清解软坚法治疗亚急性甲状腺炎热盛证临床疗效及证型转变的观察

发布时间：2018-01-02 01:32

本文关键词：清解软坚法治疗亚急性甲状腺炎热盛证临床疗效及证型转变的观察　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察清解软坚法治疗热盛证亚急性甲状腺炎的临床疗效,并对治疗后的患者进行辨证分型,观察其治疗后证型转归的分布情况及不同证型与相关理化指标的联系,以期为今后中医药治疗亚急性甲状腺炎提供更多的辨证用药思路和理论依据。方法:收集符合纳入标准的亚急性甲状腺炎患者68例,随机分为观察组35例,对照组33例,由于出现病例脱落(观察组2例,对照组3例),实际完成病例总数63例,其中观察组33例,对照组30例。在保证相同一般治疗的前提下,观察组采用以清热解毒软坚法为治疗原则拟定的清解软坚方,对照组则予地塞米松局部注射治疗,4周为1个疗程,治疗3个疗程后停药。两组治疗停药后,均继续对患者进行为期半年的跟踪随访。并根据治疗后的中医诊断及辨证分型标准对患者进行辨证分型,观察不同证型的分布情况及其与相关理化指标之间的联系。结果:1.疾病疗效:经统计学分析,两组疾病疗效无显著差别(P0.05)。2.证候疗效:经统计学分析,两组证候疗效无显著差别(P0.05)。3.症状、体征积分变化:治疗前两组症状、体征积分经统计学分析无显著差异,可以比较(P0.05);治疗后两组症状、体征积分较治疗前均有明显改善,且观察组改善优于对照组(P0.05)。4.血沉变化:治疗前两组ESR经统计学分析无显著差异,可以比较(P0.05);治疗后两组ESR均显著下降,组间比较无差异(P0.05),表明两组均可显著降低患者ESR,且疗效相当。5.甲状腺功能比较:治疗前两组甲状腺功能经统计学分析无显著差异,可以比较(P0.05);治疗后两组FT3、FT4均较治疗前有所下降,TSH较治疗前有所上升,组间比较无差异(P0.05),表明两组均可改善患者的甲状腺功能,且疗效相当。6.血糖变化:治疗前两组FBG经统计学分析无显著差异,可以比较(P0.05);治疗后观察组血糖较对照组下降明显,且有统计学差异(P0.05)。7.复发率比较:观察组复发率明显低于对照组,差异有统计学意义(P0.05)。8.治疗后的辨证分型:对照组治疗后的辨证分型显示,毒结未消证所占比例最高,其次为阴平阳秘证,气阴两虚证和阳气亏虚证;观察组治疗后的辨证分型显示,气阴两虚证所占比例最高,其次为阴平阳秘证,阳气亏虚证和毒结未消证。9.无论是观察组还是对照组,甲状腺B超提示存在结节者,均以毒结未消证最为多见。10.阳气亏虚证TSH值与阴平阳秘证相比偏高,且差异有统计学意义(P0.05)。结论:1.清解软坚法和地塞米松局部注射疗法对亚甲炎热盛证患者均有良好疗效。但清解软坚法在改善患者临床症状方面更具优势,且复发率低。2.清解软坚法可改善糖耐量异常患者的血糖,适用于亚急性甲状腺炎热盛证合并糖耐量异常的患者。3.两种方法治疗亚急性甲状腺炎热盛证均可能出现阴平阳秘证、气阴两虚证、阳气亏虚证、毒结未消证四种证型的转归。其中地塞米松局部注射疗法以毒结未消证最为多见,清解软坚法以气阴两虚证最为多见。在四种证型中,复查甲状腺B超提示有结节者以毒结未消证最为多见。阳气亏虚证患者的TSH值较阴平阳秘证高,类似亚急性甲状腺炎甲减期,当注意在扶正祛邪的基础上治以温补脾肾。
[Abstract]:Objective: To observe the clinical effect of treatment of Qingjie Ruanjian heat Zhengya acute thyroiditis, and after treatment with syndrome differentiation, syndrome type distribution of outcome after treatment and observe the different syndromes and physicochemical indices linked to the future of traditional Chinese medicine in the treatment of subacute thyroiditis with more TCM treatment ideas and theoretical basis. Methods: to collect with 68 subacute thyroiditis patients included were randomly divided into observation group 35 cases, control group 33 cases, due to the emergence of cases (2 cases in the observation group, 3 cases in the control group), the actual completion of the total number of cases in 63 cases, the observation group of 33 cases 30 cases of the control group. Under the premise of ensuring the same general treatment, the observation group used to detoxify Ruanjian method for the treatment of the principle proposed clear solution Ruanjian decoction, while the control group to the local injection of dexamethasone treatment, 4 weeks for 1 courses, 3 courses of treatment after the stop Drug treatment in the two groups. After treatment, all were followed up to half a year for patients. According to TCM diagnosis and treatment after the classification of patients of different syndrome types between the distribution of observation of different syndromes and its correlation with the physicochemical index of contact. Results: 1.: the curative effect of disease statistical analysis, no significant difference between the two groups (P0.05) clinical disease.2. syndrome curative effect: by statistical analysis, no significant difference between the clinical syndromes of two groups (P0.05).3. symptoms, signs integral change: before treatment, two groups of symptoms, signs integral statistical analysis showed no significant difference, can be compared after treatment (P0.05); two groups of symptoms, signs score were significantly improved compared with before treatment, and