优甲乐联合温阳汤治疗甲状腺术后脾肾阳虚证的临床疗效与观察

发布时间：2018-09-18 12:22

【摘要】：背景：目前手术治疗甲状腺疾病在临床上较为普遍,术后一部分患者会造成暂时性或永久性的甲减,所以术后给患者服用左甲状腺素纳片(优甲乐),这样就会控制住甲减出现的症状和(或体征)。但是在临床中发现,术后患者由于心理负担、精神压力等等因素,出现的症状不是单纯补充甲状腺素所能改善的。而且甲状腺激素治疗的不良反应较多。基于这样的背景下,探究利用中医药特色,改善术后甲状腺功能的恢复,降低外源性甲状腺素的剂量。目的：观察优甲乐联合中药温阳汤与单用优甲乐治疗在甲状腺疾病术后甲减治疗疗效方面的差异,讨论其可能的作用机理,以便于临床推广。资料与方法：收集了2005年01月至2014年12月,于北京中医药大学东直门医院普外科确诊为甲状腺术后甲减的60例患者,随机分为观察组和对照组,每组30例；进行回顾性研究分析。对照组患者采用单纯西药优甲乐治疗。而观察组采用西药基础上加中药温阳汤治疗。结果：1.治疗后两组TSH、FT3、FT4比较,差异均无统计学意义(P0.05)。2.症状积分比较：两组分别进行中医证候前后疗效比较,观察组治疗前积分10.53±2.52,治疗后3.60±1.00,差异有统计学意义(P0.05)。3.随访2年后服用优甲乐的人数：对照组中8例患者多次复查甲功水平正常,不在服用优甲乐,但仍有占随访人数的55%还在服用。而观察组2年后的服用优甲乐人数只占本组总随访人数的25%,两组在统计学意义上,存在显著差异(P0.05)。4.优甲乐服用过程中,稳定剂量所需时间：观察组的30例患者,优甲乐剂量稳定需要时间平均不到1个月。对照组的30例患者,服药后稳定优甲乐剂量所需时间相对较长,波动较大,平均需要接近2个月时间。说明联合温阳汤后能减少优甲乐的调整时间,对术后患者的症状和体征及激素水平上都有稳定作用。5.资料显示,在甲状腺术后的临床证候中,以失眠,心悸,情绪低落等症状表现较为突出,下肢胫前浮肿,皮肤干燥,记忆力下降表现不突出。结论：用中西医结合治疗甲状腺疾病手术后出现的甲减症状和(或)体征,其疗效明显优于单用西药治疗。说明了中医药在治疗术后甲减出现的一系列西药治疗不明显的症状上,如失眠、心悸等,提供了可行的治疗方法。温阳汤可以缩短调整优甲乐剂量的时间,使患者减少抽血复查的次数,也减轻患者一部分经济费用。随访2年后,观察组服用优甲乐的人数明显少于对照组,也在一定程度上反应了中西药联合对改善术后暂时性甲减的作用效果明显。其机理可能与中药联合能够较快促进甲状腺腺体分泌功能恢复正常,及通过中药分子提高机体免疫功能有关。
[Abstract]:Background: at present, surgical treatment of thyroid diseases is common in clinic. Some patients after operation may cause temporary or permanent hypothyroidism. So patients are given levothyroxine after surgery to control symptoms and (or signs) of hypothyroidism. However, it was found that the symptoms of postoperative patients due to psychological burden, mental stress and other factors can not be improved by thyroxine supplementation alone. And thyroid hormone treatment of adverse reactions are more. Based on this background, this paper explores the application of traditional Chinese medicine to improve the recovery of thyroid function and reduce the dose of exogenous thyroxine. Objective: to observe the difference of the curative effect of Youjialao combined with Wenyang decoction and that of Youjia alone in the treatment of thyroid diseases after thyroidectomy, and discuss the possible mechanism of its action, so as to facilitate clinical popularization. Materials and methods: from January 2005 to December 2014, 60 patients diagnosed as hypothyroidism after thyroidectomy in Dongzhimen Hospital of Beijing University of traditional Chinese Medicine were randomly divided into observation group (n = 30) and control group (n = 30). To carry out retrospective study and analysis. The patients in the control group were treated with simple western medicine. The observation group was treated on the basis of western medicine and traditional Chinese medicine Wenyang decoction. The result is 1: 1. After treatment, there was no significant difference in TSH,FT3,FT4 between the two groups (P0.05). Symptom score comparison: two groups were compared before and after TCM syndrome, the observation group before treatment score 10.53 卤2.52, after treatment 3.60 卤1.00, the difference was statistically significant (P0.05). 3. After 2 years follow-up, 8 patients in the control group had normal thyroid function and were not taking it, but 55% of the patients were still taking it. The observation group after 2 years of taking Youjia only accounted for 25% of the total number of follow-up, the two groups in statistical significance, there was a significant difference (P0.05). 4. The time needed to stabilize the dose in the course of taking Utrechlor: in the 30 patients in the observation group, the average time to stabilize the dose was less than one month. 30 patients in the control group needed a relatively long and fluctuating time to stabilize the dosage after taking the medicine, and the average time needed was close to 2 months. The results show that the combination of Wenyang decoction can reduce the adjustment time of Youjialao, and has a stable effect on the symptoms and signs and hormone level of the patients after operation. Data showed that the symptoms of insomnia, palpitations and depression were prominent in the clinical symptoms after thyroid surgery, such as lower extremity anterior tibia swelling, dry skin, and poor memory. Conclusion: the treatment of hypothyroidism and / or signs after thyroidectomy with combination of traditional Chinese and western medicine is better than that of western medicine alone. It shows that Chinese medicine provides a feasible treatment method for a series of non-obvious symptoms of hypothyroidism, such as insomnia, palpitation and so on. Wenyang decoction can shorten the time of adjusting the dosage of Youjia Le, reduce the times of blood sampling and recheck, and also reduce the economic cost of the patients. After 2 years follow-up, the number of patients in the observation group was significantly lower than that in the control group, which also reflected to some extent the effect of the combination of Chinese and western medicine on the improvement of temporary hypothyroidism after operation. The mechanism may be related to the rapid recovery of thyroid gland secretory function and the improvement of immune function by traditional Chinese medicine.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R653

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