【摘要】：目的：近年來,隨著社會經(jīng)濟發(fā)展,甲亢的發(fā)病率與復(fù)發(fā)率與日俱增,病程超過2年的難治性甲亢患者數(shù)量逐年增多。目前甲亢西醫(yī)藥物治療周期大概為2年,漫長的治療周期導(dǎo)致患者醫(yī)從性難以長期良好維持,使病情反復(fù),病程更加遷延。多個研究表明,中西醫(yī)結(jié)合治療甲亢能夠起到縮短治療周期、減少西藥不良反應(yīng)、改善患者癥狀的作用。因此,本研究旨在通過收集甲亢病例,對病例信息進行統(tǒng)計分析,探索甲亢的中醫(yī)證候分布特點,并觀察病程超過2年的甲亢患者的臨床病例特點,以期為日后攻破甲亢治療難關(guān)、縮短療程提供參考意見。方法：研究分為文獻研究和臨床研究兩部分。文獻研究從中醫(yī)角度概況甲亢的病因病機、辨證分型及中醫(yī)特色治療,從西醫(yī)角度歸納其發(fā)病機制和治療研究進展。臨床研究部分,通過調(diào)查自2015年6月至2016年1月在廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院內(nèi)分泌科就診的143例甲亢患者,對符合納入標準的患者,參照傷寒論六經(jīng)辨證及本院優(yōu)勢病種診治標準,采用“二綱六目”分型。設(shè)置信息采集表,記錄甲亢患者的一般情況及中醫(yī)四診信息、實驗室檢查結(jié)果等數(shù)據(jù),對數(shù)據(jù)進行統(tǒng)計分析,總結(jié)甲亢患者的中醫(yī)證候分布特點以及病程超過2年的甲亢患者的臨床病例特點。成果：共納入143例甲亢患者,分為A(病程在2年以內(nèi))、B(病程在2年以上)兩組。其中A組患者占47.55%,B組占52.4596。一般情況方面,性別上,男性、女性分別占總數(shù)的30.07%、69.93%。年齡上,最小年齡11歲,最大年齡70歲,其中45歲以下患者占總數(shù)的70.63%。體重方面,BMI指數(shù)統(tǒng)計表明,低體重、標準體重、超重患者分別占總?cè)藬?shù)的16.8%、67.8%、15.4%。職業(yè)方面,以從事腦力活動或體力活動者為主,占總的69.23%。家族史方面,19.58%患者有明確的甲亢家族史�；橛矫�,已婚已育者占總的65%。癥狀方面,出現(xiàn)頻率最高的前三個癥狀分別是疲乏無力(56.64%)、煩躁易怒(54.55%)、心悸(43.36%)。32.17%患者表示生活壓力較大。根據(jù)“二綱六目”辨證分型,結(jié)果顯示：三陰陽虛寒濕證分布最多,占37.7696,少陽失樞,膽火內(nèi)郁證占30.07%,少陽寒熱錯雜證占22.38%,余證型患者共占總的9.79%。陰證患者居多。其中,67.83%患者出現(xiàn)甲狀腺腫大,48.25%患者眼球突出,19.5896患者有甲狀腺結(jié)節(jié),11.19%患者出現(xiàn)下肢黏液性水腫。甲狀腺腫大、甲狀腺結(jié)節(jié)、突眼征患者證型多見于三陰陽虛寒濕證及少陽失樞,膽火內(nèi)郁證；下肢黏液性水腫患者多見于少陽失樞,膽火內(nèi)郁證。18.18%為甲亢復(fù)發(fā)患者,25.17%患者出現(xiàn)肝損害,8.39%患者出現(xiàn)粒細胞減少,9.09%患者出現(xiàn)合并癥或并發(fā)癥,6.29%患者有甲亢藥物過敏史。肝功能受損、粒細胞減少、甲亢藥物過敏者證型多見于少陽失樞,膽火內(nèi)郁證；復(fù)發(fā)患者多見于少陽失樞,膽火內(nèi)郁證和少陽寒熱錯雜證；有合并癥或并發(fā)癥患者多見于三陰陽虛寒濕證和少陽失樞,膽火內(nèi)郁證。37.21%女性患者有月經(jīng)不調(diào),月經(jīng)后期占月經(jīng)不調(diào)者的59.375%,其證型分布以陰證居多。統(tǒng)計表明：不同性別、職業(yè)在證型分布上差異均無顯著性意義(胗0.05)。在甲功與證型分布方面,不同TSH水平分組在證型分布上差異有顯著性意義(P=0.0020.01)。其中TSH0.01組與TSH 0.06-1.00組在證型分布上差異有顯著性意義(P=0.0070.01),TSH0.01組與TSH1組在證型分布上差異有顯著性意義(P=0.0040.01).TSH≤0.05患者證型分布以陽證居多,TSH≥0.06患者以陰證居多,陽證患者TSH水平普遍低于陰證患者。FT3水平在證型分布上有顯著性差異(P=0.0020.01),其中三陰陽虛寒濕證與少陽失樞,膽火內(nèi)郁證比較差異有顯著性意義(P=0.0000.003),少陽失樞,膽火內(nèi)郁證與少陽寒熱錯雜證比較差異有顯著性意義(P=0.0020.003)。少陽失樞,膽火內(nèi)郁證患者FT3水平高于三陰陽虛寒濕證及少陽寒熱錯雜證。FT4水平在證型分布上差異無顯著性意義(P=0.0570.05)。不同TPOAb組在證型分布上無顯著差異(P=-0.0620.05),19.58%患者TPOAb水平正常,其余患者均高于正常水平。不同TGAb組患者證型分布差異有顯著性意義(P=0.0150.05),27.273%患者TGAb水平正常,其證型分布以陰證居多。綜合TPOAb和TGAb統(tǒng)計學(xué)結(jié)果,多數(shù)患者自身抗體水平出現(xiàn)異常。B組甲亢患者證型分布：三陰陽虛寒濕證少陽失樞,膽火內(nèi)郁證少陽寒熱錯雜證其他證候,以陰證居多。57.33%患者存在甲功異常,73.33%仍有臨床癥狀,26.67%患者服藥不規(guī)律。甲功正常組與異常組在癥狀方面比較差異無顯著性意義(P=0.0670.05),服藥情況比較差異無顯著性意義(P=0.1810.05)。58.67%患者表現(xiàn)為煩躁易怒,37.33%患者有失眠情況,38.67%患者表示生活壓力較大。A、B兩組在復(fù)發(fā)情況(P=0.000)、粒細胞減少(P=0.010)、肝功能受損(P=-0.023)方面比較差異均有顯著性意義(P0.05)。B組復(fù)發(fā)人數(shù)明顯多于A組,在粒細胞減少及肝功能受損上明顯少于A組。A、B兩組間在證型分布及煩躁易怒、失眠、生活壓力大、突眼征、甲狀腺腫大、甲狀腺結(jié)節(jié)、脛前黏液性水腫方面比較差異均無顯著性意義(P0.05)。結(jié)論：143例甲亢患者中,以病程超過2年的甲亢患者居多。各中醫(yī)證型所占比例分布：三陰陽虛寒濕證少陽失樞,膽火內(nèi)郁證少陽寒熱錯雜證其他證候。以虛為主,病性虛實夾雜。本病好發(fā)于青年女性,老年人罕見,已婚人群為主,有一定遺傳傾向。分布比例最大的前三個癥狀分別為疲乏無力、煩躁易怒、心悸。女性月經(jīng)不調(diào)者以月經(jīng)后期多見,其證型分布以陰證居多。體征上多見甲狀腺腫大和突眼征,其中甲狀腺腫大、甲狀腺結(jié)節(jié)、突眼征患者多見于三陰陽虛寒濕證及少陽失樞,膽火內(nèi)郁證；下肢黏液性水腫患者多見于少陽失樞,膽火內(nèi)郁證。粒細胞減少、肝功能受損、甲亢藥物過敏者主要見于少陽失樞,膽火內(nèi)郁證；復(fù)發(fā)患者主要見于少陽失樞,膽火內(nèi)郁證和少陽寒熱錯雜證；有合并癥或并發(fā)癥患者多見于三陰陽虛寒濕證和少陽失樞,膽火內(nèi)郁證。在甲功方面,陽證患者TSH水平普遍低于陰證患者,少陽失樞,膽火內(nèi)郁證患者FT3水平高于三陰陽虛寒濕證及少陽寒熱錯雜證,多數(shù)患者自身抗體水平出現(xiàn)異常。病程超過2年的甲亢患者證型分布以陰證居多,存在情志不調(diào)、生活壓力大、醫(yī)從性欠佳問題,更多見復(fù)發(fā)情況,而病程小于2年的患者更易出現(xiàn)粒細胞減少及肝功能受損。
