亚急性甲状腺炎的中医辨证分型及相关因素研究
发布时间：2018-09-09 11:48
【摘要】：目的亚急性甲状腺炎是一种自限性非化脓性甲状腺炎性疾病,其症状主要表现为颈部疼痛不适,经常反复发作,影响患者的生存质量,现通过收集病历,分析概括其常见的中医证型,及其证型分布与年龄、性别及相关客观参数之间的联系,探讨亚急性甲状腺炎的中医证型分布与西医分型的关系,辨证论治指导中医药治疗,研究中西医结合辨证治疗亚急性甲状腺炎的疗效。方法参考《中国甲状腺疾病诊治指南》中的亚急性甲状腺炎西医诊断标准,通过在湖北省中医院甲状腺门诊及光谷内分泌病房收集病历,结合中医四诊辨证分型,陈教授主张将其分为外感风热证、肝郁热毒证、阳虚痰凝证三型,予以辨证论治中药处方加西药治疗,观察患者用药前后的证候积分、一般情况、客观参数、病程时长及中医证型与西医分型的关系,并进行统计学分析。结果1.亚急性甲状腺炎在中医证型分布上,以肝郁热毒证为主占49.51%,其次为外感风热证占35.92%,而阳虚痰凝证占14.56%最少。2.证候疗效:本次观察显示,外感风热证、肝郁热毒证、阳虚痰凝证,三种证型在治疗前后证候积分上,均有显著的统计学差异(P0.05),且阳虚痰凝证与外感风热证、肝郁热毒证有显著的统计学差异(P0.05)。3.血沉、C反应蛋白、血常规等客观参数:外感风热证、肝郁热毒证、阳虚痰凝证三种证型在治疗前后对比,均有显著的统计学差异(P0.05),且肝郁热毒证较其余两组有显著的统计学差异(P0.05)。4.甲状腺功能指标:阳虚痰凝证甲状腺功能FT3、FT4和TSH与其余两组比较差异具有显著性(P0.05),外感风热证与肝郁热毒证比较差异没有显著性(P0.05)。5.病程:亚急性甲状腺炎中医证型中,阳虚痰凝证的平均病程与其余两组比较,有显著性差异(p0.05),而外感风热证与肝郁热毒证比较两者差异无显著性(p0.05)。6.年龄、性别分布上:外感风热证、肝郁热毒证、阳虚痰凝证在性别分布上,无显著的统计学差异(p0.05),均以女性偏多为主,在年龄分布上阳虚痰凝证与其余两组比较,有显著性差异(p0.05),而其余两组间比较差异无显著性(p0.05),阳虚痰凝证年龄较其余两组偏大。7.甲状腺彩超:外感风热证、肝郁热毒证、阳虚痰凝证在结节大小上,有显著的统计学差异(p0.05),在结节个数上差异无显著性(p0.05)。8.中医证型分布与西医分型的关系:西医分型中以普通型占比最高,为35.9%,其次为结节型及甲亢型,均为24.2%,普通型及结节型中以外感风热证最多,甲亢型中以肝郁热毒证最多,而甲状腺炎型及混合型较少。结论1.亚急性甲状腺炎性别分布中,三种证型均以女性占的比重较大,年龄分布上,阳虚痰凝证年龄较其余两组偏大。2.中医证型上分为三型,外感风热证、肝郁热毒证、阳虚痰凝证,其中肝郁热毒证的血沉、c反应蛋白、白细胞计数、中性粒细胞高于其他两种证型,提示肝郁热毒证的病情较之更加严重,可能与甲状腺滤泡破坏更多有关。3.亚急性甲状腺炎外感风热证与肝郁热毒证的甲功指标常提示为ft3↑ft4↑tsh↓,说明这两种证型的亚急性甲状腺炎常有甲亢表现。4.证候积分上,阳虚痰凝证的变化小于其他两种证型,提示阳虚痰凝证的疗效较其余两组欠佳。5.病程上,阳虚痰凝证的平均病程比其余两组耗时更长,提示其多迁延不愈,反复发作。6.甲状腺彩超:阳虚痰凝证的结节大小及结节个数略大于外感风热证及肝郁热毒证。7.中医证型分布与西医分型的关系:中医辨证外感风热证中以西医分型普通型最多,其次为结节型,阳虚痰凝型中以西医分型迁延型最多,西医分型中以普通型占比最高,为35.9%,其次为结节型及甲亢型,均为24.2%,普通型及结节型中以外感风热证最多,甲亢型中以肝郁热毒证最多,而甲状腺炎型及混合型较少。
[Abstract]:Objective Subacute thyroiditis is a self-limited non-suppurative thyroiditis disease. Its main symptoms are pain and discomfort in the neck, frequent recurrence, affecting the quality of life of patients. Through collecting medical records, this paper analyzes and summarizes the common TCM syndromes and their distribution with age, sex and related objective parameters. To explore the relationship between the distribution of TCM syndrome types of subacute thyroiditis and the classification of Western medicine, and to study the curative effect of TCM-WM syndrome differentiation on subacute thyroiditis. Professor Chen advocated dividing the disease into three types: exogenous wind-heat syndrome, liver-depression-heat syndrome, yang-deficiency-phlegm-coagulation syndrome, and treating the patients with traditional Chinese medicine prescription plus Western medicine. Observing the syndrome integral before and after treatment, general situation, objective parameters, duration of disease and TCM syndrome type. Results 1. The distribution of subacute thyroiditis in TCM syndromes was 49.51%, followed by exogenous wind-heat syndrome (35.92%) and Yang-deficiency phlegm-coagulation syndrome (14.56%) at least. 2. Syndrome efficacy: This observation showed that exogenous wind-heat syndrome, liver-depression-heat syndrome, Yang-deficiency phlegm-coagulation syndrome, three syndromes. There were significant statistical differences in syndrome scores before and after treatment (P 0.05), and there were significant statistical differences between Yang-deficiency phlegm coagulation syndrome and exogenous wind-heat syndrome, liver-depression-heat toxicity syndrome (P 0.05). 3. Objective parameters such as erythrocyte sedimentation, C-reactive protein, blood routine: exogenous wind-heat syndrome, liver-depression-heat toxicity syndrome, yang-deficiency-phlegm coagulation syndrome were compared before and after treatment. Significant statistical differences (P 0.05), and liver stagnation-heat toxicity syndrome than the other two groups had significant statistical differences (P 0.05). 4. Thyroid function indicators: Yang deficiency-phlegm coagulation syndrome thyroid function FT3, FT4 and TSH and the other two groups were significantly different (P 0.05), exogenous wind-heat syndrome and liver stagnation-heat toxicity syndrome difference was not significant (P 0.05). 