桥本一过性甲状腺毒症的临床研究

发布时间：2018-06-21 02:24

本文选题：桥本一过性甲状腺毒症 + 桥本甲亢　；参考：《湖北中医药大学》2017年硕士论文

【摘要】：目的:本研究采用回顾性分析方法,选取经临床确诊为桥本一过性甲状腺毒症病例、桥本甲亢病例各32例为研究对象,比较桥本一过性甲状腺毒症与桥本甲亢在发病特点、临床症状、体征以及实验室检查等方面的异同,并分析使用复方消瘿甲亢片、复方甲亢片治疗桥本一过性甲状腺毒症的特点,对本病的临床识别和处理进行初步探讨,以期为桥本一过性甲状腺毒症的诊治提供新的认识。方法:收集湖北省中医院甲状腺专科门诊收治的经临床确诊为桥本一过性甲状腺毒症的患者32例(A组),确诊为桥本甲亢的患者32例(B组)。分别统计A、B两组患者在发病年龄、性别,临床症状,甲状腺肿大程度、质地,血清FT3、FT4、TSH、FT3/FT4、TGAb、TPOAb、TRAb测定结果及合并症的异同。分析使用复方消瘿甲亢片、复方甲亢片治疗前后各时间点典型临床症状及实验室指标的差异,并进行统计学分析。结果:1.两组发病年龄均集中在18-50岁之间,且均以女性占比更高,两组年龄、性别比率无统计学差异(P0.05)。2.桥本一过性毒症组在中医证候积分、心率水平均较桥本甲亢组低(P0.05),说明桥本一过性毒症发病时临床症状较轻。3.两组间甲状腺肿大各分度所占比例有统计学差异(P0.05),桥本一过性毒症组以Ⅰ°肿大及以内占比最多。4.两组间甲状腺不同质地所占比例差异无统计学意义(P0.05),均以质地中或质地韧占比为多。5.血清FT3升高各幅度所占比例在两组间差异有显著统计学意义(P0.01),FT4升高各幅度所占比例在两组间差异有统计学意义(P0.05)。桥本一过性毒症组以FT3、FT4轻度升高者最为多见。TSH水平比较差异无统计学意义(P0.05)。桥本一过性毒症组FT3/FT4值低于桥本甲亢组,差异有统计学意义(P0.05)。6.两组间TGAb、TPOAb阴性、阳性、强阳性率比较差异均有显著统计学意义(P0.01),且桥本一过性毒症组两抗体阳性水平较桥本甲亢更低。单、双抗体强阳性率比较差异无统计学意义(P0.05)。7.桥本一过性毒症组TRAb阴性率显著高于桥本甲亢组(96.9%),差异有显著统计学意义(P0.01)。8.桥本一过性毒症组无合并症比例更大(75.0%),差异有显著统计学意义(P0.01)。9.桥本一过性甲状腺毒症组的甲亢(亚甲亢)病程以1-3月占比最高(65.6%),在6月内恢复的比例均显著高于桥本甲亢组,差异有显著统计学意义(P0.01)。10.复方消瘿甲亢片、复方甲亢片治疗本病前后各时间点中医证候积分、各实验室指标整体差异均有统计学意义(P0.05),疗效随着治疗时间而稳步增加。11.桥本一过性甲状腺毒症组治疗后甲功恢复更快,一般可在1个疗程内恢复,2个疗程内病情稳定。经2个疗程的巩固治疗后两组治愈率均明显高于1个疗程者。结论:1.桥本一过性甲状腺毒症一般为青、中年发病,女性比例较男性大。2.桥本一过性甲状腺毒症患者的临床典型甲亢症状、体征均较轻。甲状腺肿大程度对本病鉴别诊断有意义,一般表现为甲肿Ⅰ°及以内。甲状腺质地对本病与桥本甲亢鉴别无意义,甲状腺质地中或质地韧仅作为识别的参考依据。3.桥本一过性甲状腺毒症的甲状腺功能,以FT3、FT4轻度升高,FT3/FT4比值较低为特点,且存在FT3、FT4正常的亚临床甲亢者,可作为本病诊断依据,TSH水平高低尚不能作为诊断依据。4.桥本一过性甲状腺毒症的TGAb、TPOAb阳性水平较桥本甲亢为低,单、双抗体强阳性对本病鉴别意义不大。5.TRAb阴性可作为本病的诊断依据,但也存在个别(3.1%)可疑阳性结果。6.桥本一过性甲状腺毒症一般不出现甲亢常见合并症,但若出现合并症,需在控制甲亢的同时积极治疗合并症。7.本病甲状腺毒症表现为一过性,治疗后甲亢期一般不超过3个月,临床症状也在3个月内明显缓解。8.使用复方消瘿甲亢片治疗桥本一过性甲状腺毒症甲功表现为亚甲亢者,使用复方甲亢片治疗甲功表现为甲亢者,具体剂量遵循个体化原则,初治后需严密监测甲状腺功能,适时调整剂量,并以3个月为1个疗程,甲功一般可在1个疗程内恢复,2个疗程内稳定。9.本病诊断性治疗后应重视随访,若甲功波动较大,必要时仍需行FNAC病理学检查重新确诊。
[Abstract]:Objective: in this study, 32 cases of Hashimoto hyperthyroidism were selected by retrospective analysis, and 32 cases of Hashimoto hyperthyroidism were selected to compare the similarities and differences of Hashimoto's hyperthyroidism and Hashimoto hyperthyroidism in the characteristics, clinical symptoms, physical signs and laboratory examination, and to analyze the use of compound elimination. Gall hyperthyroidism tablets, compound hyperthyroidism tablets in the treatment of Hashimoto hyperthyroidism, the clinical identification and treatment of this disease are preliminarily discussed in order to provide a new understanding of the diagnosis and treatment of Hashimoto hyperthyroidism. Methods: the clinical diagnosis of Hashimoto hyperthyroidism in the Hubei Provincial Traditional Chinese Medical Hospital of the thyroid specialist clinic was collected. 32 cases (group A) and 32 cases (group B) were diagnosed as hyperthyroidism (group B). The age of onset, sex, clinical symptoms, thyroid enlargement, texture, serum FT3, FT4, TSH, FT3/FT4, TGAb, TPOAb, TRAb determination and the similarities and differences between the A, B two groups were analyzed. The difference between the typical clinical symptoms and the laboratory indexes at the time point, and the statistical analysis. Results: 1. the age of the 1. two groups were all concentrated between 18-50 years, and both were higher in women, two groups of age, sex ratio was not statistically significant (P0.05).2. Hashimoto hypertoxic group in TCM syndrome score, heart rate level was lower than the Hashimoto hyperthyroidism group (P 0.05), it shows that there is a statistical difference in the proportion of the degrees of thyroid enlargement between the.3. two groups and the.3. two groups. There is no statistically significant difference in the proportion of the thyroid dissimilarity between the two groups of.4. and two groups, which are not statistically significant in texture or texture. The proportion of the increase in the proportion of.5. serum FT3 was significantly different between the two groups (P0.01), and the proportion of the FT4 increased in the two groups was statistically significant (P0.05). There was no statistical significance (P0.05) for the most common.TSH