芪夏消瘿合剂干预育龄期女性桥本甲状腺炎甲减患者的疗效及与性激素的相关性研究

发布时间：2018-02-28 02:19

本文关键词： 桥本甲状腺炎甲减期育龄期女性芪夏消瘿合剂泌乳素雌二醇孕酮　出处：《安徽中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:以芪夏消瘿合剂(原名“夏芍消瘿合剂”)为基本方治疗育龄期女性桥本甲状腺炎甲减期患者,观察其临床疗效及患者性激素的改善情况,并探索性激素与桥本甲减的相关性,以引起临床对育龄期女性甲状腺疾病患者的生殖内分泌功能的关注,为中医药治疗本病提供新的思路和方法。方法:(1)选取30例无甲状腺疾病的健康育龄期女性体检者作为健康体检组,与60例符合纳入条件的育龄期女性桥本甲状腺炎甲减患者组,比较两组患者的月经第3-5天性激素水平,根据统计学处理分析两组是否存在差异性。(2)根据随机对照临床观察原则,将60例符合纳入条件的育龄期女性桥本甲状腺炎甲减期同时中医辨证属肝郁脾虚兼夹肾虚证的患者分为治疗组和对照组。对照组给予左旋甲状腺素钠进行常规治疗;治疗组在进行左旋甲状腺素钠治疗的基础上加服芪夏消瘿合剂,一日一剂,疗程三个月经周期。观察治疗后两组的甲状腺激素水平、甲状腺抗体水平、月经第3-5天性激素水平的变化及中医症候积分的变化,经统计学处理后评定临床疗效。结果:(1)经对比发现,桥本甲状腺炎甲减组泌乳素(Prolactin,PRL)较健康体检组升高,雌二醇(Estradiol,E2)、孕酮(Progesterone,PROG)较健康体检组降低,两组差异均具有统计学意义(P0.01)。(2)(1)桥本甲状腺炎甲减患者经治疗后,对照组与治疗组FT3、FT4均较治疗前上升,TSH较治疗前下降,甲状腺球蛋白抗体(TGAb)和甲状腺过氧化物酶(TPOAb)抗体滴度分别较治疗前下降,两组治疗前后FT3、FT4、TSH、TPOAb、TGAb抗体滴度均有显著性差异(P0.01);组间比较,治疗组血清FT3、FT4升高水平,血清TSH及TPOAb、TGAb抗体滴度降低水平均优于对照组(P0.05),芪夏消瘿合剂在改善FT3、FT4、TSH及TPOAb、TGAb抗体滴度方面优于单纯西药。(2)桥本甲状腺炎甲减患者经治疗后,两组PRL均有下降,但治疗组泌乳素降低较对照组显著(P0.01);两组雌二醇(Estradiol,E2)治疗后均有增高,但治疗组比对照组雌二醇增高显著(P0.05)。(3)桥本甲状腺炎甲减患者经治疗之后,临床疗效进行比较,芪夏消瘿治疗组的总有效率达93.33%,常规治疗对照组的总有效率达76.67%,治疗组总有效率高于对照组(P0.05)。(4)芪夏消瘿合剂在安全性方面,本方不良反应较少,安全性及依从性好。结论:(1)育龄期女性桥本甲状腺炎甲减期患者与健康女性相比存在一定程度的性激素水平紊乱。(2)在替代疗法基础上加用芪夏消瘿合剂进行治疗之后,可以明显改善育龄期女性桥本甲状腺炎甲减期患者的甲状腺激素水平,有效减低患者的甲状腺自身抗体TGAb、TPOAb滴度,调节异常的女性生殖内分泌激素,减轻甲状腺组织的破坏,恢复甲状腺功能,从而改善女性生殖内分泌功能,缓解临床症状,提高治愈率。芪夏消瘿合剂治疗组的各项指标均优于对照组。本方不良反应较少,依从性好。
[Abstract]:Objective: to treat female Hashimoto thyroiditis patients with hypothyroidism by using Qi-Xia Xiao-ying mixture (formerly named "Xia Shao Xiao Ying mixture") as the basic prescription, and to observe the clinical effect and the improvement of sex hormone in the patients. And to explore the correlation between sex hormone and Hashimoto hypothyroidism in order to arouse clinical attention to reproductive endocrine function of female patients with thyroid disease of childbearing age. Methods 30 healthy women of childbearing age without thyroid disease were selected as the healthy physical examination group, and 60 women with Hashimoto's thyroiditis of childbearing age who were eligible for inclusion were selected as the healthy physical examination group, and 60 patients with Hashimoto's thyroiditis of childbearing age were included in the study. To compare the sex hormone levels at day 3-5 of menstruation between the two groups, and to analyze whether there was any difference between the two groups according to statistical analysis) according to the principle of randomized controlled clinical observation, Sixty cases of female Hashimoto's thyroiditis of childbearing age were divided into treatment group and control group according to syndrome differentiation of liver stagnation and spleen deficiency and kidney deficiency, and the control group was given routine treatment with levothyroxine sodium. The treatment group was treated with levothyroxine sodium plus Qixia Xiaoying mixture, one dose on 1st for three menstrual cycles. The thyroid hormone level and thyroid antibody level were observed in the two groups after treatment. The changes of sex hormone level on the 3-5 day of menstruation and the change of TCM symptom score were evaluated after statistical treatment. Results: compared with the control group, Prolactinus prolactinus PRL in Hashimoto