健脾益肾化浊法治疗桥本甲状腺炎伴甲减的临床研究

发布时间：2018-06-10 15:03

本文选题：桥本甲状腺炎伴甲减 + 健脾益肾化浊法　；参考：《云南中医学院》2017年硕士论文

【摘要】：研究目的本研究采用健脾益肾化浊法治疗证型属脾肾不足兼痰浊的桥本合并甲减的患者,通过对患者治疗前后的甲状腺抗体、甲状腺功能、血脂、临床症状及甲肿程度情况的观察,了解该法对本病的疗效,为本病今后的预防和治疗提供新的方法和思路。研究方法1.选取共计64例于2015年12月--2016年9月在云南省中医医院内分泌科、红会医院中医科住院和门诊的本病患者。治疗组和对照组被随机各分为32例。2.服药方法(1)对照组:使用常规剂量的左甲状腺素钠片(优甲乐(Euthyrox);50μg*100片;批准文号:注册证号H20100523;德国默克公司)进行治疗(根据患者的具体情况,在医生指导下,起始剂量为每天服用1/4片,逐渐增加剂量至1/2片,间隔2-4周,最大增加到每天1-2片)。(2)治疗组:在常规使用左甲状腺素钠片(同对照组)的基础上加服中药二仙参草汤,每日一剂。二仙参草汤服法:每剂冷水煎450ml,水煎20min,分三次温服,每天一付。3.疗程:治疗组和对照组都以4周为一疗程,共治疗两个疗程。4.主要观察内容:治疗前后甲状腺相关免疫学指标、甲状腺激素水平、血脂、甲状腺彩超及症状等变化情况。研究结果1.桥本甲状腺炎并甲状腺功能减退症属脾肾亏虚兼痰浊证的患者共64例。男性11例(17.19%),女性53例(82.81%),男女之比约为1:4.8;年龄在16-75岁,平均54.97±15.95岁。2.治疗前:两组的年龄、性别、甲状腺激素水平、甲状腺相关免疫学指标、血脂、甲状腺肿大情况、症状和疗效经统计学处理(49)0.05,无显著性差异,有可比性。3.治疗后:(1)降低甲状腺抗体方面:治疗组治疗前后比较有明显差异((49)0.01),对照组治疗前后比较无统计学意义((49)0.05)。治疗后两组组间比较(49)0.01,说明治疗组在降低甲状腺抗体方面较对照组有明显治疗效果。(2)改善甲状腺功能方面:治疗组治疗后FT3、FT4水平与治疗前比较显著升高((49)0.01),治疗后TSH水平与治疗前比较显著下降((49)0.01)。说明治疗组能显著改善甲状腺功能;对照组治疗后FT3和FT4都有升高,(49)0.01,TSH水平与治疗前比较显著降低,(49)0.01。说明对照组也能有效改善甲状腺功能;治疗后两组组间甲状腺功能比较:TSH(49)0.05,FT3(49)0.05,无统计学差异;FT4(49)0.05,有差异,说明在甲状腺功能改善方面治疗组和对照组无差异性。(3)降脂方面:治疗组治疗前后比较:TG、CHOL、HDL-C、LDL-C方面均有明显改善((49)0.01)。而对照组在改善TG、CHOL、HDL-C、LDL-C均无显著差异((49)0.05)。治疗后两组血脂比较:治疗组明显优于对照组((49)0.01)。(4)在临床症状改善方面:治疗组治疗后临床症状改善较治疗前显著治疗后与治疗前的差值分别为-9.91±5.81和-0.33±1.45,治疗组对症状的改善作用明显优于对照组((49)0.01)。(5)在甲状腺肿大程度改善方面:治疗组和对照组在改善甲状腺肿大方面无明显差异,均没有显著疗效((49)0.05)。(6)疗效评价:按桥本甲减疗效评定标准、中医症候疗效评定标准对所有实验对象进行评价:治疗组显效19列,有效13列,对照组显效10例,有效22例,治疗组疗效好于对照组(?2=4.661,P=0.031)(7)治疗组患者在服药后无明显不良反应。研究结论桥本甲减属脾肾不足兼痰浊型患者,通过运用二仙参草汤治疗,并与对照组比较,发现可以调节异常甲状腺功能水平,降低甲状腺抗体及血脂,缓解和改善临床症状,临床疗效显著,安全可靠,拥有广阔的应用前景;但在缩小甲状腺肿大情况方面,暂未发现有明显疗效,这可能以观察的时间及数量有限有关。
[Abstract]:Objective to study the treatment of Hashimoto with hypothyroidism with spleen and kidney deficiency and phlegm turbidity by strengthening spleen and kidney and turbidity method. Through observation of thyroid antibody, thyroid function, blood lipid, clinical symptoms and degree of swelling of the patients before and after treatment, the effect of this method on the disease is understood and provided for the prevention and treatment of the disease in the future. New methods and ideas. Method 1. a total of 64 cases were selected in the Department of Endocrinology, Yunnan traditional Chinese medicine hospital, Yunnan Province, September December 2015, and the patients in the hospital and outpatient department of Honghui hospital. The treatment group and the control group were randomly divided into 32 cases of.2. medicine (1) control group: Levothyroxine Sodium Tablets (Euth) with regular dose (Euth Yrox); 50 mu g*100 tablets; Approval Number: registration number H20100523; German Merck Co) for treatment (according to the patient's specific circumstances, under the guidance of a doctor, the initial dose of 1/4 tablets daily, gradually increased to 1/2 tablets, interval 2-4 weeks, maximum to 1-2 tablets per day). (2) treatment group: in the routine use of Levothyroxine Sodium Tablets (control group) On the basis of the traditional Chinese medicine Erxian Shen grass soup, a daily dose of Erxian Shen Cao Decoction: each dose of cold water decoction 450ml, water decocted 20min, three times warm clothes, one day for a period of.3. treatment: the treatment group and the control group are 4 weeks for a course of treatment, a total of two courses of treatment of the main contents of the thyroid immunology indexes, thyroid hormone levels before and after treatment. Research results 1. Hashimoto's thyroiditis and hypothyroidism are 64 cases of spleen and kidney deficiency and phlegm syndrome. 