water level in the patients with Hashimoto transient toxicity (FT3), and there was no statistical significance (P0.05). The FT3/FT4 value of the drug group was lower than the Hashimoto hyperthyroidism group, the difference was statistically significant (P0.05).6. two groups TGAb, TPOAb negative, positive, the difference of strong positive rate had significant statistical significance (P0.01), and the positive level of the pashimoto hypertoxic group was lower than that of the Hashimoto hyperthyroidism. The difference of the strong positive rate of double antibody was not statistically significant (P0.05). The negative rate of TRAb in.7. bridge hypertoxic group was significantly higher than that of Hashimoto hyperthyroidism group (96.9%), the difference was significant (P0.01), the proportion of.8. Hashimoto hypertoxic group was greater (75%), and the difference was statistically significant (P0.01).9. bridge hyperthyroidism group hyperthyroidism (Ya Jiakang) course of 1-3 months was the highest (65.6%). The proportion of recovery in June was significantly higher than that of Hashimoto hyperthyroidism group, the difference was statistically significant (P0.01).10. compound gall gall hyperthyroidism tablets, compound hyperthyroidism tablets were treated with TCM syndrome scores at each time point before and after the disease, and the overall difference in the laboratory indexes was statistically significant (P0.05). The curative effect increased steadily with the time of treatment of.11. Hashimoto. After treatment, the recovery of thyroid function was faster in the group of sexual thyroidism, generally within 1 courses of treatment and stable in 2 courses. After 2 courses of consolidation treatment, the cure rate of two groups was obviously higher than that of 1 courses. Conclusion: 1. Hashimoto hyperthyroidism is generally green, middle-aged and female, and the proportion of women is larger than male.2. Hashimoto and hyperthyroidism The typical symptoms and signs of hyperthyroidism in the patients with toxic disease are lighter. The degree of thyroid enlargement is significant to the differential diagnosis of this disease. The thyroid texture is not significant for the identification of the disease and the hyperthyroidism. The thyroid texture or texture is only a reference basis for the identification of.3. Hashimoto hyperthyroidism. Gland function, with FT3, FT4 mild elevation, low FT3/FT4 ratio, and FT3, FT4 normal subclinical hyperthyroidism, can be used as a diagnostic basis for this disease. The level of TSH can not be used as a diagnostic basis for.4. Hashimoto hyperthyroidism TGAb, TPOAb positive level is lower than Hashimoto hyperthyroidism, single, double antibody strongly positive for this disease identification meaning .5.TRAb negative can be used as the basis for diagnosis of this disease, but there are also individual (3.1%) suspected positive results of.6. bridge, hyperthyroidism usually do not appear hyperthyroidism common complication, but if there is a combination of hyperthyroidism, it is necessary to take active treatment of hyperthyroidism at the same time that the.7. is a hyperthyroidism, after treatment, hyperthyroidism is a period of one period. The clinical symptoms were not more than 3 months, and the clinical symptoms were obviously relieved within 3 months..8. used compound Xiaoying hyperthyroidism in the treatment of Hashimoto hyperthyroidism and hyperthyroidism. The use of compound hyperthyroidism to treat Jia Gong was hyperthyroidism. The specific dose followed the individualized principle. After the initial treatment, the thyroid function should be closely monitored and the dose was adjusted in time. And in 3 months as a course of 1, a general recovery work in the 1 treatment period, 2 treatment in stable.9. treatment should pay attention to the follow-up after the diagnosis of the disease, if a power fluctuations, when necessary, still need FNAC pathological examination were diagnosed again.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R581

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