【目的】 探讨黄芪桂枝五物汤联合单唾液酸四己糖神经节苷脂（GM1）治疗脊髓损伤（SCI）患者的疗效及对神经突起因子 （Neuritin）、神经丝轻链蛋白（NFL）的影响。【方法】 采用回顾性研究方法，根据治疗方法的不同，将2022年2月至2024年5月陕 西省宝鸡市中医医院和陕西省宝鸡市人民医院收治的100例SCI患者分为对照组和研究组，每组各50例。对照组给予GM1联 合甲泼尼龙治疗，研究组给予GM1联合黄芪桂枝五物汤治疗，疗程为3周。观察2组患者治疗前后中医证候积分、脊髓损伤 程度美国脊髓损伤协会（ASIA）评分、肌张力和肌力评估[改良Ashworth痉挛量表（MASS）、徒手肌力测定（MMT）]、下肢运动 功能[功能性步行能力量表（FAC）、美国脊柱损伤协会的下肢运动子量表（LEMS）]评分及血清神经元特异性烯醇化酶（NSE）、 胶质纤维酸性蛋白（GFAP）、神经生长因子（NGF）、S100B蛋白（S100B）、Neuritin、NFL水平的变化情况，比较2组患者的临 床疗效和并发症发生率。【结果】（1）疗效方面，治疗3周后，研究组的总有效率为90.00%（45/50），对照组为74.00%（37/50）， 组间比较（χ2 检验），研究组的临床疗效明显优于对照组（P < 0.05）。（2）中医证候积分方面，治疗后，2组患者的肢体麻木、肢 体不遂、小便不利、大便不调、面色淡白、伤处肿痛、心悸自汗、气短乏力等中医证候积分均较治疗前降低（P < 0.05），且 研究组的降低幅度均明显优于对照组（P < 0.01）。（3）脊髓损伤程度方面，治疗后，2组患者脊髓损伤程度ASIA评分的运动功 能、触觉、痛觉评分均较治疗前升高（P < 0.05），且研究组的升高幅度均明显优于对照组（P < 0.01）。（4）肌张力和肌力方面， 治疗后，2组患者的MASS、MMT评分均较治疗前升高（P < 0.05），且研究组的升高幅度均明显优于对照组（P < 0.01）。（5）下 肢运动功能方面，治疗后，2组患者的FAC评分和LEMS评分均较治疗前升高（P < 0.05），且研究组的升高幅度均明显优于对 照组（P < 0.01）。（6）血清因子方面，治疗后，2组患者的血清 NSE、GFAP、NGF、S100B、Neuritin、NFL水平均较治疗前降 低（P < 0.05），且研究组的降低幅度均明显优于对照组（P < 0.01）。（7）并发症方面，研究组的并发症发生率为 6.00%（3/50）， 对照组为16.00（8/50），组间比较，差异无统计学意义（P > 0.05）。【结论】 黄芪桂枝五物汤联合GM1治疗脊髓损伤患者疗效显 著，可改善临床症状，减轻脊髓损伤程度，提高下肢运动功能，改善肌力、肌张力，其机制可能与改善Neuritin、NFL等血 清因子表达水平有关。

Objective To investigate the therapeutic efficacy of Huangqi Guizhi Wuwu Decoction combined with monosialotetrahexosyl ganglioside（GM1）in the treatment of spinal cord injury（SCI）and to observe its effect on neuritin and neurofilament light chain protein（NFL）. Methods A retrospective study was carried out in 100 cases of SCI patients. The patients admitted to Baoji Hospital of Traditional Chinese Medicine and Baoji People􀆳s Hospita from February 2022 to May 2024 were divided into a control group and a study group according to the treatment method，with 50 patients in each group. The control group was given GM1 combined with methylprednisolone， and the study group was given Huangqi Guizhi Wuwu Decoction combined with GM1. The course of treatment covered three weeks. Before and after the treatment，the two groups were observed in the changes of traditional Chinese medicine（TCM）syndrome scores，American Spinal Injury Association（ASIA）scores for evaluating the degree of spinal cord injury， Modified Ashworth Spasticity Scale（MASS）and Manual Muscle Testing（MMT） scores for assessing muscle tone and muscle strength，scores of Functional Ambulation Category Scale（FAC）and Lower-Extremity Motor Subscale（LEMS）of ASIA for assessing lower extremity motor function，and serum levels of neuron-specific enolase（NSE），glial fibrillary acidic protein（GFAP），nerve growth factor（NGF），S100B protein（S100B），Neuritin，and NFL. After treatment，the clinical efficacy and the incidence of complications in the two groups were compared. Results（1）After three weeks of treatment，the total effective rate of the study group was 90.00%（45 /50）and that of the control group was 74.00%（37 /50），and the intergroup comparison （tested by chi-square test）showed that the clinical efficacy of the study group was significantly superior to that of the control group（P < 0.05）.（2）After treatment， the two groups presented a decrease in the scores of TCM symptoms of limb numbness，limb paralysis，dysuria，irregular defecation，pale complexion，swelling and pain at injured spot，palpitation and spontaneous sweating，and shortness of breath and fatigue when compared with those before treatment（P < 0.05），and the decrease of the scores in the study group was significantly superior to that in the control group（P < 0.01）.（3）After treatment，the evaluation of ASIA scores for the degree of spinal cord injury showed that the motor function，tactile and pain scores in the two group were increased compared with those before treatment（P < 0.05），and the increase in the study group was significantly superior to that in the control group（P < 0.01）.（4）After treatment， MASS and MMT scores for assessing muscle tone and muscle strength in the two groups were increased compared with those before treatment（P < 0.05），and the increase in the study group was significantly superior to that in the control group（P < 0.01）.（5）After treatment，the FAC score and LEMS scores for assessing lower extremity motor function in the two groups were increased compared with those before treatment（P < 0.05），and the increase in the study group was significantly superior to that in the control group（P < 0.01）.（6）After treatment，the serum levels of NSE，GFAP，NGF，S100B，Neuritin，and NFL in the two groups were decreased compared with those before treatment（P < 0.05），and the decrease in the study group was significantly superior to that in the control group（P < 0.01）.（7）The incidence of complications in the study group was 6.00%（3/50），and that in the control group was 16.00（8/50），the comparison between the two groups showed that the difference was not statistically significant（P > 0.05）. Conclusion Huangqi Guizhi Wuwu Decoction combined with GM1 exerts remarkable efficacy in treating patients with SCI，and is effective on relieving clinical symptoms， reducing the degree of spinal cord injury， enhancing the motor function of the lower extremitiess， and improving the muscle strength and tone. Its therapeutic mechanism may be related to the improvement of the expression level of serum factors such as Neuritin and NFL.

R274.9

：国家自然科学基金资助项目（编号：81960234）