11 men (17.19%), 53 women (82.81%), women and men are about 1:4.8; age 16-75, and before.2. treatment of 54.97 + 15.95 years old: two groups of age, sex, thyroid gland Hormone level, thyroid related immunological index, blood lipid, goiter, symptoms and curative effect were statistically treated (49) 0.05, no significant difference, (1) reduction of thyroid antibody: the treatment group before and after treatment was significantly different (49) 0.01 ((49)) before and after treatment (49) 0.05 (49). After treatment, the comparison between the two groups (49) was 0.01, indicating that the treatment group had obvious therapeutic effect in reducing thyroid antibody compared with the control group. (2) to improve the thyroid function, the level of FT3 in the treatment group was significantly higher ((49) 0.01) after treatment ((49) 0.01). The level of TSH in the treatment group was significantly decreased after treatment (49) 0.01. The thyroid function was improved; FT3 and FT4 in the control group were increased, (49) 0.01, and the level of TSH was significantly lower than before treatment. (49) 0.01. showed that the control group could also effectively improve the thyroid function. The thyroid function of the two groups after treatment: TSH (49) 0.05, FT3 (49) 0.05, FT4 (49) 0.05, there were differences, indicating thyroid gland in the thyroid gland. There was no difference between the treatment group and the control group. (3) in the treatment group, there was a significant improvement in TG, CHOL, HDL-C, and LDL-C before and after treatment ((49) 0.01). The control group had no significant difference (49) in the improvement of TG, CHOL, HDL-C, LDL-C (0.05). The treatment group was significantly better than the control group (49) 0.01. (4) in the treatment group. The improvement of bed symptoms: the difference between the clinical symptoms after treatment and before treatment was -9.91 + 5.81 and -0.33 + 1.45, respectively. The improvement of the symptoms in the treatment group was significantly better than that of the control group (49) 0.01. (5) the improvement of the thyroid enlargement: the treatment group and the control group were in the improvement of the thyroid enlargement. There was no significant difference (49) ((6) 0.05). (6) the evaluation of curative effect: according to the evaluation standard of hypothyroidism, the evaluation standard of TCM syndrome effect was evaluated: 19 in the treatment group, 13 in effective, 10 in the control group and 22 in the control group. The curative effect of the treatment group was better than that of the control group (2=4.661, P=0.031) (7) in the treatment group. There is no obvious adverse reaction after taking the medicine. Conclusion Hashimoto hypothyroidism is the patients with spleen and kidney deficiency and phlegm turbid type. By using Erxian Shen Cao Decoction and compared with the control group, it is found that it can regulate abnormal thyroid function level, reduce thyroid antibody and blood lipid, alleviate and improve clinical symptoms. The clinical effect is significant, safe and reliable, and has broad and safe clinical effect. Application prospects; however, no significant effect has been found in reducing the size of thyroid enlargement, which may be related to the limited time and quantity of observation.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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