理气消瘿方治疗结节性甲状腺肿的临床疗效观察

发布时间：2018-10-07 20:48

【摘要】：目的:观察理气消瘿方治疗结节性甲状腺肿的临床疗效,探讨结节性甲状腺肿的病因病机及理气消瘿方治疗结甲的作用机制,为治疗结甲提供更为优化的方案,从而发挥中医药在辨证治疗结甲方面的特色和优势。方法:收集70例符合诊断标准的结甲病例,采用治疗前后自身对照研究,于实验入组当天给予理气消瘿方口服治疗,3个月为1个疗程,共治疗2个疗程。观察统计治疗前后相关指标(如患者临床症状、体征,甲状腺及结节的大小,实验室指标等),进行疗效判定及数据分析比较。结果:(1)治疗前与治疗后中医症候积分比较:治疗3个月及6个月的中医症候总积分与治疗前症候总积分对比均有明显改变,有显著统计差异(p0.01);个别症状(如甲状腺肿大)在1个疗程结束后没有明显变化(p0.05),但随着疗程的增加,症状亦逐渐好转,有明显的差异(p0.01);(2)结节大小与中医症候积分关系的比较:结节直径为2-3cm与直径小于2cm比较,在吞咽梗阻、咽喉异物感症候方面有显著性差异(p0.01);结节直径大于3cm与结节直径小于2cm比较,在咽喉异物感、吞咽梗阻症候方面亦有显著统计学意义(p0.01),在呼吸不畅症候方面有统计学意义(p0.05);除此之外在其他症候方面,结节大小互相间的比较无统计学意义,结果说明结节大小主要引起患者呼吸、吞咽及咽喉的不适,且大于2cm以上的结节引起上述症状更常见。(3)三种类型结节的疗效及与疗程的比较:囊性、实性及囊实性三种结节在治疗1个疗程后总有效率分别为:80%、45%、67.5%;治疗2个疗程后总有效率分别为100%、75%、92.5%。在同一疗程,囊实性结节与实性结节疗效比较均有统计差异(p0.05),同时结果显示每种类型的结节,2个疗程后的总有效率分别高于1个疗程;(4)治疗前与治疗后甲状腺体积及结节最大直径比较:治疗2个疗程后,甲状腺的体积及结节的最大直径较治疗前具有显著统计学意义(p0.01),治疗2个疗程后甲状腺体积及结节的最大直径与治疗1个疗程比较,有统计意义(p0.05),治疗1个疗程后甲状腺的体积及结节的最大直径较治疗前无显著性差异(p0.05);(5)甲状腺结节大小与疗效关系:与治疗前结节的直径小于2cm、2-3cm和3cm以上相比,在2个疗程结束后不同直径结节的总有效率分别为95.74%、87.23%、68.75%;治疗1个疗程后不同直径结节总有效分别为76.6%、48.94%、62.5%,对同一范围直径的结节,2个疗程结束后的总有效率均较1个疗程的总有效率高;(6)毒副作用:治疗前后甲状腺功能(FT3、FT4、TSH、TGAb、TPOAb)、血常规(WBC)及肝肾功能(ALT、AST、BUN、CREA)无显著差异(p0.05)。结论:理气消瘿方可以有效改善结甲患者的临床症状、缩小甲状腺体积及结节的大小,且毒副作用小。表明理气消瘿方在辨证治疗结甲方面具有显著的特色和优势。
[Abstract]:Objective: to observe the clinical effect of Liqi Xiaoying recipe in the treatment of nodular goiter, to explore the etiology and pathogenesis of nodular goiter and the mechanism of Liqi Xiaoying prescription in the treatment of nodular goiter, so as to provide a better scheme for the treatment of nodular goiter. So as to give play to the characteristics and advantages of traditional Chinese medicine in the treatment of syndrome differentiation. Methods: 70 cases of nodular A were collected and treated by self-control study before and after treatment. The patients were treated orally with Liqi Xiaoying recipe on the day of experiment, 3 months as a course of treatment, 2 courses of treatment. The clinical symptoms, signs, size of thyroid and nodule, laboratory indexes were observed before and after treatment, and the curative effect and data were analyzed and compared. Results: (1) comparison of TCM symptom scores before and after treatment: the total scores of TCM symptoms after 3 and 6 months of treatment were significantly different from those before treatment. There were significant statistical differences (p0.01), individual symptoms (such as goiter) did not change significantly after one course of treatment (p0.05), but with the increase of the course of treatment, the symptoms gradually improved. There was a significant difference (p0.01); (2) in the relationship between nodule size and TCM symptom score: the diameter of nodules was 2-3cm and smaller than that of 2cm, and the diameter of the nodules was less than that of 2cm in the patients with dysphagia. There was significant difference in the symptoms of foreign body in throat (p0.01), the diameter of nodule was larger than that of 3cm and the diameter of nodule was smaller than that of 2cm. There was also significant difference in the symptoms of swallowing obstruction (p0.01), and in the symptoms of dyspnea (p0.05). In addition, there was no significant difference between nodule size and size in other symptoms. The results showed that the nodule size mainly caused the discomfort of breathing, swallowing and throat in the patients, and the above symptoms were more common in the nodules larger than 2cm. (3) the curative effect of the three types of nodules and the comparison with the course of treatment: cystic, or not. After one course of treatment, the total effective rates of solid and cystic nodules were 67.50.The total effective rates after two courses of treatment were 1000.75 and 92.5, respectively. In the same course, The results showed that the total effective rate of each type of nodules was higher than that of one course of treatment. (4) the thyroid volume and nodule were the largest before and after treatment. Diameter comparison: after 2 courses of treatment, The volume of thyroid gland and the maximum diameter of nodule were significantly higher than those before treatment (p0.01). After two courses of treatment, the volume of thyroid and the maximum diameter of nodule were compared with that of one course of treatment. There was statistical significance (p0. 05). There was no significant difference between the volume of thyroid gland and the maximum diameter of thyroid nodules after one course of treatment (p0. 05); (5). The size of thyroid nodules was correlated with the curative effect. The diameter of the nodules before treatment was less than 2 cm ~ 2 ~ 3 cm and the diameter of 3cm was more than 2 cm ~ 3 cm. After two courses of treatment, the total effective rate of different diameter nodules was 95.7447.23and 68.75.The total effective rate of different diameter nodules after one course of treatment was 76.6n 48.94 and 62.5, respectively. For nodules of the same diameter, the total effective rate after two courses of treatment was all higher than that after one course of treatment. (6) side effects: thyroid function (FT3,FT4,TSH,TGAb,TPOAb), blood routine (WBC) and liver and kidney function (ALT,AST,BUN,CREA) had no significant difference before and after treatment (p0.05). Conclusion: Liqi Xiaoying prescription can effectively improve the clinical symptoms, reduce the volume of thyroid gland and the size of nodule, and the toxic side effect is small. It shows that Liqi Xiaoying prescription has remarkable characteristics and advantages in treating nail knot by differentiation of symptoms and signs.
【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】：2016
【分类号】：R259

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