血清前白蛋白与甲亢合并肝损的相关性分析及中西医结合治疗近期疗效观察

发布时间：2018-07-20 12:18

【摘要】：目的：探讨血清前白蛋白(PA)与甲状腺功能亢进症伴肝功能损伤患者甲状腺免疫学指标、肝功能指标的相关性。同时,通过对单纯西药、单纯中药、中西医结合治疗方案的对比研究,客观评价自拟清肝养阴方治疗甲亢伴肝功能损伤肝火旺盛证的疗效及安全性。方法：1.采用病例对照研究方法,选取2011年1月1日至2013年12月31日期间,在江苏省中医院内分泌科住院甲状腺功能亢进症伴肝功能损伤患者60例,正常对照组随机选取同期甲状腺功能亢进症非肝功能损伤患者60例,对血清前白蛋白及甲状腺免疫学指标、肝功能指标进行统计学分析。2.选取2012年12月1日-2013年12月31日在江苏省中医院内分泌科住院甲状腺功能亢进伴肝损伤患者共90例,根据治疗方法,分为对照组30例,中西医结合治疗组(治疗组1)30例,中医治疗组(治疗组2)30例。观测治疗前后临床症状、甲状腺免疫学指标、肝功能、甲状腺肿大程度等,以及不良反应、依从性。全部数据使用SPSS17.0统计软件进行统计学分析。结果： (1)相关性分析：经过对照组、甲亢肝损组的统计学分析,提出推测：PA与ALT、FT3、FT4呈负向直线关系。 (2)症状改善：组内比较,治疗后0.5月与治疗前相比,对照组烦躁、胸胁胀痛、口干口苦、少寐多梦、消瘦、大便频数症状较前好转(P0.05),除治疗组1、2甲状腺肿、治疗组2神疲乏力外余症状均较前好转(P0.05)；治疗后3月与治疗前相比,三组中除对照组甲状腺肿、心悸未见明显好转,余症状较前均有明显好转(P0.05)；治疗后3月与治疗后0.5月相比,三组神疲乏力、胸胁胀痛、口干口苦、大便频数、震颤症状均有明显改善(P0.05)。组间比较,治疗后0.5月,治疗组1与对照组相比,除烦躁、大便频数、消瘦症状无显著性统计学意义外,余症状均明显改善(P0.05)；治疗组2与对照组比,除烦躁、大便频数、消瘦、多汗恶热症状无显著性统计学意义外,余症状均明显改善(P0.05)；治疗组1与治疗组2比较,症状改善均无显著性统计学意义(P0.05)。治疗后3月,三组间症状比较均无显著性统计学意义(P0.05)。 (3)中医临床证候积分：经治疗后,3组患者症状较前均明显改善(P0.01)。组间比较,3月后,治疗组2较对照组症状改善(P0.05),治疗组1较对照组改善有非常显著性统计学意义(P0.01)。治疗组1较治疗组2改善效果更佳,但组间无显著性统计学意义(P0.05)。 (4)实验室指标：治疗后0.5月,三组PA均较治疗前升高(P0.05)。ALT、AST、γ-GT、ALP均较治疗前下降(P0.05),其中,对照组及治疗组1PA、ALT、γ-GT;治疗组2ALT、AST、γ-GT较治疗前明显改善(P0.01)。治疗后3月,对照组PA、ALT、AST、γ-GT、ALP较治疗前及治疗后0.5月改善(P0.05),其中ALT较治疗前及治疗后0.5月、AST较治疗前、γ-GT较治疗前及治疗后0.5月明显改善(P0.01)。治疗组1PA、ALT、AST、ALP较治疗前,治疗组2PA、ALT、ALP较治疗前及治疗后0.5月、AST、γ-GT较治疗前改善(P0.05),其中治疗组1ALT较治疗前及治疗后0.5月、AST较治疗前、ALP较治疗后0.5月,治疗组2ALT较治疗前及治疗后0.5月、AST、γ-GT较治疗前有显著统计学意义(P0.01)。组间比较,治疗后0.5月,治疗组1PA、ALT、AST、γ-GT较对照组,均有显著性统计学意义(P0.05)。治疗组2与对照组比较,PA上升较对照组明显,有显著性统计学意义(P0.05)。治疗组1与治疗组2比较,治疗组1PA较治疗组2明显上升,ALT、γ-GT明显下降(P0.05)。治疗后3月,治疗组1与对照组PA上升幅度相比,有显著统计学意义(P0.01)；ALT、AST、γ-GT、ALP降低幅度均有统计学意义(P0.05)。治疗组1与治疗组2比较,治疗组1PA、ALT、AST下降较治疗组2明显,有统计学意义(P0.05)。 (5)疾病疗效比较：治疗组1疗效显著优于对照组(P0.01)。 (6)治疗前后肝功能指标恢复正常时间比较：治疗组1肝功能恢复时间与对照组及治疗组2相比有统计学意义(P0.05)。 (7)安全性：三组安全性比较无显著性统计学意义(P0.05)。结论： (1)甲状腺功能亢进症伴肝功能损伤患者血清前白蛋白水平明显降低。 (2)血清前白蛋白水平可伴随患者肝损恢复而恢复,有助于病情进展的判断。 (3)清肝养阴方可明显缓解甲亢伴肝损患者的症状、缩短肝功能恢复时间。中西医结合治疗可缩短病程,对降低复发率有一定意义。此方安全、有效、无严重不良反应。
[Abstract]:Objective : To study the correlation between serum prealbumin ( PA ) and thyroid function injury in patients with liver function impairment .

