黄芪桂枝五物汤联合西药治疗神经根型颈椎病(气虚血瘀证)的临床观察

Clinical Observation of Huangqi Guizhi Wuwu Decoction Combined with Western Medicine in Treating Cervical Spondylotic Radiculopathy (Qi Deficiency and Blood Stasis Syndrome)

摘要: 目的：观察黄芪桂枝五物汤联合塞来昔布与甲钴胺片治疗气虚血瘀型神经根型颈椎病的临床疗效及安全性。方法：采用随机对照试验设计，将120例患者按1:1比例分为治疗组与对照组，每组60例。对照组给予塞来昔布胶囊联合甲钴胺片口服，治疗组在对照组的基础上加服黄芪桂枝五物汤，疗程均为4周。观察两组患者治疗前后视觉模拟量表(VAS)评分、颈椎功能障碍指数(NDI)评分，以及血清白细胞介素-6 (IL-6)、肿瘤坏死因子-α (TNF-α)水平的变化，评估临床总有效率及不良反应发生率。结果：治疗后，两组患者的VAS、NDI评分及血清IL-6、TNF-α水平均较治疗前显著下降(p < 0.05)。治疗组在VAS评分(1.82 ± 0.71 vs 2.95 ± 0.88)、NDI评分(11.34 ± 3.05 vs 16.78 ± 4.21)及IL-6、TNF-α水平下降幅度方面均显著优于对照组(p < 0.05)。治疗组总有效率为95.0% (57/60)，显著高于对照组的81.7% (49/60) (p < 0.05)。两组不良反应发生率无统计学差异(p > 0.05)。结论：黄芪桂枝五物汤联合塞来昔布与甲钴胺片治疗气虚血瘀型神经根型颈椎病疗效确切，可显著缓解疼痛、改善功能、减轻炎症反应，疗效优于单纯西药治疗，且安全性良好。

Abstract: Objective: To observe the clinical efficacy and safety of Huangqi Guizhi Wuwu Decoction combined with celecoxib and mecobalamin in the treatment of cervical spondylotic radiculopathy (CSR) with qi deficiency and blood stasis syndrome. Methods: In a randomized controlled trial, 120 patients were divided into a treatment group and a control group in a 1:1 ratio, with 60 cases in each group. The control group received oral celecoxib capsules and mecobalamin tablets, while the treatment group received additional Huangqi Guizhi Wuwu Decoction on top of the control group’s treatment. The treatment course for both groups was 4 weeks. Changes in Visual Analogue Scale (VAS) score, Neck Disability Index (NDI) score, and serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were observed before and after treatment. The total clinical effective rate and incidence of adverse reactions were evaluated. Results: After treatment, VAS, NDI scores, and serum IL-6, TNF-α levels significantly decreased in both groups compared to before treatment (p < 0.05). The treatment group showed significantly greater improvements in VAS score (1.82 ± 0.71 vs 2.95 ± 0.88), NDI score (11.34 ± 3.05 vs 16.78 ± 4.21), and reductions in IL-6 and TNF-α levels compared to the control group (p < 0.05). The total effective rate was 95.0% (57/60) in the treatment group, significantly higher than 81.7% (49/60) in the control group (p < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (p > 0.05). Conclusion: The combination of Huangqi Guizhi Wuwu Decoction with celecoxib and mecobalamin is effective in treating CSR with qi deficiency and blood stasis syndrome. It can significantly relieve pain, improve function, and reduce inflammatory responses, with superior efficacy and good safety compared to Western medicine alone.