5. Course of disease: sub-acute: heat syndrome The average course of disease of Yang-deficiency phlegm-coagulation syndrome was significantly different from the other two groups (p0.05), but there was no significant difference between exogenous wind-heat syndrome and liver-depression-heat-toxicity syndrome (p0.05). 6. Age, gender distribution: exogenous wind-heat syndrome, liver-depression-heat syndrome, yang-deficiency-phlegm-coagulation syndrome in gender distribution, there was no significant difference. The difference (p0.05), are mainly female, in the age distribution of Yang deficiency phlegm coagulation syndrome compared with the other two groups, there is a significant difference (p0.05), but there is no significant difference between the other two groups (p0.05), Yang deficiency phlegm coagulation syndrome is older than the other two groups.7. Significant statistical difference (p0.05), there was no significant difference in the number of nodules (p0.05). 8. The relationship between the distribution of TCM syndrome types and the classification of Western medicine: the common type accounted for the highest proportion, 35.9%, followed by nodular type and hyperthyroidism type, 24.2%, the common type and nodular type of exogenous wind-heat syndrome was the most, hyperthyroidism type of liver depression-heat syndrome was the most. Conclusion 1. In the sex distribution of subacute thyroiditis, the proportion of the three syndrome types is larger in women, and the age distribution of Yang-deficiency-phlegm-coagulation syndrome is older than the other two groups. 2. TCM syndrome types are divided into three types: exogenous wind-heat syndrome, liver-depression-heat syndrome, Yang-deficiency-phlegm-coagulation syndrome, in which the blood sedimentation rate of liver-depression-heat-toxin syndrome, and C-reflex syndrome. Albumin, white blood cell count and neutrophils were higher than the other two syndrome types, suggesting that the condition of liver depression-heat syndrome was more serious than that of the other two syndrome types, which may be related to the destruction of thyroid follicles. Adenitis often has hyperthyroidism. 4. Syndrome integral, Yang deficiency phlegm coagulation syndrome changes less than the other two types, suggesting that the effect of Yang deficiency phlegm coagulation syndrome is less than the other two groups. The number of small and nodules was slightly larger than that of exogenous wind-heat syndrome and liver-stagnation-heat syndrome. Type A and hyperthyroidism were 24.2%. External wind-heat syndrome was the most common type and nodular type, liver depression-heat toxicity syndrome was the most common type of hyperthyroidism, while thyroiditis type and mixed type were less.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259
本文编号：2232284
[Abstract]:Objective Subacute thyroiditis is a self-limited non-suppurative thyroiditis disease. Its main symptoms are pain and discomfort in the neck, frequent recurrence, affecting the quality of life of patients. Through collecting medical records, this paper analyzes and summarizes the common TCM syndromes and their distribution with age, sex and related objective parameters. To explore the relationship between the distribution of TCM syndrome types of subacute thyroiditis and the classification of Western medicine, and to study the curative effect of TCM-WM syndrome differentiation on subacute thyroiditis. Professor Chen advocated dividing the disease into three types: exogenous wind-heat syndrome, liver-depression-heat syndrome, yang-deficiency-phlegm-coagulation syndrome, and treating the patients with traditional Chinese medicine prescription plus Western medicine. Observing the syndrome integral before and after treatment, general situation, objective parameters, duration of disease and TCM syndrome type. Results 1. The distribution of subacute thyroiditis in TCM syndromes was 49.51%, followed by exogenous wind-heat syndrome (35.92%) and Yang-deficiency phlegm-coagulation syndrome (14.56%) at least. 