甲状腺功能亢进症合并糖尿病常见中医证型与相关因素的研究

发布时间：2018-02-21 02:28

  本文关键词： 甲亢合并糖尿病 中医证型 相关因素　出处：《湖北中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的通过搜集甲亢合并糖尿病患者的病例,与单纯甲亢或单纯糖尿病患者病史作一比较,并以常见中医证型分类,研究不同证型与患者病史及某些相关检查客观参数之间的关系,寻求其内在联系,以揭示甲亢合并糖尿病病情判断、治疗用药、预后评估及中医辨证论治的规律。方法根据统一的诊断标准及疾病特点,制定纳入和排除标准,搜集甲亢、糖尿病或甲亢合并糖尿病患者临床资料各42例,其中甲亢合并糖尿病患者为观察组,单纯甲亢、单纯糖尿病分别为对照A组、B组。采取对照研究方法,比较甲亢合并糖尿病患者病史与单纯甲亢或单纯糖尿病患者的差异。并以常见中医证型分类,观察不同证型间患者病史及某些相关检查客观参数的差异。主要常见证型分为热盛伤津、阴虚火旺和气阴两虚3型,而相关检查则包括甲状腺功能(FT3、FT4和TSH)、空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、血脂(TC、TG、LDL-C和HDL-C)及颈部血管彩超、甲状腺彩超等。结果使用SPSS19.0统计软件处理。结果(1)甲亢组与甲亢合并糖尿病组患者在性别构成比、平均年龄等方面相比较,经统计学方法检验,差异无显著性(P0.05),其中甲亢较甲亢合并糖尿病患者的女性比例稍高,平均年龄稍低。糖尿病组与甲亢合并糖尿病组患者性别构成比有统计学差异但不显著(0.01P0.05),平均年龄有显著性差异(P0.01)。其中糖尿病较甲亢合并糖尿病患者的女性比例更低,平均年龄更大。甲亢组、糖尿病组与甲亢合并糖尿病组患者相比较,在合并血脂异常、高血压、冠心病病史比例等方面,经统计学方法检验,差异均无显著性(P0.05)。其中甲亢较甲亢合并糖尿病患者合并血脂异常、高血压、冠心病病史的比例均更低;糖尿病较甲亢合并糖尿病患者的血脂异常出现比例稍高,合并高血压、冠心病病史更少。(2)甲亢组与甲亢合并糖尿病组患者甲状腺彩超在甲状腺肿大、甲状腺结节最大直径1cm(大小)及低回声(回声性质)的检出率等方面比较,经统计学方法检验,差异无显著性(P0.05)。但在甲状腺肿大、甲状腺结节最大直径1cm(大小)及低回声(回声性质)的检出率等方面,甲亢合并糖尿病组较甲亢组患者更高。糖尿病组与甲亢合并糖尿病组患者甲状腺肿大检出率有显著性差异(P0.01),甲状腺结节最大直径1cm(大小)及低回声(回声性质)的检出率等方面差异无显著性(P0.05)。(3)甲亢合并糖尿病的中医证型,以阴虚火旺为主占52.4%,其次为气阴两虚(占35.7%),而热盛伤津(占11.9%)最少。(4)甲亢合并糖尿病证型中,热盛伤津组的平均病程、BMI与其余两组比较,有显著性差异(P0.01),而其余两组间比较差异无显著性(P0.05);三组间在合并血脂异常、高血压、冠心病病史方面,差异无显著性(P0.05)。但热盛伤津型病程短,BMI偏低,合并血脂异常、高血压、冠心病病史少见。(5)甲亢合并糖尿病证型中,热盛伤津组患者FT3、FT4、TSH、FPG和Hb A1c与其余两组比较,有显著性差异(P0.01),而余两组比较差异无显著性(P0.05)。其中,热盛伤津型FT3、FT4、FPG和Hb A1c升高,而TSH明显降低。(6)甲亢合并糖尿病证型中,三组间在血脂TC、TG、LDL-C和HDL-C水平方面,差异无显著性(P0.05)。但热盛伤津型血脂水平较余两组要低。可见甲亢合并糖尿病对血脂有多重影响,表现复杂。热盛伤津组与气阴两虚组IMT有差异但不显著(0.01P0.05),而二者与阴虚火旺组比较均无差异(P0.05);三组间动脉粥样斑块检出率者无显著性差异(P0.05)。结论本研究证实,之所以糖尿病较正常人群更易合并甲亢,主要可能是由疾病本身引起,与患者病史无关。而中医常见证型以阴虚火旺、气阴两虚等虚候为主,病情危重时可表现热盛伤津等实证。患者甲状腺功能、血糖紊乱、血脂异常等相关检查客观参数,也从一定程度支持这一结论。在临床上患者急性发病时,应积极控制甲亢和糖尿病,待检查结果恢复正常后,仍需继续治疗,以巩固患者的阴虚之本。
[Abstract]:Objective to collect the patients with hyperthyroidism complicated with diabetes were compared with simple hyperthyroidism or simple diabetes history, and with the common TCM syndrome type classification, the study of the relationship between different syndromes and patient history and some related parameters of the inspection objective, to seek the internal relations, in order to reveal the severity of hyperthyroidism complicated with diabetes, drug treatment, theory treatment and prognostic assessment of TCM syndrome patterns. Methods according to the unified diagnosis standard and disease characteristics, formulate the inclusion and exclusion criteria, collect hyperthyroidism, diabetes or hyperthyroidism patients with diabetes clinical data of 42 cases, including patients with hyperthyroidism complicated with diabetes as the observation group, simple hyperthyroidism, diabetes mellitus were divided into the control group A, B group. The control study method, comparative history of hyperthyroidism complicated with diabetic patients with simple hyperthyroidism patients with diabetes or simple difference. And with the common TCM syndrome type classification, observation The difference between patients with syndromes of history and some relevant inspection objective parameters. The main common