本文選題：甲狀腺機(jī)能減退癥 + 腎陽虛證　； 參考：《廣州中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:本研究將甲狀腺機(jī)能減退癥患者隨機(jī)分為兩組,分別給予治療,觀察兩組患者中醫(yī)癥候積分及甲功、血脂的變化,評(píng)估溫腎陽中藥治療甲狀腺機(jī)能減退癥的臨床療效,為臨床應(yīng)用溫腎陽法治療甲減提供依據(jù)。方法:本研究將84例甲狀腺機(jī)能減退癥患者隨機(jī)分為兩組,對照組42例予優(yōu)甲樂口服治療,治療組42例在優(yōu)甲樂治療的基礎(chǔ)上聯(lián)合溫腎陽中藥(加減右歸丸湯劑)口服,觀察兩組患者中醫(yī)癥候積分及甲功、血脂的變化,評(píng)估溫腎陽中藥治療甲狀腺機(jī)能減退癥的臨床療效,為臨床應(yīng)用溫腎陽法治療甲減提供依據(jù)。成果:1.中醫(yī)癥候積分方面:經(jīng)獨(dú)立樣本t檢驗(yàn),治療前兩組患者在中醫(yī)癥候積分方面的比較的差異無統(tǒng)計(jì)學(xué)意義。提示兩組患者在中醫(yī)癥候方面的基線資料一致,具有可比性。經(jīng)配對樣本t檢驗(yàn),治療后兩組患者自身前后比較其中醫(yī)癥候積分方面的差異均具有統(tǒng)計(jì)學(xué)意義,提示兩種治療方法均可改善患者臨床癥狀。經(jīng)獨(dú)立樣本t檢驗(yàn),兩組患者治療前后癥候積分差值的比較的差異有統(tǒng)計(jì)學(xué)意義(其中腰膝酸軟、肢體浮腫、動(dòng)則氣促三個(gè)癥狀的積分差值的比較的差異無統(tǒng)計(jì)學(xué)意義,其余癥狀及總積分差值的比較的差異有統(tǒng)計(jì)學(xué)意義),提示溫補(bǔ)腎陽中藥配合小劑量優(yōu)甲樂較單純使用優(yōu)甲樂治療甲狀腺機(jī)能減退癥在改善中醫(yī)癥候方面效果更優(yōu)。2.甲功方面:經(jīng)獨(dú)立樣本t檢驗(yàn),治療前兩組患者在甲功方面的比較的差異無統(tǒng)計(jì)學(xué)意義。提示兩組患者在甲功方面的基線資料一致,具有可比性。經(jīng)配對樣本t檢驗(yàn),治療前后兩組患者自身前后比較其甲功方面的差異均具有統(tǒng)計(jì)學(xué)意義,提示兩種治療方法均可改善患者的甲功水平。經(jīng)獨(dú)立樣本t檢驗(yàn),治療后兩組患者甲功差值的比較的差異有統(tǒng)計(jì)學(xué)意義,提示溫補(bǔ)腎陽中藥配合小劑量優(yōu)甲樂較單純使用優(yōu)甲樂治療甲狀腺機(jī)能減退癥在改善甲功水平方面效果更優(yōu)。3.血脂方面:經(jīng)獨(dú)立樣本t檢驗(yàn),治療前兩組患者在血脂方面的比較的差異無統(tǒng)計(jì)學(xué)意義。提示兩組患者在血脂方面的基線資料一致,具有可比性。經(jīng)配對樣本t檢驗(yàn),治療前后兩組患者自身前后比較其血脂方面的差異均具有統(tǒng)計(jì)學(xué)意義,提示兩種治療方法均可改善患者的血脂水平。經(jīng)獨(dú)立樣本t檢驗(yàn),治療后兩組患者血脂差值的比較的差異有統(tǒng)計(jì)學(xué)意義(其中TG治療后差值比較,P=0.2290.05,差異無統(tǒng)計(jì)學(xué)意義),提示溫補(bǔ)腎陽中藥配合小劑量優(yōu)甲樂較單純使用優(yōu)甲樂治療甲狀腺機(jī)能減退癥在改善血脂水平方面效果更優(yōu)。4.治療效果方面:治療后,西藥組42例患者中3例控制,8例顯效,18例有效,13例無效,總有效率為69.05%;中西藥結(jié)合組42例患者中7例控制,16例顯效,16例有效,3例無效,總有效率為92.86%。經(jīng)秩和檢驗(yàn),西藥組與中西藥結(jié)合組治療后臨床療效比較的差異有統(tǒng)計(jì)學(xué)意義,提示溫補(bǔ)腎陽中藥配合小劑量優(yōu)甲樂較單純使用優(yōu)甲樂治療甲狀腺機(jī)能減退癥臨床療效更優(yōu)。5.不良反應(yīng)方面:經(jīng)χ2檢驗(yàn),兩組患者治療后出現(xiàn)心悸、多汗、失眠、煩躁癥狀的人數(shù)的差異有統(tǒng)計(jì)學(xué)意義。提示溫補(bǔ)腎陽中藥配合小劑量優(yōu)甲樂較單純使用優(yōu)甲樂治療甲狀腺機(jī)能減退癥臨床更少出現(xiàn)心悸、多汗、失眠、煩躁等不良反應(yīng),安全性更好。結(jié)論:單純優(yōu)甲樂治療與溫補(bǔ)腎陽中藥聯(lián)合小劑量優(yōu)甲樂治療均可改善患者臨床腎陽虧虛的癥狀,改善甲功水平,使FT3、FT4水平升高,TSH水平下降,并可改善血脂水平。但溫補(bǔ)腎陽中藥配合小劑量優(yōu)甲樂較單純使用優(yōu)甲樂治療甲狀腺機(jī)能減退癥臨床療效更優(yōu),且患者更少出現(xiàn)心悸、多汗、失眠、煩躁等不良反應(yīng),安全性更可靠。
[Abstract]:Objective: This study randomly divided the patients with hypothyroidism into two groups, respectively, to give treatment, to observe the score of TCM syndrome and the change of blood lipid in the two groups, to evaluate the clinical efficacy of Wen Shen Yang in the treatment of hypothyroidism, and to provide the basis for clinical application of temperature and kidney yang to treat hypothyroidism. Methods: 84 cases of thyroidism were used in this study. The patients with adenosine hypogonadism were randomly divided into two groups. 42 cases in the control group were given orally in the treatment group, and 42 cases in the treatment group were combined with warm Kidney Yang traditional Chinese medicine (plus and subtract right return pill) on the basis of yorule therapy. The score of TCM syndrome and the change of blood lipid were observed in the two groups, and the clinical evaluation of Wen Shen Yang Chinese medicine for the treatment of hypothyroidism was evaluated. The curative effect, provide basis for clinical application of warm Kidney Yang method to treat hypothyroidism. Results: 1. TCM syndrome score: the difference of TCM syndrome score in the two groups of patients before treatment is not statistically significant. It suggests that the basis line data of TCM syndrome in the two groups of the two groups are consistent and comparable. By paired sample t examination. After treatment, the differences of TCM syndrome scores in the two groups were statistically significant, suggesting that the two methods could improve the clinical symptoms of the patients. The difference of the difference