桥本甲状腺炎自身抗体与甲功的相关性及与中医证型的关系

发布时间：2018-11-23 07:42

【摘要】：目的:分析桥本甲状腺炎(HT)患者的甲状腺微粒体抗体(TmAb)和甲状腺球蛋白抗体(TgAb)与甲状腺功能的相关性,并探讨桥本甲状腺炎(HT)与瘿病辨证分型的关系。方法:收集就诊于南京中医药大学第一附属医院内分泌科门诊符合要求的甲状腺肿大患者313例,按照中医瘿病辨证分型标准分为气郁痰阻型141例,肝火炽盛型62例,脾肾阳虚型110例,记录性别、年龄,检测血清TmAb、TgAb、TSH、FT_3、FT_4、TT_3、TT_4,B超检查甲状腺,按照西医诊断标准分为桥本甲状腺炎132例和非桥本甲状腺炎181例,研究HT患者自身抗体与甲状腺功能的相关性,并探讨桥本甲状腺炎与瘿病辨证分型的关系。结果:1.甲状腺肿大患者三组证型之间性别和年龄存在不同程度的差异性,其中,女性患病率:脾肾阳虚证气郁痰阻证肝火炽盛证,(P0.05)。脾肾阳虚证年龄为32.01±10.08岁,显著低于其他证型(P0.05);2.三组证型的HT患病率有显著性差异,脾肾阳虚证肝火炽盛证气郁痰阻证,(P0.05);3.HT患者年龄低于非HT,TSH高于非HT患者(均P0.05);HT女性患者的TSH、TmAb和TgAb与男性无显著差异,但FT3、FT4、TT3、TT4低于男性(P0.05);4.Pearson相关分析显示HT患者中,TmAb与TSH呈正相关(P0.05),与 FT4呈负相关(P0.05),TgAb 与 FT_3、FT_4、TT_4呈负相关(P0.05)。结论:1.桥本甲状腺炎患者以脾肾阳虚证最为常见,提示脾肾阳虚证与桥本甲状腺炎的发病关系密切。2.性别可作为HT患者甲功的影响因素之一,在初诊HT患者自身抗体无显著性差异时,女性的甲状腺功能较男性患者受损更显著。3.HT患者自身抗体与甲功存在密切关系,但两种抗体在甲状腺损伤过程中呈现不同作用特点。
[Abstract]:Objective: to analyze the relationship between thyroid microsomal antibody (TmAb) and thyroglobulin antibody (TgAb) and thyroid function in patients with Hashimoto's thyroiditis (HT), and to explore the relationship between (HT) and syndrome differentiation and classification of Hashimoto's thyroiditis. Methods: a total of 313 patients with goitre were collected from the Department of Endocrinology of the first affiliated Hospital of Nanjing University of traditional Chinese Medicine. According to the criteria of syndrome differentiation of gall disease, 141 cases were classified as qi depression and phlegm obstruction type, 62 cases as liver-fire type. One hundred and ten patients with deficiency of spleen and kidney yang were recorded by sex, age, and serum TmAb,TgAb,TSH,FT_3,FT_4,TT_3,TT_4, B ultrasound was used to examine thyroid gland. According to the diagnostic criteria of western medicine, 132 cases of Hashimoto's thyroiditis and 181 cases of non-Hashimoto 's thyroiditis were divided into two groups. The correlation between autoantibodies and thyroid function in patients with HT was studied, and the relationship between Hashimoto's thyroiditis and syndrome differentiation and classification of gall diseases was discussed. Results: 1. There were differences in sex and age among the three groups of patients with goitre, among which, the prevalence rate of female was: spleen and kidney yang deficiency syndrome qi stagnation phlegm stagnation syndrome liver fire flourishing syndrome (P0.05). The age of spleen and kidney yang deficiency syndrome was 32.01 卤10.08 years old, which was significantly lower than that of other syndrome types (P0.05). The prevalence of HT was significantly different among the three groups (P0.05), and the age of 3.HT patients was lower than that of non-HT patients (P0.05). There was no significant difference in TSH,TmAb and TgAb between female and male patients with HT, but FT3,FT4,TT3,TT4 was lower than that in male (P0.05). 4.Pearson correlation analysis showed that there was a positive correlation between TmAb and TSH (P0.05) and a negative correlation with FT4 (P0.05) between), TgAb and FT_3,FT_4,TT_4 in HT patients (P0.05). Conclusion: 1. The syndrome of deficiency of spleen and kidney yang is the most common in Hashimoto's thyroiditis, suggesting that deficiency of spleen and kidney yang is closely related to the pathogenesis of Hashimoto's thyroiditis. 2. Sex can be regarded as one of the influencing factors of thyroid function in patients with HT. When there is no significant difference in autoantibodies in newly diagnosed HT patients, the thyroid function of women is more significantly damaged than that of male patients. There is a close relationship between autoantibodies and thyroid function in patients with 3.HT. However, the two antibodies showed different characteristics in the process of thyroid injury.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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