the observation group was better than the control group (P0.05).4. ESR: two groups before treatment ESR statistical analysis showed no significant difference, can be compared (P0.05); ESR in the two groups after treatment were significantly decreased, compared between groups No difference (P0.05), showed that the two groups were significantly lower in patients with ESR,.5. and thyroid function efficacy comparison: two groups of thyroid function before and after the treatment showed no significant difference compared (P0.05); the two groups after treatment FT3, FT4 were decreased after treatment compared with before treatment, TSH increased, compared with no significant difference between groups (P0.05), showed that the two groups can improve the thyroid function of the patients, and the curative effect is.6. blood glucose change: before treatment, two groups of FBG statistical analysis showed no significant difference, can be compared (P0.05); the observation group after treatment of blood glucose decreased significantly than the control group, and there was statistical difference (P0.05) rate of.7. the recurrence, the recurrence rate of the observation group was significantly lower than the control group, the difference was statistically significant (P0.05) syndrome after treatment of.8. type: the control group after treatment, the syndrome differentiation typing showed that poison knot disappeared which accounting for the highest proportion, followed by Yin Pingyang constipation syndrome, two Qi and yin deficiency syndrome And Qi deficiency syndrome; observation group after treatment of the type of display, with the highest proportion of Qi and yin deficiency, followed by Yin Pingyang constipation syndrome, Qi deficiency syndrome and poison knot disappeared.9. either observation group or control group, suggesting the presence of ultrasound on thyroid nodules, the poison knot disappeared symptoms..10. Qi deficiency TSH value compared with the Yin Pingyang constipation syndrome is high, and the difference was statistically significant (P0.05). Conclusion: 1. clear solution softening method and local injection of dexamethasone therapy on methylene hot syndrome patients had good curative effect. But the clear solution Ruanjian method is more advantage in improving the clinical symptoms of patients. And the recurrence rate is low.2. clear solution Ruanjian method can improve patients with abnormal glucose tolerance of blood glucose, suitable for subacute thyroiditis and heat syndrome with abnormal glucose tolerance in patients with.3. two methods in the treatment of subacute thyroiditis and heat syndrome may appear constipation syndrome of Qi Yin Yin Pingyang, two Deficiency syndrome, Qi deficiency syndrome, prognosis of poison knot disappeared four syndromes. The local injection of dexamethasone therapy to poison the node consumer card is the most common, clear solution Ruanjian method with two Qi and yin deficiency syndrome is the most common. In the four card, review of thyroid ultrasound suggesting nodules in poison knot disappeared syndrome is the most common. Qi deficiency in patients with TSH compared with Yin Pingyang constipation syndrome, similar to subacute thyroiditis hypothyroidism, when attention to reinforcing the spleen and kidney in Fuzhengquxie Wen Zhi basis.

【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】：2017
【分类号】：R259

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