温肾阳法治疗甲减临床疗效观察

发布时间：2018-05-05 23:57

本文选题：甲状腺机能减退症 + 肾阳虚证　；参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:本研究将甲状腺机能减退症患者随机分为两组,分别给予治疗,观察两组患者中医症候积分及甲功、血脂的变化,评估温肾阳中药治疗甲状腺机能减退症的临床疗效,为临床应用温肾阳法治疗甲减提供依据。方法:本研究将84例甲状腺机能减退症患者随机分为两组,对照组42例予优甲乐口服治疗,治疗组42例在优甲乐治疗的基础上联合温肾阳中药(加减右归丸汤剂)口服,观察两组患者中医症候积分及甲功、血脂的变化,评估温肾阳中药治疗甲状腺机能减退症的临床疗效,为临床应用温肾阳法治疗甲减提供依据。成果:1.中医症候积分方面:经独立样本t检验,治疗前两组患者在中医症候积分方面的比较的差异无统计学意义。提示两组患者在中医症候方面的基线资料一致,具有可比性。经配对样本t检验,治疗后两组患者自身前后比较其中医症候积分方面的差异均具有统计学意义,提示两种治疗方法均可改善患者临床症状。经独立样本t检验,两组患者治疗前后症候积分差值的比较的差异有统计学意义(其中腰膝酸软、肢体浮肿、动则气促三个症状的积分差值的比较的差异无统计学意义,其余症状及总积分差值的比较的差异有统计学意义),提示温补肾阳中药配合小剂量优甲乐较单纯使用优甲乐治疗甲状腺机能减退症在改善中医症候方面效果更优。2.甲功方面:经独立样本t检验,治疗前两组患者在甲功方面的比较的差异无统计学意义。提示两组患者在甲功方面的基线资料一致,具有可比性。经配对样本t检验,治疗前后两组患者自身前后比较其甲功方面的差异均具有统计学意义,提示两种治疗方法均可改善患者的甲功水平。经独立样本t检验,治疗后两组患者甲功差值的比较的差异有统计学意义,提示温补肾阳中药配合小剂量优甲乐较单纯使用优甲乐治疗甲状腺机能减退症在改善甲功水平方面效果更优。3.血脂方面:经独立样本t检验,治疗前两组患者在血脂方面的比较的差异无统计学意义。提示两组患者在血脂方面的基线资料一致,具有可比性。经配对样本t检验,治疗前后两组患者自身前后比较其血脂方面的差异均具有统计学意义,提示两种治疗方法均可改善患者的血脂水平。经独立样本t检验,治疗后两组患者血脂差值的比较的差异有统计学意义(其中TG治疗后差值比较,P=0.2290.05,差异无统计学意义),提示温补肾阳中药配合小剂量优甲乐较单纯使用优甲乐治疗甲状腺机能减退症在改善血脂水平方面效果更优。4.治疗效果方面:治疗后,西药组42例患者中3例控制,8例显效,18例有效,13例无效,总有效率为69.05%;中西药结合组42例患者中7例控制,16例显效,16例有效,3例无效,总有效率为92.86%。经秩和检验,西药组与中西药结合组治疗后临床疗效比较的差异有统计学意义,提示温补肾阳中药配合小剂量优甲乐较单纯使用优甲乐治疗甲状腺机能减退症临床疗效更优。5.不良反应方面:经χ2检验,两组患者治疗后出现心悸、多汗、失眠、烦躁症状的人数的差异有统计学意义。提示温补肾阳中药配合小剂量优甲乐较单纯使用优甲乐治疗甲状腺机能减退症临床更少出现心悸、多汗、失眠、烦躁等不良反应,安全性更好。结论:单纯优甲乐治疗与温补肾阳中药联合小剂量优甲乐治疗均可改善患者临床肾阳亏虚的症状,改善甲功水平,使FT3、FT4水平升高,TSH水平下降,并可改善血脂水平。但温补肾阳中药配合小剂量优甲乐较单纯使用优甲乐治疗甲状腺机能减退症临床疗效更优,且患者更少出现心悸、多汗、失眠、烦躁等不良反应,安全性更可靠。
[Abstract]:Objective: This study randomly divided the patients with hypothyroidism into two groups, respectively, to give treatment, to observe the score of TCM syndrome and the change of blood lipid in the two groups, to evaluate the clinical efficacy of Wen Shen Yang in the treatment of hypothyroidism, and to provide the basis for clinical application of temperature and kidney yang to treat hypothyroidism. Methods: 84 cases of thyroidism were used in this study. The patients with adenosine hypogonadism were randomly divided into two groups. 42 cases in the control group were given orally in the treatment group, and 42 cases in the treatment group were combined with warm Kidney Yang traditional Chinese medicine (plus and subtract right return pill) on the basis of yorule therapy. The score of TCM syndrome and the change of blood lipid were observed in the two groups, and the clinical evaluation of Wen Shen Yang Chinese medicine for the treatment of hypothyroidism was evaluated. The curative effect, provide basis for clinical application of warm Kidney Yang method to treat hypothyroidism. Results: 1. TCM syndrome score: the difference of TCM syndrome score in the two groups of patients before treatment is not statistically significant. It suggests that the basis line data of TCM syndrome in the two groups of the two groups are consistent and comparable. By paired sample t examination. After treatment, the differences of TCM syndrome scores in the two groups were statistically significant, suggesting that the two methods could improve the clinical symptoms of the patients. The difference of the difference of symptom score between the two groups before and after the treatment of the two groups was significant (including the soft, swollen limbs, and movement of the waist and knees). There is no statistically significant difference in the difference of the score difference between the three symptoms