2. Syndrome efficacy: This observation showed that exogenous wind-heat syndrome, liver-depression-heat syndrome, Yang-deficiency phlegm-coagulation syndrome, three syndromes. There were significant statistical differences in syndrome scores before and after treatment (P 0.05), and there were significant statistical differences between Yang-deficiency phlegm coagulation syndrome and exogenous wind-heat syndrome, liver-depression-heat toxicity syndrome (P 0.05). 3. Objective parameters such as erythrocyte sedimentation, C-reactive protein, blood routine: exogenous wind-heat syndrome, liver-depression-heat toxicity syndrome, yang-deficiency-phlegm coagulation syndrome were compared before and after treatment. Significant statistical differences (P 0.05), and liver stagnation-heat toxicity syndrome than the other two groups had significant statistical differences (P 0.05). 4. Thyroid function indicators: Yang deficiency-phlegm coagulation syndrome thyroid function FT3, FT4 and TSH and the other two groups were significantly different (P 0.05), exogenous wind-heat syndrome and liver stagnation-heat toxicity syndrome difference was not significant (P 0.05). 5. Course of disease: sub-acute: heat syndrome The average course of disease of Yang-deficiency phlegm-coagulation syndrome was significantly different from the other two groups (p0.05), but there was no significant difference between exogenous wind-heat syndrome and liver-depression-heat-toxicity syndrome (p0.05). 6. Age, gender distribution: exogenous wind-heat syndrome, liver-depression-heat syndrome, yang-deficiency-phlegm-coagulation syndrome in gender distribution, there was no significant difference. The difference (p0.05), are mainly female, in the age distribution of Yang deficiency phlegm coagulation syndrome compared with the other two groups, there is a significant difference (p0.05), but there is no significant difference between the other two groups (p0.05), Yang deficiency phlegm coagulation syndrome is older than the other two groups.7. Significant statistical difference (p0.05), there was no significant difference in the number of nodules (p0.05). 8. The relationship between the distribution of TCM syndrome types and the classification of Western medicine: the common type accounted for the highest proportion, 35.9%, followed by nodular type and hyperthyroidism type, 24.2%, the common type and nodular type of exogenous wind-heat syndrome was the most, hyperthyroidism type of liver depression-heat syndrome was the most. Conclusion 1. In the sex distribution of subacute thyroiditis, the proportion of the three syndrome types is larger in women, and the age distribution of Yang-deficiency-phlegm-coagulation syndrome is older than the other two groups. 2. TCM syndrome types are divided into three types: exogenous wind-heat syndrome, liver-depression-heat syndrome, Yang-deficiency-phlegm-coagulation syndrome, in which the blood sedimentation rate of liver-depression-heat-toxin syndrome, and C-reflex syndrome. Albumin, white blood cell count and neutrophils were higher than the other two syndrome types, suggesting that the condition of liver depression-heat syndrome was more serious than that of the other two syndrome types, which may be related to the destruction of thyroid follicles. Adenitis often has hyperthyroidism. 4. Syndrome integral, Yang deficiency phlegm coagulation syndrome changes less than the other two types, suggesting that the effect of Yang deficiency phlegm coagulation syndrome is less than the other two groups. The number of small and nodules was slightly larger than that of exogenous wind-heat syndrome and liver-stagnation-heat syndrome. Type A and hyperthyroidism were 24.2%. External wind-heat syndrome was the most common type and nodular type, liver depression-heat toxicity syndrome was the most common type of hyperthyroidism, while thyroiditis type and mixed type were less.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259
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