Effect Clinical Efficacy Of Modified Qinggusan In The Treatment Of Thoracolumbar Tuberculosis With Yin Deficiency And Internal Heat And Its Effect On T Lymphocyte Subsets

Objective:To observe the clinical efficacy and safety of Jiawei Qinggusan combined with one-stage focal debridement in the treatment of thoracolumbar tuberculosis of Yin deficiency and internal heat type,to observe the improvement of TCM syndromes,to alleviate pain,to alleviate inflammatory reaction,to reduce side effects of chemotherapy,and to influence the level of T lymphocyte subsets.The purpose of this study is to explore the relevant mechanisms of TCM in the clinical prevention and treatment of spinal tuberculosis,and to explore the practical application value and advantages of TCM in order to provide a theoretical basis for clinical promotion and use.Methods:Seventy-two patients with thoracolumbar tuberculosis were selected from the Department of Spinal Orthopedics,Gansu Hospital of Traditional Chinese Medicine from September 2016 to September 2018.The patients included in the study had definite surgical indications.According to the syndrome differentiation of TCM,they belonged to Yin deficiency and internal heat type.They were divided into two groups,observation group and control group,with 36 patients in each group.All patients were treated with one-stage focal debridement on the basis of standardized anti-tuberculosis chemotherapy,and the chemotherapy regimen was adjusted according to the drug sensitivity results after operation.The control group was treated with anti-tuberculosis drug chemotherapy alone.The observation group began to intervene on the 2nd day after operation.On the basis of chemotherapy,the two groups were treated with traditional Chinese medicine decoction Jiawei Qinggusan.The treatment course lasted for 5 days,and the second course was taken at2 days interval.After 4 courses of treatment,the clinical effects of the two groups were compared and analyzed.Observe and record the changes of TCM symptom scores before and after 4 weeks,and compare the curative effect of TCM syndromes between the two groups;compare the changes of visual analogue score?VAS?before and after 3 days,2 weeks and 4weeks;compare the changes of erythrocyte sedimentation rate?ESR?and C-reactive protein?CRP?inflammation index before and after 4 weeks.The changes of T lymphocyte subsets immune function?CD3+,CD4+,CD4+/CD8+?in peripheral blood at 4 weeks after operation were compared between the two groups,and the incidence of adverse drug reactions was analyzed by SPSS 19.0 software.Result:?1?There was no significant difference between the two groups in general baseline data such as gender,average age,average course of disease,ethnic distribution,distribution of lesions invading vertebral body,ASIA classification of spinal nerve function,scores of TCM symptoms,operative approach,intraoperative blood loss,operative time and postoperative drainage flow?P>0.05?.?2?TCM symptom integral and TCM syndrome curative effect:TCM symptom integral of patients in two groups decreased after treatment and before treatment,but after treatment,TCM symptom integral of observation group had significant difference compared with control group?P<0.05?.After 4 weeks of treatment,the curative effect of TCM symptoms was compared between the two groups.In the control group,19 cases were cured,10 cases were markedly effective,5 cases were effective and 2 cases were ineffective.The total effective rate was 94.44%.Observation group:5 cases were cured clinically,9 cases were markedly effective,10 cases were effective,12 cases were ineffective,the total effective rate was66.67%?P<0.05?.The clinical control rates of TCM syndromes in the control group and the observation group were 38.89%and 80.56%,respectively.There was significant difference between the two groups?P<0.05?.?3?Pain Visual Analogue Score?VAS score?:The VAS scores of the two groups were significantly lower than those of the control group after repeated measurements of variance analysis.With the prolongation of treatment time,the decrease of VAS score in the observation group was more significant than that in the control group?P<0.05?;there was no significant difference in VAS score between the two groups after 3 days?P>0.05?;and there was no significant difference in VAS score between the two groups after 2 weeks and 4 weeks?P>0.05?.There was significant difference in VAS score between the observation group and the control group?P<0.05?.?4?ESR and CRP:The mean ESR and CRP of the two groups before operation were analyzed by paired sample t test,respectively.There was no significant difference(T_ESR=-0.792,P=0.434>0.05;T_CRP=-1.047,P=0.302),which was comparable;ESR and CRP were analyzed by paired Wilcoxon rank and test between the two groups 4 weeks after operation,and the observation group was significantly better than the control group.There were significant statistical differences(Z _ESR=-2.038,P=0.042<0.05;Z_CRP=-2.311,P=0.021<0.05).?5?Immune function indices of T lymphocyte subsets?CD3+,CD4+,CD4+/CD8+?:one test before operation and four weeks after operation.Wilcoxon rank sum test was used to measure the preoperative values.There was no significant difference between the two groups?P>0.05?and there was comparability.Four weeks after operation,there was no statistical difference between the two groups before and after intervention,and CD8+,relatively dry in the control group.In the observation group,CD4+,CD8+,CD4+/CD8+and the control group,CD4+,CD4+/CD8+had significant regulatory effect?P<0.05?,and the regulation of the observation group was significantly better than that of the control group,with significant statistical difference?P<0.05?.?6?Incidence of adverse reactions?safety indicators?:In the course of drug adverse reactions,9 cases?25.0%?in the control group and 2 cases?5.56%?in the observation group.There were 4 cases of ALT elevation,3 cases in the control group and 1 case in the observation group.In the control group,there were 1 case of drug allergic skin papules,4cases of gastrointestinal reaction,1 case in the observation group and 5 cases in the control group.There was no renal impairment or tinnitus hearing loss in both groups.There was significant difference in adverse drug reactions between the two groups?X²=5.258,P=0.022<0.05?.After adjusting the chemotherapy regimen and symptomatic treatment of protecting liver and stomach,all patients recovered gradually.Conclusion:72 patients with thoracolumbar tuberculosis of Yin deficiency and internal heat type were treated with individualized and standardized anti-tuberculosis according to drug sensitivity results after primary focus clearance.36 patients in the observation group were treated with Jiawei Qinggu Powder,which could further relieve the integral of internal heat symptoms of Yin deficiency and improve anxiety of patients after operation.