰痛患者炎症因子和椎基底动脉血流动力学的影响OA

Objective To investigate the efficacy of Gegen Decoction combined with sagittal-plane needle insertion at the lumbar Jiaji points in the treatment of chronic low back pain(CLBP),and to evaluate its effects on serum pain-related markers,inflammatory factors,and vertebrobasilar hemodynamics.Methods A total of 135 patients with CLBP treated at the Affiliated Suzhou Hospital of Nanjing University Medical School from February 2021 to October 2024 were enrolled.According to treatment method,they were assigned to a treatment group(n=64)and a control group(n=71).Propensity score matching(PSM)was used for 1∶1 matching,and 116 patients were successfully matched,with 58 patients in each group.The control group received sagittal-plane needle insertion at the lumbar Jiaji points,while the treatment group received Gegen Decoction in addition to the same acupuncture intervention.Clinical efficacy,visual analog scale(VAS)score,Japanese Orthopaedic Association(JOA)low back pain score,Oswestry Disability Index(ODI),pain-related inflammatory factors(β-endorphin[β-EP],substance P[SP],interleukin-1β[IL-1β],interleukin-6[IL-6],tumor necrosis factor-α[TNF-α]),and systolic blood flow velocity of the vertebrobasilar arteries(basilar artery,left vertebral artery,and right vertebral artery)were compared between the two groups.Difference-in-differences models were used to analyze VAS,JOA,and ODI scores;repeated-measures analysis of variance was used for serum pain-related markers,inflammatory factors,and vertebrobasilar hemodynamics;generalized estimating equations(GEE)were applied to assess improvements in these parameters;and binary log-binomial regression was used to analyze the incidence of adverse reactions.Results The total effective rate was 91.38%(53/58)in the treatment group and 74.14%(43/58)in the control group;the treatment group had a significantly higher total effective rate than the control group(P<0.05).After 1,2,and 3 treatment courses,VAS and ODI scores in both groups were lower than before treatment(P<0.05),whereas JOA low back pain scores were higher than before treatment(P<0.05);pairwise comparisons at each time point showed statistically significant differences(P<0.05).After 1,2,and 3 treatment courses,VAS and ODI scores were lower in the treatment group than in the control group(P<0.05),while JOA low back pain scores were higher in the treatment group than in the control group(P<0.05).Difference-in-differences analysis showed statistically significant differences in VAS,JOA low back pain,and ODI scores for group,time,and group×time interaction effects(P<0.001).After 1,2,and 3 treatment courses,SP,IL-1β,IL-6,and TNF-α levels in both groups were lower than before treatment(P<0.05),whereas β-EP levels and systolic blood flow velocities of the basilar artery,left vertebral artery,and right vertebral artery were higher than before treatment(P<0.05);pairwise comparisons at each time point showed statistically significant differences(P<0.05).After 1,2,and 3 treatment courses,SP,IL-1β,IL-6,and TNF-α levels were significantly lower in the treatment group than in the control group,while β-EP levels and systolic blood flow velocities of the basilar artery,left vertebral artery,and right vertebral artery were significantly higher in the treatment group than in the control group(P<0.05).For both groups,significant time effects,between-group effects,and group×time interaction effects were observed for SP,IL-1β,IL-6,TNF-α,β-EP,and systolic blood flow velocities of the basilar artery,left vertebral artery,and right vertebral artery(P<0.05).GEE analysis showed that the effects of the treatment group on serum pain-related markers,inflammatory factors,and vertebrobasilar hemodynamics were statistically significant(P<0.05).There was a statistically significant difference in the total incidence of adverse reactions between the two groups(P<0.05).Compared with the control group,the treatment group had a reduced risk of adverse reactions(RR<1,P<0.05).Conclusion Gegen Decoction combined with sagittal-plane needle insertion at the lumbar Jiaji points can effectively improve clinical symptoms in patients with CLBP,reduce systemic inflammatory responses,promote normalization of vertebrobasilar hemodynamics,and has good safety.