[Abstract]:Objective: in recent years, with the development of social and economic development, the incidence and recurrence rate of hyperthyroidism have increased with each passing day. The number of patients with refractory hyperthyroidism in more than 2 years is increasing year by year. At present, the period of medicine treatment for hyperthyroidism is about 2 years, and the long period of treatment leads to a good maintenance of the patient's medicine from a long period, and the disease is repeated and the course of the disease is more deferred. Multiple studies have shown that the combination of traditional Chinese and Western medicine can shorten the treatment cycle, reduce the adverse reaction of Western medicine and improve the symptoms of patients. Therefore, the purpose of this study is to collect the cases of hyperthyroidism, to analyze the case information, to explore the characteristics of the syndrome distribution of hyperthyroidism, and to observe the presence of hyperthyroidism in patients with the course of more than 2 years. The characteristics of the bed cases, in order to provide references for the treatment of hyperthyroidism in the future, and to shorten the course of treatment. Methods: the study is divided into two parts: literature research and clinical research. The literature studies the etiology and pathogenesis of hyperthyroidism from the point of view of traditional Chinese medicine, syndrome differentiation and traditional Chinese medicine treatment, and summarize the pathogenesis and treatment research progress from the angle of Western medicine. In the study, 143 cases of hyperthyroidism in the Department of endocrinology of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from June 2015 to January 2016 were investigated. According to the syndrome of typhoid and the diagnosis and treatment of dominant diseases in the hospital, the "two class six order" classification was adopted. The information collection table was set up to record the hyperthyroidism patients. The general situation and the data of four diagnosis and laboratory examination of Chinese medicine and the results of laboratory examination were statistically analyzed, and the characteristics of TCM Syndrome Distribution in hyperthyroidism and the clinical case characteristics of hyperthyroidism patients for more than 2 years were summarized. The results were included in 143 cases of hyperthyroidism, divided into A (the course of disease within 2 years) and B (the course of disease more than 2 years) in two groups. The patients in group A accounted for 47.55%, and group B accounted for the general situation of 52.4596., gender, male and female accounted for 30.07% of the total, 69.93%. age, the minimum age 11 years and the maximum age of 70 years, of which the patients under 45 years of age accounted for the total number of 70.63%. weight, the BMI index statistics showed that low weight, standard weight, overweight patients accounted for 16.8%, 67 of the total number respectively. .8%, 15.4%. professional, mainly engaged in mental activity or physical activity, accounting for the total family history of 69.23%., 19.58% patients have a clear family history of hyperthyroidism. In marriage and childbirth, married children have the total 65%. symptoms, the highest frequency of the first three symptoms are fatigue weakness (56.64%), irritability (54.55%), palpitation (43.36%).32 .17% patients showed great pressure of life. According to the syndrome differentiation of "two classes and six orders", the results showed that three of yin and yang deficiency cold damp syndrome were distributed most, accounted for 37.7696, Shaoyang lost armature, 30.07% in biliary fire, 22.38% in Shaoyang cold and heat mishybrid syndrome, and most of the patients with residual syndrome type accounted for the majority of the total 9.79%. negative patients. 