thyroiditis hypothyroidism group was higher than that in healthy control group. Estradiol estradiol (Estradiolol), Progesterone prog (prog) were significantly lower than those in the control group (P 0.01). After treatment, the TSH levels in the control group and the treatment group were higher than those before treatment, and the levels of TSH in both the control group and the treatment group were lower than those before treatment, and the difference between the two groups was statistically significant (P < 0.01) after treatment, FT3 / FT4 levels in the control group and the treatment group were higher than those before treatment. The titers of TGAband TPOAb-thyroid peroxidase (TPOB) antibody were lower than those before and after treatment, and there were significant differences in the titer of TGAband TPOAbb antibody between the two groups before and after treatment (P < 0.01), and the serum FT _ 3 / FT _ 4 level in the treatment group was higher than that in the control group, and there was a significant difference between the two groups in the titer of TGAband TPO-TGAb before and after treatment (P < 0.05). The titers of serum TSH and TPOAb TGAb antibody were higher than those of control group (P 0.05). Qi-Xia Xiao Ying mixture was superior to western medicine. After treatment, the PRL in both groups was lower than that in the control group in improving the titer of FT _ 3, FT _ 4, TGA _ (4) and TPO _ (2) TGA _ (2) after treatment, the levels of PRL in both groups were significantly lower than those in control group (P < 0.05). However, the prolactin level in the treatment group was significantly lower than that in the control group (P 0.01), and the estradiol estradiol E2 (Estradiolol E2) in both groups was higher than that in the control group (P < 0.05. 3) after treatment, the clinical efficacy of the patients with Hashimoto's thyroiditis was compared. The total effective rate of Qixia Xiaoying treatment group was 93.33 and that of routine treatment control group was 76.67. The total effective rate of treatment group was higher than that of control group (P0.05P0.05P.P0.05.P0. 4) the safety of Qixia Xiaoying mixture was less than that of routine treatment group, and the side effect of Qxixiaoxiaoying mixture was less than that of control group. Conclusion there is a certain degree of sex hormone disorder in female patients with Hashimoto's thyroiditis during hypothyroidism compared with that of healthy women. [conclusion] after the treatment of Qixia Xiaoying mixture on the basis of substitution therapy, there is a certain degree of sex hormone disorder in female patients with Hashimoto's thyroiditis. It can obviously improve the thyroid hormone level of female patients with Hashimoto's thyroiditis at the stage of hypothyroidism, reduce the titer of thyroid autoantibody TGAb-TPOAb, regulate the abnormal female reproductive endocrine hormone, and alleviate the destruction of thyroid tissue. Restore thyroid function, improve female reproductive endocrine function, alleviate clinical symptoms, improve the cure rate. Qi-Xia Xiao-ying mixture treatment group is superior to the control group, the side effect of this prescription is less, compliance is good.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

【相似文献】