益肾健脾方对育龄期桥本甲减女性孕前调理的临床疗效观察

发布时间：2018-05-01 14:12

本文选题：益肾健脾方 + 桥本甲状腺炎　；参考：《南京中医药大学》2017年硕士论文

【摘要】：目的:观察育龄期桥本甲减女性使用益肾健脾方进行孕前调理后在甲状腺功能、甲状腺自身抗体水平、甲状腺体积大小及峡部厚度及中医证候等方面的临床疗效,并评估其安全性。为临床使用中医中药对育龄期的桥本甲减女性患者进行孕前调理提供理论依据。方法:根据桥本甲状腺炎合并甲状腺功能减退的西医诊断标准,中医辨证属肾阳亏虚、脾虚痰凝证,选取临床上符合以上两个诊断标准的20～40岁育龄期备孕女性患者60例进行观察,采用随机对照方法将60例患者分为治疗组和对照组。对照组30例患者单纯予常规优甲乐治疗;治疗组30例患者在予常规优甲乐治疗的基础上,加用益肾健脾方水煎剂,早晚口服,两组均观察12周。主要观察指标:甲状腺激素水平(FT3、FT4、TSH),甲状腺相关抗体水平(TGAb、TMAb),甲状腺弹性B超(甲状腺体积、峡部厚度)以及中医临床症状、体征的变化,同时评价患者的不良反应和依从性情况。结果:基线比较,治疗前两组的年龄和病程等经统计学分析无显著差异(P0.05),有可比性。①甲状腺激素水平:治疗前后组内比较,治疗后两组血清TSH水平较治疗前显著下降,血清FT3、FT4水平较治疗前显著上升,差异均有统计学意义(P0.01);组间比较,治疗组FT3、FT4水平升高幅度明显高于对照组(P0.01),血清TSH水平降低程度较对照组更为显著(P0.01),差异均有统计学意义。②甲状腺抗体水平:治疗前后组内比较,治疗后治疗组与对照组TGAb水平和TMAb水平较治疗前均显著降低,差异有统计学意义(P0.01);组间比较,治疗组TGAb水平下降幅度显著优于对照组(P0.01),治疗组TMAb水平下降幅度显著优于对照组,差异均有统计学意义(P0.01)。③甲状腺体积和峡部厚度:治疗前后组内比较,治疗后甲状腺体积及峡部厚度较治疗前均显著下降(P0.01);组间比较,治疗组甲状腺体积及峡部厚度改变程度均优于对照组(P0.05或0.01),均有统计学意义。④证候疗效:治疗组总有效率86.67%;对照组总有效率53.33%,治疗组证候改善显著优于对照组(P0.05)。⑤安全性:两组患者的血、尿、粪常规以及肝肾功能均在正常水平范围内,安全性良好,服药后未见明显副作用。结论:使用益肾健脾方对育龄期桥本甲减女性患者进行孕前调理,能明显改善患者的甲状腺功能及甲状腺抗体滴度水平,减小甲状腺体积和峡部厚度,并能显著改善患者的临床症状和体征,未出现明显不良反应,疗效确切,安全可靠。
[Abstract]:Objective: to observe the clinical effects of Yishen Jianpi recipe on thyroid function, thyroid autoantibody level, thyroid volume size, isthmus thickness and TCM syndromes in women of childbearing age. And evaluate its safety. To provide a theoretical basis for the clinical use of traditional Chinese medicine for the reproductive age of female patients with Hashimoto hypothyroidism before pregnancy. Methods: according to the diagnostic criteria of Hashimoto's thyroiditis combined with hypothyroidism, TCM syndrome differentiation is deficiency of kidney yang, spleen deficiency and phlegm coagulation syndrome. Sixty pregnant women aged 20 ~ 40 years old who met the above two diagnostic criteria were selected for observation, and 60 cases were divided into treatment group and control group by randomized control method. 30 patients in the control group were treated with routine euthyroidism alone, and 30 patients in the treatment group were treated with Yishen Jianpi decoction on the basis of routine treatment. Both groups were observed for 12 weeks. Main outcome measures: thyroid hormone level FT3 / FT4 / TSHN, thyroid associated antibody level / TGAbT / TMAbA, thyroid elasticity B ultrasound (thyroid volume, isthmus thickness), and changes of clinical symptoms and signs of TCM. Adverse reactions and compliance of the patients were evaluated at the same time. Results: compared with baseline, there was no significant difference in age and course of disease between the two groups before treatment (P 0.05). 1 thyroid hormone level was comparable. 1 the serum TSH level of the two groups decreased significantly after treatment compared with that before and after treatment. The serum FT _ 3 FT _ 4 level was significantly higher than that before treatment, and the difference was statistically significant (P 0.01). The level of FT3 FT-4 in the treatment group was significantly higher than that in the control group (P 0.01), and the decrease of serum TSH level was more significant than that in the control group (P 0.01). The difference was statistically significant. 2. The level of thyroid antibody in the treatment group was higher than that in the control group before and after treatment. After treatment, the levels of TGAb and TMAb in the treatment group and the control group were significantly lower than those before the treatment, and the difference was statistically significant (P 0.01). Compared with the control group, the TGAb level in the treatment group was significantly lower than that in the control group (P 0.01), and the TMAb level in the treatment group was significantly lower than that in the control group. There were significant differences in thyroid volume and isthmus thickness before and after treatment. The thyroid volume and isthmus thickness decreased significantly after treatment. The changes of thyroid volume and isthmus thickness in the treatment group were better than those in the control group (P0.05 or 0.01), and there were statistically significant effects on the syndromes of the treatment group: the total effective rate of the treatment group was 86.67, the total effective rate of the control group was 53.33, and the improvement of the syndrome in the treatment group was significantly better than that in the control group. Safety of P0.05: blood from two groups of patients, Urine, fecal routine and liver and kidney function were in normal range, safety was good, no side effects were observed after taking medicine. Conclusion: using Yishen Jianpi recipe to regulate the thyroid function and thyroid antibody titer of female patients with Hashimoto hypothyroidism during childbearing period can obviously improve the thyroid function and thyroid antibody titer and decrease the thyroid volume and isthmus thickness. It can significantly improve the clinical symptoms and signs of the patients, no obvious adverse reactions, the curative effect is accurate, safe and reliable.
【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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