67.83% patients had thyroid enlargement, 48.25 % of the patients had protrusion of the eyeball, 19.5896 had thyroid nodules and 11.19% patients had mucinous edema of the lower extremities. Thyroid enlargement, thyroid nodule, and exophthalmos syndrome were mostly found in three yin and yang deficiency cold damp syndrome and Shaoyang lost armature, qi stagnation in the biliary fire; the patients with myxedema of the lower extremities were mostly seen in the Shaoyang loss armature, and the.18.18% in the choledocholia was a recurrence of hyperthyroidism. There were 25.17% patients with liver damage, 8.39% patients with granulocytic degeneration, 9.09% patients with complications or complications, 6.29% patients with hyperthyroidism allergy history. Liver function damage, granulocytic reduction, hyperthyroidism drug allergy syndrome mostly seen in Shaoyang lost armature, qi stagnation in the bile; most of the recurrent patients in the Shaoyang lost armature, the Qi stagnation within the bile fire and Shaoyang. Syndromes of cold and heat mismix; patients with complications or complications are often seen in three yin yang deficiency cold damp syndrome and Shaoyang lost armature. The.37.21% female patients in the cholera fire syndrome have irregular menstruation and 59.375% of the late menstrual period, whose syndrome distribution is mostly negative syndrome. Statistics show that there is no significant difference in the distribution of syndrome types between different sex. 0.05). In the distribution of thyroid function and syndrome type, there were significant differences in the distribution of TSH level between different levels of group (P=0.0020.01). There was significant difference in the distribution of syndrome type between group TSH0.01 and TSH 0.06-1.00 group (P=0.0070.01), and there was a significant difference in the distribution of syndrome type between group TSH0.01 and TSH1 group (P=0.0040.01).TSH < 0.05 patients. Most of the syndrome type distribution was Yang Syndrome, TSH more than 0.06 patients were mostly Yin Syndrome, and the TSH level of the positive syndrome patients was generally lower than that of the negative syndrome (P=0.0020.01). Among them, three yin and yang deficiency cold damp syndrome and Shaoyang lost armature were significant (P=0.0000.003), Shaoyang lost armature and qi stagnation syndrome in bile and fire. There was significant difference in the difference of cold and heat syndrome in Shaoyang (P=0.0020.003). There was no significant difference in the level of FT3 of the patients with deficiency cold and cold damp syndrome of yin and Yang and the.FT4 level of Shaoyang cold and heat in the syndrome distribution (P=0.0570.05). There was no significant difference in the distribution of syndrome types (P=-0.0620.05) in different TPOAb groups (P=-0.0620.05), and there was no significant difference in the distribution of syndrome type (P=-0.0620.05). The level of TPOAb was normal and the rest of the patients were higher than the normal level. There were significant differences in the distribution of syndrome types in the different TGAb groups (P=0.0150.05). 27.273% patients had normal TGAb level, and the distribution of syndrome type was mostly negative. Comprehensive TPOAb and TGAb statistical results showed that most of the patients' autoantibody level appeared in abnormal.B group hyperthyroidism syndrome type distribution: three yin. Yang deficiency and cold dampness syndrome of Shaoyang lost armature and other syndromes in Shaoyang cold and heat mishybrid syndrome, 73.33% patients with Yin Syndrome were abnormal in thyroid function, 73.33% still had clinical symptoms and 26.67% patients had irregular medication. There was no significant difference in symptoms between normal group and abnormal group (P=0.0670.05), and