世界中医药

作者	单位
李德魁1，许筱颖2，李鹏洋1，钱博1，张花2，康晓乐1	1 北京中医药大学东直门医院，北京，100007； 2 北京中医药大学，北京，100029

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目的：研究腰椎间盘突出症（肝肾亏虚型）患者的症状体征积分特点、Pfirrmann分级的特点及探讨二者之间的相关性，为中医辨证施治提供客观的量化方式，并为中西医结合治疗提供临床参考。方法：选取2016年11月至2017年12月东直门医院门诊或病房诊治的腰椎间盘突出症患者50例作为研究对象，根据诊断标准将主次症的临床严重程度分别赋予分值，制定症状体征的积分量表，根据患者椎间盘退变的Pfirrmann分级进行分析，通过SPSS 20.0对收集的数据进行处理，观察该型腰椎间盘突出症的症状体征积分特点、各影像学指标特点即探讨两者之间的相关性。结果：1）50例患者症状体征积分总积分范围为8～23分，平均范围（15.04±3.76）分；各主症积分与总积分之间存在相关性，且主症2较主症1相关性高，其代表的意义更大，而次症与总积分无明显相关性。2）50例患者中的偏阳型平均积分（14.79±3.64）分，偏阴型平均积分（15.56±4.01）分，其与症状体征总积分之间无明显相关性。3）经统计，收集的50例患者根据椎间盘退变的Pfirrmann等级分级统计后得出，Ⅰ级为3例，占6%；Ⅱ级为1例，占2%；Ⅲ级为29例，占58%；Ⅳ级为15例，占30%；Ⅴ级为2例，占4%。4）症状体征积分与影像学表现上椎间盘的退变程度具有相关性。结论：1）肝肾亏虚型腰椎间盘突出症患者的有较典型的症状体征表现，且主症中腰部酸痛及下肢放射痛症状临床最为典型，而下肢放射痛更具代表性。下肢麻木、腿膝乏力作为诊断该证型的参考，但腿膝乏力的诊断价值要高于下肢麻木。2）肝肾亏虚型腰椎间盘突出症患者中阴阳分型与症状体征总积分之间无明显相关性，对其临床症状体征的严重程度影响不大。3）肝肾亏虚型腰椎间盘突出症患者的症状体征积分与影像学表现上的椎间盘的退变程度具有一定的相关性，椎间盘退变越重时，其临床表现的症状体征积分越高。

English Summary:

To study the characteristics of the Pfirrmann classification of patients with lumbar disc herniation (liver-kidney deficiency syndrome) and to explore the correlation between the two characteristics，so as to provide an objective quantitative method for TCM syndrome differentiation and treatment，and provide a clinical reference for integrative medicine therapy.Methods:A total of 50 patients with lumbar disc herniation in our hospital from November 2016 to December 2017 were selected.The clinical severity of the primary and secondary symptoms was assigned to the scores according to the diagnostic criteria.An integral scale of the symptoms and signs was established.According to the Pfirrmann grading of the patient's intervertebral disc degeneration，the collected data were processed by SPSS 20.0.The characteristics of the symptoms and signs of the lumbar disc herniation and the characteristics of each imaging index were discussed.Results:1）The total scores of symptoms and signs in 50 patients ranged from 8 to 23 points，about 15.04±3.76 points on average.There was a correlation between the scores of each main symptom and the total score，and the second main symptom was higher than that of the first main symptom.The significance of the representative was greater，and there was no obvious correlation between the secondary disease and the total score.2）In the 50 patients，the mean score of the partial yang syndrome was 14.79±3.64，and the mean score of the partial yin syndrome was 15.56±4.01.There was no significant correlation between the positive scores and the total scores of symptoms and signs.3）According to Pfirrmann grade grading statistics of intervertebral disc degeneration，grade I had 3 cases，accounting for 6%.Grade II had 1 case，accounting for 2%.Grade III had 29 cases，accounting for 58%.Grade IV had 15 cases，accounting for 30%.Grade V had 2 cases，accounting for 4%.4）Symptoms and signs were correlated with the degree of herniation，the position of herniation，and intervertebral disc degeneration on radiographic findings，and were not significantly correlated with lumbar curvature and endplate degeneration.Conclusion:1）Patients with liver-kidney deficiency syndrome of LDH have typical symptoms and signs，and the symptoms of lumbar pain and lower extremity radiating pain are the most typical in the main symptoms，and the lower limb radiating pain is more representative.Lower extremity numbness and weakness in the legs and knees were used as a reference in diagnosing the syndrome，but the diagnostic value of leg and knee fatigue was higher than that of lower limb numbness.2）There was no significant correlation between yin and yang classification and the total score of symptoms and signs in patients with liver-kidney deficiency syndrome LDH，and the severity of their clinical symptoms and signs was not significant.3）There is a certain correlation between the scores of symptoms and signs of patients with hepatic-renal deficiency syndrome lumbar disc herniation and the degree of degeneration of intervertebral discs on imaging findings.The disc degeneration is more severe，the scores of clinical symptoms and physical signs are higher.

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