联合贞芪扶正胶囊治疗伴甲状腺功能减退型桥本病的疗效观察

发布时间：2018-04-12 18:08

本文选题：桥本病 + 贞芪扶正胶囊　；参考：《河北医科大学》2016年硕士论文

【摘要】：目的:桥本病是甲状腺炎中最常见的一种疾病,但是该病发病隐匿,并且早期临床症状不明显且无特异性。由于绝大多数患者的发病比较缓慢,常常以无症状性的甲状腺结节或肿块就诊,少数患者有憋气、呼吸不畅、乏力、颈部疼痛、颈部异样感。体检可见其甲状腺弥漫性肿大,或呈肿块分叶状,存在多个大小不等的结节,表面不平,质地偏硬。该病在血清学上主要依据的是甲状腺功能指标。因其在不同的阶段具有不同的甲状腺功能指示值,初期甲状腺功能可能是正常的,但是对于I-131的摄取率可能会轻度升高,而血清中游离三碘甲状腺氨酸(FT3),游离甲状腺素(FT4)会在正常值范围内。随着甲状腺摄碘率试验(RAIU)以及蛋白结合碘(PBI)的升高,甲状腺的储备功能也会降低,血清中的TSH会升高。从而表现为甲亢性桥本病患者的血清中游离三碘甲状腺氨酸(FT3),游离甲状腺素(FT4)升高,晚期最终会发展成为甲状腺功能减退,I-131的摄取率降低,基础代谢率也会降低,追究其原因,可能是由于甲状腺实质逐渐被淋巴细胞或是纤维组织取代。桥本病及其复杂的病理性过程使该病确诊有一定的难度,并且误诊率极高,更关键的是目前没有安全快捷有效的治疗方法,本研究拟对通过观察联合贞芪扶正胶囊治疗伴甲状腺功能减退型桥本病的疗效来探索该病的新型疗法的研究进行回顾性总结,进行以贞芪为主的中西医结合治疗桥本甲状腺炎的Meta分析,以便为该病的新型疗法提供有力证据。方法:将符合研究标准的甲减型桥本病患者60例随机平均分为两组,试验组和对照组,试验组给予左甲状腺素钠片联合贞芪扶正胶囊治疗,对照组采用常规单纯左甲状腺素钠给药治疗,通过观察患者血清中各种甲状腺激素水平(TSH,FT3,FT4)和相关抗体的水平(TPOAb,TGAb)以及临床症状的改善情况研究两种不同疗法的效果。对已有的研究结果进行检索汇总,并利用Meta分析的方法和SATAT软件(Version 13.0)及统计学的方法对中药联合西药治疗效果进行评估。结果:治疗结束后试验组和对照组的患者血清中游离三碘甲状腺氨酸(FT3),游离甲状腺素(FT4)水平差异具有统计学差异(P0.05);甲状腺过氧化物酶抗体(TPOAb),抗甲状腺球蛋白抗体(TGAb)水平差异也具有统计学差异(P0.05)。纳入标准的研究共计11个,试验组与对照组在用药有效率方面OR=1.35,95%CI(1.28~1.51),总体效应检验Z=7.90,P0.05,具有统计学意义。试验组与对照组在改善病人TGAb水平方面SMD=-1.25,95%CI(-1.42~-1.08),总体效应检验Z=14.10,P0.05,具有统计学意义,试验组与对照组在改善病人TPOAb方面SMD=-1.72,95%CI(-1.90~-1.54),总体效应检验Z=17.52,P0.05,具有统计学意义。结论:本研究表明联合贞芪扶正胶囊用于桥本病的治疗与单纯药物治疗相比,联合贞芪扶正胶囊改善桥本病临床症状效果更好,疗效更稳定,更能改善患者的生存质量。第二部分的Meta分析结果表明联合贞芪扶正胶囊用于桥本病的治疗与单纯应用西药左甲状腺素治疗相比,联合贞芪扶正胶囊改善桥本病临床症状效果更好。
[Abstract]:Objective: Hashimoto's disease is the most common disease in the disease's thyroiditis, but the incidence of occult, and early clinical symptoms was not obvious and nonspecific. Due to the incidence of most patients is relatively slow, often asymptomatic thyroid nodules or masses, few patients have shortness of breath, shortness of breath, fatigue the neck, neck pain, strange feeling. The physical examination revealed diffuse enlargement of the thyroid gland, or in the presence of multiple lobulated mass, nodules, uneven surface, hard texture. The disease is mainly based on the serological parameters of thyroid function. Because of the thyroid function in different stages of early indication, thyroid function may be normal, but the I-131 uptake rate may be slightly increased, while the serum free triiodothyronine three (FT3), free thyroxine (FT4) in the normal range with thyroid. Gland iodine uptake test (RAIU) and protein bound iodine (PBI) elevated thyroid function reserve will be reduced, serum TSH increased. Thus the performance of serum hyperthyroidism in patients with Hashimoto's disease free three triiodothyronine (FT3), free thyroxine (FT4) rise, late will eventually become hypothyroid, I-131 uptake, basal metabolic rate will be reduced, for the reason, may be due to thyroid parenchyma was gradually replaced with fibrous tissue or lymphocytes. The pathological process of Hashimoto's disease and complicated the disease diagnosis is difficult, and the misdiagnosis rate is high, but the key is that there is currently no effective treatment method is safe and efficient, were retrospectively summarized this research study model through the observation of combined therapy on the curative effect of Zhenqifuzheng capsule in the treatment of hypothyroidism type of Hashimoto's disease to explore the disease, Combined treatment of Hashimoto's thyroiditis Meta analysis to Zhenqi traditional Chinese and Western medicine, so as to provide evidence for the new treatment of the disease. Methods: according to the standard of bridge type hypothyroidism patients 60 cases were randomly divided into two groups, experimental group and control group. The experimental group was given combined with Zhenqifuzheng Levothyroxine Sodium Tablets capsule treatment, the control group using conventional pure levothyroxine sodium treatment, by observing the various levels of thyroid hormone in the serum of patients with (TSH, FT3, FT4) and the related antibody levels (TPOAb, TGAb) and the effect of the improvement of clinical symptoms in two different treatments. The existing research results of retrieval summary and using the method of Meta analysis and SATAT software (Version 13) methods and statistics to evaluate the therapeutic effect of traditional Chinese medicine combined with western medicine. Results: the patients in experimental group and control group after treatment. In the three free triiodothyronine (FT3), free thyroxine (FT4) levels had a significant difference (P0.05); thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TGAb) level difference was statistically difference (P0.05). The inclusion criteria of a total of 11, the experimental group and the control groups in terms of efficiency of OR=1.35,95%CI (1.28~1.51), the overall effect of test Z=7.90, P0.05, with statistical significance. The experimental group and the control group in improving the level of TGAb in patients with SMD=-1.25,95%CI (-1.42~-1.08), the overall effect of test Z=14.10, P0.05, have statistical significance, the experimental group and the control group in improving patients with TPOAb SMD=-1.72,95%CI (-1.90~-1.54). The overall effect of Z=17.52 test, P0.05, with statistical significance. Conclusion: This study showed that the combined Zhenqifuzheng capsule for the treatment of Hashimoto's disease and simple drug treatment compared with Zhenqi Fuzheng Capsule improve clinical symptoms of Hashimoto's disease curative effect, more stable, more can improve the quality of life in patients with Meta. The second part of the analysis results show that the combined Zhenqifuzheng capsule for the treatment of Hashimoto's disease and the simple application of Western medicine levothyroxine treatment compared with Zhenqifuzheng capsule can improve the clinical symptoms of Hashimoto's disease.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R581

【参考文献】