of Qi, and the difference of the difference of the other symptoms and the difference of the total integral is statistically significant. Independent sample t test, there was no significant difference in the comparison between the two groups before treatment. It suggested that the baseline data of the two groups were consistent and comparable. The difference between the two groups of the two groups before and after the treatment was statistically significant, suggesting two therapeutic parties. The method can improve the level of thyroid function of the patients. After the independent sample t test, the difference of the difference between the two groups of patients after treatment is statistically significant. It is suggested that the effect of warming up kidney yang traditional Chinese medicine with small dose of yoruyle is better than that of thyroidism in the treatment of thyroidism in the improvement of the square surface of thyroidism.3. blood lipid: through independent sample This t test showed no significant difference in blood lipid comparison between the two groups before treatment. It was suggested that the baseline data of blood lipids in the two groups were consistent and comparable. The difference in blood lipids between the two groups before and after the treatment was statistically significant, suggesting that the two treatments were all available. The blood lipid level of the patients was improved. After the independent sample t test, the difference of blood lipid difference between the two groups was statistically significant (in which the difference of TG after treatment was compared, P=0.2290.05, the difference was not statistically significant). The effect of good blood lipid level was better.4. treatment: after treatment, 3 cases were controlled in 42 patients in the western medicine group, 8 cases were effective, 18 cases were effective, 13 cases were invalid, the total effective rate was 69.05%, 42 patients in the middle western medicine group 42 cases were controlled in 7, 16 cases were markedly effective, 16 cases were effective, 3 cases were ineffective, the total effective rate was the rank sum test, western medicine group and Chinese Western medicine combined with the combination. The difference of clinical curative effect after treatment was statistically significant. It was suggested that the clinical effect of warming up kidney yang traditional Chinese medicine and small dose of yorule in treating hypothyroidism was better than that in the treatment of hypothyroidism. The difference of the number of palpitations, hyperhidrosis, insomnia and irritability in the two groups after the treatment was 2. The conclusion: the combination of Dan Chunyou thyroidectomy with warm up kidney yang traditional Chinese medicine combined with small dose of traditional Chinese medicine can improve the clinical kidney of the patients. The symptoms of deficiency of Yang deficiency, improve the level of thyroid function, increase the level of FT3 and FT4, decrease the level of TSH, and improve the level of blood lipid. But the clinical effect of the Chinese medicine with kidney yang and the small dose of yorule is better than that of the simple use of yorule in the treatment of hypothyroidism, and the patients have less palpitations, perspiration, insomnia and irritability, and the safety is more safe. Rely on.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R581.2

【参考文献】