syndromes are divided into heat injury Tianjin, Yindeficiency and Qi and yin deficiency type 3, and the relevant examination included thyroid function (FT3, FT4 and TSH), fasting blood glucose (FPG), glycosylated hemoglobin (Hb A1c), blood lipid (TC, TG, LDL-C and HDL-C) and neck vascular ultrasound, thyroid ultrasound. Results using SPSS19.0 statistical software. Results (1) in hyperthyroid group and hyperthyroidism combined with diabetes mellitus group in sex ratio, average age, comparison, statistics test, there was no significant difference (P0.05), including hyperthyroidism the proportion of women with diabetes than hyperthyroidism with slightly higher, the average age of less than. There were significant differences but not significant in diabetic group and hyperthyroidism combined with diabetes mellitus group (0.01P0.05), the average age of sex had significant difference (P0.01). The diabetes is associated with hyperthyroidism The proportion of women with diabetes is lower, the average age of greater. Hyperthyroidism group, diabetes group and hyperthyroidism combined with diabetes mellitus group compared with dyslipidemia, hypertension, coronary heart disease and other aspects of proportion, by statistical test, there were no significant differences (P0.05). The diabetic patients with hyperthyroidism complicated with hyperthyroidism with dyslipidemia hypertension, history of coronary heart disease were lower than diabetes; hyperthyroidism complicated with diabetic dyslipidemia appears slightly higher proportion of hypertension, coronary heart disease less. (2) the hyperthyroid group and hyperthyroidism and thyroid ultrasound in diabetic patients with goiter, thyroid nodule maximum diameter of 1cm (size) and low echo (echo property comparison) the detection rate, the statistical analysis, no significant difference (P0.05). But in goiter, thyroid nodule maximum diameter of 1cm (size) and low echo ( The detection rate of echo property), hyperthyroidism combined with diabetes mellitus group than in hyperthyroidism group were higher. The diabetic group and hyperthyroidism combined with diabetes mellitus group goiter rate had significant difference (P0.01), thyroid nodule maximum diameter of 1cm (size) and low echo (echo character) the differences in detection rate was not significantly of (P0.05). (3) TCM Syndromes of hyperthyroidism complicated with diabetes, with hyperactivity of fire due to yin deficiency accounted for 52.4%, followed by Qi and yin deficiency (35.7%), and heat injury Tianjin (11.9%) at least. (4) with diabetes syndromes of hyperthyroidism, the average duration of heat injury Tianjin group, and BMI the other two groups, there was significant difference (P0.01), while the remaining two were no significant differences between the three groups (P0.05); in patients with dyslipidemia, hypertension, coronary heart disease, there was no significant difference (P0.05). But the heat injury Tianjin type of short duration, low BMI, dyslipidemia., hypertension, crown 蹇冪梾鐥呭彶灏戣��.(5)鐢蹭孩鍚堝苟绯栧翱鐥呰瘉鍨嬩腑,鐑�鐩涗激娲ョ粍鎮ｈ�匜T3,FT4,TSH,FPG鍜孒b A1c涓庡叾浣欎袱缁勬瘮杈，

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