“结甲平”膏外治气滞血瘀痰凝型良性非毒性甲状腺结节的临床观察

发布时间：2018-01-31 07:15

  本文关键词： 良性非毒性甲状腺结节 结甲平膏 外治　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:评价以化瘀散结为治法的"结甲平"膏外治气滞血瘀痰凝型良性非毒性甲状腺结节的临床疗效,以期获得该病有效的中医外治方案,指导临床治疗和用药。方法:1.在北京中医药大学东直门医院2013年11月至2017年4月的内分泌科门诊病人中,纳入符合中西医诊断的气滞血瘀痰凝型良性非毒性甲状腺结节患者44例。2.研究采用随机对照法,分为治疗组22例和对照组22例,治疗组在基础治疗上予中药"结甲平"膏外敷联合"结甲汤"内服,对照组予基础治疗加"结甲汤"内服。治疗6个月,统计分析治疗前后两组中医症状体征积分、左右叶最大结节直径、结节个数及结节恶性风险积分变化,对比内外合治与内治法的优效性,评价"结甲平"膏外治气滞血瘀痰凝型良性非毒性甲状腺结节的临床疗效。结果:1.一般资料比较:治疗前两组一般资料(包括性别、年龄、病程、甲状腺疾病家族史、最大结节直径、中医症状体征积分、结节恶性风险积分)无统计学差异(P0.05),具有可比性。2.两组治疗前后中医症状体征积分比较:治疗组、对照组在治疗后的中医症状体征积分与治疗前相比有显著性差异(P0.01),两组治疗后的中医症状体征积分组间相比无统计学差异(P0.05),但治疗组治疗前后的积分差值与对照组相比有统计学差异(P0.05)。3.两组治疗前后最大结节直径、结节个数比较:治疗组、对照组治疗后的最大结节直径与治疗前相比无统计学差异(P0.05),两组治疗后的最大结节直径相比无统计学差异(P0.05),两组治疗前后最大结节直径差值相比无统计学差异(P0.05),两组治疗后的结节个数减少比例相比亦无统计学差异(P0.05)。4.两组治疗前后结节恶性风险积分比较:治疗组治疗后的恶性风险积分与治疗前相比有显著性差异(P0.01),对照组治疗后的恶性风险积分与治疗前相比无统计学差异(P0.05)。两组治疗后的恶性风险积分组间对比有统计学差异(P0.05)。5.两组疗效比较:根据症状体征疗效判定标准,治疗组总有效率为72.73%,临床治愈0例,显效0例,有效16例,无效6例;对照组总有效率为40.91%,临床治愈0例,显效0例,有效9例,无效13例。两组间总有效率有统计学差异(P0.05)。根据甲状腺B超的疗效判定标准,治疗组总有效率为22.73%,临床治愈0例,显效4例,有效1例,无效17例,对照组总有效率为13.64%,临床治愈0例,显效1例,有效2例,无效19例。两组间总有效率无统计学差异(P0.05)。6.两组治疗前后安全性指标比较:治疗组、对照组治疗后的甲状腺功能(FT3、FT4、TT3、TT4、TSH)、肝功能(ALT、AST)和肾功能(Scr、BUN)与治疗前相比无统计学差异(P0.05)。结论:"结甲平"膏外敷联合中药"结甲汤"内服及单纯"结甲汤"内服治疗气滞血瘀痰凝型良性非毒性甲状腺结节,在改善症状、体征方面疗效显著,两相比较,内外合治法疗效优于内治法。内外合治及内治法治疗半年后结节大小保持稳定,未见增长,但内外合治法降低结节恶性风险疗效显著,内治法不能降低恶性风险。综上,以化瘀散结为治法的"结甲平"膏外治气滞血癌痰凝型良性非毒性甲状腺结节,在改善症状体征及降低结节恶性风险方面疗效较好,且无毒副作用,安全可靠,值得临床推广和深入研究。
[Abstract]:Objective: To evaluate the Huayusanjie for treatment of "knot a flat" cream treating phlegm stagnation and blood stasis type of benign thyroid nodules clinical curative effect, in order to obtain the effective treatment of traditional Chinese medicine disease, clinical treatment and medication. Methods: 1. in Dongzhimen Hospital of Beijing University of Chinese Medicine from November 2013 to April 2017 in the outpatient department of endocrinology in patients with traditional Chinese medicine and Western medicine diagnosis of qi stagnation and blood stasis and phlegm of benign thyroid nodules in patients with non.2. toxicity study of 44 cases randomly divided into treatment group of 22 cases and 22 cases in the control group, the treatment group was treated by traditional Chinese medicine "Jia Ping" paste and "a soup" orally on the basis of the treatment, control group were treated with "ng Decoction" orally. After 6 months of treatment, statistical analysis of the two groups before and after treatment the symptom scores, left lobe nodule maximum diameter, number of nodules and nodular malignant risk product changes, and contrast Effective treatment and treatment, clinical evaluation of "Jia Ping" cream treating phlegm stagnation and blood stasis type of benign thyroid nodules. Results: 1. general information: two groups before treatment (data including gender, age, course of disease, family history of thyroid disease, the nodule diameter. The symptom scores, nodule risk score) no significant difference (P0.05), which can be compared with the symptom scores before and after.2. treatment in the two groups: the treatment group, Chinese medicine symptom control and treatment group after treatment than before there was significant difference (P0.01), the symptom scores of two groups after treatment, the comparison between no statistical difference (P0.05), compared with the control group, but the difference between integral treatment group before and after treatment there was significant difference (P0.05) before and after.3. treatment in the two groups compared the number of maximum diameter of nodules, nodules: treatment group and control group after treatment The maximum diameter of the nodules compared with before treatment there was no significant difference (P0.05), the two groups after treatment the maximum diameter of nodules had no statistical difference (P0.05), the two groups before and after treatment the maximum nodule diameter difference had no statistical difference (P0.05), the number of nodes of the two groups after treatment decreased compared to the proportion also had no significant difference (P0.05 comparison of the risk of malignancy nodules).4. score before and after treatment in the two groups: the treatment of malignant risk score and treatment group after treatment than before there was significant difference (P0.01), the control of malignant risk score and treatment group after treatment than before no statistical difference (P0.05). The malignant risk score two groups after treatment compared there were significant differences (P0.05) between.5. two groups: according to the criteria of symptoms and signs of efficacy, the total effective rate of treatment group was 72.73%, 0 cases were cured, 0 cases markedly effective in 16 cases, 6 cases were ineffective; the total efficiency of the control group was 40.91%, clinical 娌绘剤0渚，

本文编号：1478551