there was no significant difference in the situation of taking medicine. Significance (P=0.1810.05).58.67% patients showed irritability, 37.33% patients had insomnia, 38.67% patients indicated that life pressure was larger.A, B two groups in recurrence (P=0.000), granulocytic (P=0.010), liver function impairment (P=-0.023), the difference was significant (P0.05) group.B more recurrent than the A group, in the granulocytic reduction. The impairment of liver function was less than that of group A.A, and there was no significant difference between the two groups in the syndrome distribution and irritability, insomnia, life pressure, exophthalmos, thyroid enlargement, thyroid nodules, and pretibial myxedema (P0.05). Conclusion: among the 143 cases of hyperthyroidism, the majority of patients with hyperthyroidism for more than 2 years. The proportion distribution of syndrome type: three yin and yang deficiency cold damp syndrome, Shaoyang lost armature and other syndromes in Shaoyang cold and heat mishybrid syndrome in choledanic fire. The disease is mainly deficiency and false and solid. This disease is well sent to young women, old people are rare, married people are the dominant, and there are certain genetic tendencies. The first three symptoms of the largest distribution are tired and weak, irritable and irritable, respectively. Heart palpitations. Women with irregular menstruation are often seen in the late period of menstruation, whose syndrome distribution is mostly cloudy. There are more thyroid enlargement and exophthalmos on their physical signs, among which thyroid enlargement, thyroid nodules, and exophthalmos are often seen in three Yin Yang dampness damp syndrome and Shaoyang lost armature, qi stagnation in the bile. Depressive syndrome. Granulocytic reduction, liver function damage, hyperthyroidism drug allergy mainly seen in the Shaoyang lost armature, qi stagnation in the bile; the recurrent patients are mainly seen in Shaoyang lost armature, qi stagnation syndrome and Shaoyang cold and heat mishybrid syndrome; the patients with complications or complications are mostly seen in three yin yang deficiency cold damp syndrome and Shaoyang lost armature, qi stagnation syndrome. The level of TSH was generally lower than that of negative syndrome, Shaoyang lost armature, and the level of FT3 was higher than that of yin and yang deficiency cold damp syndrome and Shaoyang cold and heat mishybrid syndrome. The level of self antibody in most patients was abnormal. The distribution of hyperthyroidism in patients with hyperthyroidism in the course of more than 2 years was mostly Yin Syndrome, there was no emotional disorder, great pressure of life, and more problems of medical treatment, and more problems, more problems of medical treatment, and more problems, more problems, more problems of medical treatment, and more problems, more problems, more problems of medical treatment, more problems, more problems, more problems, more problems, more problems of medical treatment, more problems, more problems, more problems of medical treatment, more problems, more problems, more problems of medical treatment, more problems, more problems, more problems of medical treatment, more problems, more problems, more problems, more problems, more problems, more problems, more problems, more problems, more problems, more problems, more problems and more problems. Recurrence was observed, and patients with a course less than 2 years were more likely to suffer from granulocytic reduction and impaired liver function.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259

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