Effect Of Paravertebral Injection Of Zhengqing Fengtongning On Acute Phase Of LDH And Its Effect On Serum TLR4 And NF-κB P65 MRN

Background and Objective:Lumber disc herniation（LDH）is a common clinical syndrome with an increasing incidence and a trend towards the younger age,which seriously affects people’s healthy life.In this study,to observe the efficacy and safety of Zhengqing Fengtongning paravertebral injection in the treatment of acute LDH patients,and preliminatively discover its mechanism.Methods:40 patients with acute LDH stage were enrolled according to the diagnostic criteria by self-controlled test,all of whom were from the orthopedics and traumatology outpatient Department of Hunan Hospital of Integrated Traditional Chinese and Western Medicine,and signed informed consent.In addition to basic health education,all included patients were given lumbar paravertebral injection of Zhengqing Fengtongning injection,once 2 days,10 days as a course of treatment for 2 consecutive courses.Four treatment observation time points were set,namely before treatment,during treatment（after the first course of treatment）,after treatment（after the second course of treatment）,and during follow-up（1 month after the course of treatment）.The therapeutic effect was analyzed and evaluated according to the VAS score and ODI score of the treated patients.At the same time,ELISA was used to detect the expression levels of serum IL-1β,IL-6 and TNF-αbefore and after treatment,and RT-q PCR was used to detect the m RNA expression levels of serum p65 and TLR4.The differences before and after treatment were compared and summarized.Results:（1）General data:there were 19 males and 21 females,with an average age of52.23±16.65 years and an average course of disease of 3.90±2.10.The onset stages were mainly L4/5 and L5/S1.（2）Comparison of VAS scores at different time points,repeated measure analysis of variance showed that VAS scores at different time points were different（F=322.35,P<0.001）,and VAS scores were lower during and after treatment than before treatment（P<0.05）.There was no statistical significance at 1 month follow-up compared with after treatment（P>0.05）.（3）Comparison of ODI scores at different time points,repeated measure analysis of variance showed that VAS scores at different time points were different（F=251.46,P<0.001）,and ODI scores were lower during and after treatment than before treatment（P<0.05）,and there was no statistical significance at one month follow-up compared with after treatment（P>0.05）.（4）Serum levels of IL-1β,IL-6 and TNF-αwere significantly decreased before and after treatment（t₁=3.591,t₂=3.179,t₃=6.652,P<0.05）,and the difference was statistically significant.（5）m RNA expression levels of serum p65 and TLR4 were significantly decreased before and after treatment（t₁=5.682,t₂=6.684,P<0.05）,and the differences were statistically significant.（6）In the observation group,the total effective rate was 87.5%,and the incidence of total adverse events was 20%,including skin rash and pruritus 15%,dizziness and headache 2.5%,dry throat and cough 2.5%,respectively.All adverse events could be resolved by themselves within 1 hour after injection.Conclusions:（1）Zhengqing Fengtongning paravertebral injection in the treatment of acute stage of lumbar disc herniation has a definite effect,which can reduce the patients’back and leg pain as soon as possible,improve the patients’lumbar function to a large extent,improve life treatment,and has good short-term safety,worthy of clinical application.（2）Through the detection of objective indicators,this study also reached a preliminary conclusion on the treatment mechanism,and Zhengqing Fengtening lumbar side injection may be related to the inhibition of TLR4/NF-κB signaling pathway mediated inflammatory response.