泻火消瘿方联合甲巯咪唑治疗甲亢初治期心肝火旺证的临床研究

发布时间：2018-07-25 07:30

【摘要】：目的:探讨泻火消瘿方联合甲巯咪唑治疗甲亢(Graves病)初治期心肝火旺证的临床疗效。方法:纳入2015年7月—2016年10月期间在南京中医药大学附属中西医结合医院内分泌门诊诊治的初治或复发再就诊初治患者80例,所有患者均符合西医Graves病初治期和中医心肝火旺证诊断标准。根据随机数字表法分为对照组和治疗组,每组40例。对照组予甲巯咪唑(赛治,德国默克公司)10-30mg/d,症状控制后逐渐减量至2.5-10mg/d。治疗组在对照组基础上加用泻火消瘿方,每日1剂,水煎服,分早晚两次温服。中药以4周为1个疗程,共观察3个疗程。结果:共有61例患者完成本研究,两组患者基线心率、体重、FT3、FT4、TSH、TRAb水平具有可比性(p0.05)。治疗后,两组心率及体重较各组治疗前均有明显改善(p0.01),治疗组治疗后心率低于对照组(65.00±12.00bpmvs.74.00±14.00bpm,p=0.021),体重相比无明显差异。治疗后,FT3、FT4、TRAb水平均显著低于各组治疗前水平,TSH水平显著高于各组治疗前水平,且有统计学差异(p0.01)。治疗组在第1、2月时FT3和FT4 下降幅度大于对照组(治疗 1 月后 FT3:5.56±2.46pmol/l vs.8.00士3.95pmol/l,p=0.001;治疗 1 月后 FT4:19.90±8.28pmol/l vs.23.37±9.42pmol,p=0.019;治疗 2 月后FT3:3.94±1.57pmol/l vs.4.96±2.187Pmol/l,p=0.010;治疗 2 月后 FT4:13.52±4.69pmol/l vs.16±7.59pmol/l,p=0.043),疗程结束(第3月)时,两组甲状腺功能无明显差异;第1个疗程结束后,治疗组FT3、FT4水平恢复正常比例优于对照组(FT3恢复正常比例:19(63.33%)vs.11(35.48%),p=0.03;FT4 恢复正常比例:21(70.00%)vs.12(38.70%),p=0.014);FT3、FT4恢复至正常水平所需平均时间亦少于对照组(FT3平均恢复时间:1.00±1.00月v.2.00±2.00 月,p=0.014;FT4 平均恢复时间:1.00±1.00月 s 2.00±1.00 月,p=0.008)。两组患者起始甲巯咪唑剂量无明显区别(30.0±15.0mg vs.30.0±15.0mg,p=0.620),在疗程期间,治疗组使用甲巯咪唑剂量均小于对照组(治疗1月后:15.00±6.25mgvs.20.00±15.00mg,p=0.03;治疗 2 月后:10.00±8.13mgvs.15.00±10.00mg,p=0.04;治疗3月后:5.00±5.75mg vs.10.00±10.00mg,p=0.015)。两组患者治疗后中医症候积分明显小于各组间治疗前(p0.01);治疗组治疗后中医症候积分低于对照组(5.38±4.00 vs.11.09±5.46,p0.0001)。治疗组不良反应事件少于对照组,但无统计学差异。结论:泻火消瘿方联合甲巯咪唑治疗甲亢(Graves病)初治期疗效显著,可更快降低激素水平、缩短激素恢复正常的时间、提高恢复率、减少甲巯咪唑剂量,且不良反应更少,有重要的临床研究价值。
[Abstract]:Objective: to investigate the clinical effect of Xiehuoxiaoying recipe combined with mercaptopril in the treatment of hyperthyroidism (Graves disease). Methods: from July 2015 to October 2016, 80 newly treated or relapsed patients were enrolled in the endocrine clinic of Nanjing University of traditional Chinese Medicine (TCM) affiliated Hospital of Integrated traditional Chinese and Western Medicine (TCM). All the patients were in accordance with the diagnostic criteria of Graves's disease and the syndrome of heart-liver-fire flourishing in traditional Chinese medicine. According to the random digital table method, the patients were divided into control group and treatment group with 40 cases in each group. The control group was given methimazole 10-30 mg / d, which was gradually reduced to 2.5-10 mg / d after symptom control. The treatment group in the control group on the basis of Xiehuoxiaoying prescription, 1 dose per day, water decoction, divided into morning and evening twice warm. Four weeks as a course of treatment, a total of three courses of observation. Results: a total of 61 patients completed the study. The baseline heart rate and body weight of the two groups were comparable (p0.05). After treatment, the heart rate and body weight of the two groups were significantly improved (p0.01). After treatment, the heart rate in the treatment group was lower than that in the control group (65.00 卤14.00 12.00bpmvs.74.00 卤14.00 bpmmP0.021), and there was no significant difference in body weight between the two groups. After treatment, the levels of FT3 / FT4TRAb were significantly lower than those before treatment and TSH levels were significantly higher than those before treatment (p0.01). 娌荤枟缁勫湪绗，

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