调神针刺结合甲巯咪唑治疗初发Graves病的临床研究

发布时间：2018-10-22 20:27

【摘要】：目的：Graves病(以下简称GD)是甲状腺功能亢进症中最常见的类型,是严重危害人类健康的常见病。现代已有学者证实多数的GD患者在发病前有精神刺激或创伤的病史。中医学认为情志内伤与瘿病的发病关系密切,是导致其致病的重要诱因。近年来针灸治疗甲亢取得了不错的疗效,而调神针刺更能明显改善患者的精神、躯体症状,因此,应该伴随GD治疗的始终。本研究从临床上最后成功收取了58例的GD患者,分为治疗组28例与对照组30例,观察调神针刺联合甲巯咪唑治疗初发GD患者,对Graves病患者抑郁、焦虑症状、甲功三项及甲状腺大小的影响。从而为针刺调神能缓解Graves病患者的精神、躯体征状提供临床依据。方法：对照组患者每天予西药甲巯咪唑片(赛治)对症治疗,初始的剂量为30mg/d,每天顿服,此后每月后复查患者的甲功3项,并按GD治疗指南中的治疗,常规调整甲巯咪唑剂量。而治疗组在对照组治疗的基础上予以一周三次的针刺治疗,主穴：定神针、四神针、四关穴,配穴方面,若痰气郁结者配丰隆穴、阴陵泉穴；若肝火旺盛者配手智针(内关穴、神门穴、劳宫穴)、行间穴；若心肝阴虚者配太溪穴、足三里穴。每次留针时间为1小时,其中每15分钟予患者行提插捻转补泻手法1次,两组患者均连续干预3个月。在治疗前后分别予以甲功三项检测、甲状腺彩超检查、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评定。结果：①治疗组比对照组更能缓解患者的抑郁、焦虑状态,差异具有统计学意义；②治疗组患者在改善患者FT3激素水平比对照组佳,差异显著,而在减少FT4、增加TSH方面两组差异不明显；③治疗组比对照组更能改善患者甲状腺腺体肿大的问题,差异具有统计学意义。结论：①调神针刺联合甲巯咪唑片治疗GD患者比单纯甲巯咪唑治疗更能缓解患者精神上的抑郁、焦虑状态；②调神针刺联合甲巯咪唑片治疗GD患者比单纯甲巯咪唑治疗更能减少患者FT3激素水平,而在减少FT4、增加TSH方面两组差异不明显；③调神针刺联合甲巯咪唑片治疗GD患者比单纯甲巯咪唑治疗更能明显改善患者甲状腺腺体肿大的问题。
[Abstract]:Objective: Graves disease (hereinafter referred to as GD) is the most common type of hyperthyroidism. Modern scholars have confirmed that most GD patients have a history of mental stimulation or trauma before onset. Chinese medicine thinks that the internal injury of emotion is closely related to the occurrence of gall disease, which is an important inducement to cause the disease. In recent years, acupuncture and moxibustion have achieved a good effect in treating hyperthyroidism, and the acupuncture of regulating the mind can improve the mental and physical symptoms of the patients significantly. Therefore, it should be accompanied with the treatment of GD all the time. In this study, 58 patients with GD were successfully received from the clinic. They were divided into treatment group (n = 28) and control group (n = 30). The symptoms of depression and anxiety in patients with Graves disease were observed. The effects of three items of thyroid function and the size of thyroid gland. Therefore, acupuncture can relieve the mental and somatic symptoms of patients with Graves disease. Methods: the patients in the control group were treated with methimazole tablets every day. The initial dose was 30 mg / d. After that, 3 items of thyroid function were reexamined after each month. The dosage of methimazole was adjusted according to the treatment guidelines of GD. On the basis of the treatment in the control group, the treatment group was treated with acupuncture three times a week. The main points were as follows: Dingshen acupuncture, Siguan points, and points matching points, such as phlegm and qi stagnation, Fenglong points and Yin Lingquan points; if liver-fire patients had strong liver-fire points, they were matched with hand intelligence acupuncture points (Neiguan point). Shenmen acupoint, Laogong point), Xingjian acupoint; if the heart and liver yin with Taixi point, Zusanli point. The time of needle retention was 1 hour, in which every 15 minutes the patients were treated with lifting, twisting, twisting and reducing manipulation once, and the patients in both groups were intervened continuously for 3 months. Before and after treatment, three items of thyroid function were tested, thyroid ultrasonography, Hamilton depression scale (HAMD),) and Hamilton anxiety scale (HAMA). Results: 1 the treatment group can relieve the depression and anxiety more than the control group, and the difference is statistically significant, 2 the treatment group can improve the FT3 hormone level of the patients better than the control group, the difference is significant. However, there was no significant difference between the two groups in reducing FT4, and increasing TSH. 3 the treatment group improved the thyroid gland enlargement more than the control group, and the difference was statistically significant. Conclusion: (1) Tiaoshen Acupuncture combined with methimazole tablet can relieve the mental depression and anxiety of GD patients more than that of simple methimazole alone. 2Tiaoshen acupuncture combined with mercapto tablet can reduce the level of FT3 hormone in patients with GD more than that in patients with GD alone, but there is no significant difference between the two groups in decreasing FT4, and increasing TSH. 3Tiaoshen Acupuncture combined with methimazole tablet can significantly improve the thyroid gland enlargement in patients with GD as compared with simple methimazole therapy.
【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】：2015
【分类号】：R581.1

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