of symptom score between the two groups before and after the treatment of the two groups was significant (including the soft, swollen limbs, and movement of the waist and knees). There is no statistically significant difference in the difference of the score difference between the three symptoms of Qi, and the difference of the difference of the other symptoms and the difference of the total integral is statistically significant. Independent sample t test, there was no significant difference in the comparison between the two groups before treatment. It suggested that the baseline data of the two groups were consistent and comparable. The difference between the two groups of the two groups before and after the treatment was statistically significant, suggesting two therapeutic parties. The method can improve the level of thyroid function of the patients. After the independent sample t test, the difference of the difference between the two groups of patients after treatment is statistically significant. It is suggested that the effect of warming up kidney yang traditional Chinese medicine with small dose of yoruyle is better than that of thyroidism in the treatment of thyroidism in the improvement of the square surface of thyroidism.3. blood lipid: through independent sample This t test showed no significant difference in blood lipid comparison between the two groups before treatment. It was suggested that the baseline data of blood lipids in the two groups were consistent and comparable. The difference in blood lipids between the two groups before and after the treatment was statistically significant, suggesting that the two treatments were all available. The blood lipid level of the patients was improved. After the independent sample t test, the difference of blood lipid difference between the two groups was statistically significant (in which the difference of TG after treatment was compared, P=0.2290.05, the difference was not statistically significant). The effect of good blood lipid level was better.4. treatment: after treatment, 3 cases were controlled in 42 patients in the western medicine group, 8 cases were effective, 18 cases were effective, 13 cases were invalid, the total effective rate was 69.05%, 42 patients in the middle western medicine group 42 cases were controlled in 7, 16 cases were markedly effective, 16 cases were effective, 3 cases were ineffective, the total effective rate was the rank sum test, western medicine group and Chinese Western medicine combined with the combination. The difference of clinical curative effect after treatment was statistically significant. It was suggested that the clinical effect of warming up kidney yang traditional Chinese medicine and small dose of yorule in treating hypothyroidism was better than that in the treatment of hypothyroidism. The difference of the number of palpitations, hyperhidrosis, insomnia and irritability in the two groups after the treatment was 2. The conclusion: the combination of Dan Chunyou thyroidectomy with warm up kidney yang traditional Chinese medicine combined with small dose of traditional Chinese medicine can improve the clinical kidney of the patients. The symptoms of deficiency of Yang deficiency, improve the level of thyroid function, increase the level of FT3 and FT4, decrease the level of TSH, and improve the level of blood lipid. But the clinical effect of the Chinese medicine with kidney yang and the small dose of yorule is better than that of the simple use of yorule in the treatment of hypothyroidism, and the patients have less palpitations, perspiration, insomnia and irritability, and the safety is more safe. Rely on.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R581.2

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本文編號(hào)：1849832