Methods : 1 . A case - control study was used to select 60 patients with hyperthyroidism complicated with liver function during the period from January 1 , 2011 to December 31 , 2013 .

Results :

( 1 ) Correlation analysis :

Through the statistical analysis of the control group and the liver loss group of hyperthyroidism , it is suggested that PA is in negative linear relation with ALT , FT3 and FT4 .

( 2 ) Improvement of symptoms :

In the treatment group , the symptoms of fatigue and fatigue were better than those in the treatment group ( P0.05 ) .
Compared with the control group , there was no obvious improvement in the three groups except that in the control group before and after the treatment ( P0.05 ) .
Compared with 0 . 5 months after treatment , three groups of mental fatigue , chest pain , dry mouth , stool frequency and tremor were significantly improved ( P0.05 ) .

Compared with the control group , compared with the control group , there was no significant difference between treatment group 1 and the control group except for the symptoms of irritability , stool frequency and thin - thin symptom , and the residual symptoms were obviously improved ( P0.05 ) .
Compared with control group , there was no significant difference between treatment group 2 and control group than that in control group ( P0.05 ) .
No significant difference was found between treatment group 1 and treatment group 2 ( P0.05 ) .

( 3 ) Clinical syndrome integration of traditional Chinese medicine :

After treatment , the symptoms of the three groups were significantly improved ( P0.01 ) . After 3 months , the symptoms of the treatment group were improved compared with those in the control group ( P0.05 ) . The improvement of the treatment group 1 was better than that of the control group ( P0.01 ) .

( 4 ) Laboratory index :

ALT , AST , 纬 - GT and ALP decreased before treatment ( P0.05 ) .

ALT , AST , 纬 - GT and ALP were significantly improved before and after treatment ( P0.05 ) .

Compared with the control group , the level of PA in the treatment group was significantly higher than that in the control group ( P0.05 ) .

Compared with control group , there was significant difference between treatment group and control group ( P0.01 ) .
The levels of ALT , AST , 纬 - GT and ALP decreased significantly ( P0.05 ) . Compared with the treatment group , the decrease of 1PA , ALT and AST in the treatment group was significantly higher than that in the treatment group ( P0.05 ) .

( 5 ) Comparison of curative effect :

The curative effect of the treatment group was significantly better than that of the control group ( P0.01 ) .

( 6 ) Before and after treatment , the liver function indexes were returned to normal time :

The recovery time of liver function in the treatment group was significantly higher than that of the control group and the treatment group ( P0.05 ) .

( 7 ) Safety :

There was no significant difference between the three groups ( P0.05 ) .

Conclusion :

( 1 ) The levels of serum prealbumin in patients with hyperthyroidism accompanied with liver function were significantly lower .

( 2 ) The level of serum prealbumin can be recovered with the recovery of liver loss of the patient , which can help to judge the progress of the disease .

( 3 ) Clearing the liver and nourishing yin can obviously relieve the symptoms of the patients with hyperthyroidism and liver loss , shorten the recovery time of the liver function , shorten the course of the treatment by combining the traditional Chinese medicine and western medicine , and have a certain meaning to reduce the recurrence rate .
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R581.1;R575

【参考文献】