本文選題：橋本病 + 貞芪扶正膠囊　； 參考：《河北醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:橋本病是甲狀腺炎中最常見的一種疾病,但是該病發(fā)病隱匿,并且早期臨床癥狀不明顯且無特異性。由于絕大多數(shù)患者的發(fā)病比較緩慢,常常以無癥狀性的甲狀腺結(jié)節(jié)或腫塊就診,少數(shù)患者有憋氣、呼吸不暢、乏力、頸部疼痛、頸部異樣感。體檢可見其甲狀腺彌漫性腫大,或呈腫塊分葉狀,存在多個(gè)大小不等的結(jié)節(jié),表面不平,質(zhì)地偏硬。該病在血清學(xué)上主要依據(jù)的是甲狀腺功能指標(biāo)。因其在不同的階段具有不同的甲狀腺功能指示值,初期甲狀腺功能可能是正常的,但是對于I-131的攝取率可能會(huì)輕度升高,而血清中游離三碘甲狀腺氨酸(FT3),游離甲狀腺素(FT4)會(huì)在正常值范圍內(nèi)。隨著甲狀腺攝碘率試驗(yàn)(RAIU)以及蛋白結(jié)合碘(PBI)的升高,甲狀腺的儲(chǔ)備功能也會(huì)降低,血清中的TSH會(huì)升高。從而表現(xiàn)為甲亢性橋本病患者的血清中游離三碘甲狀腺氨酸(FT3),游離甲狀腺素(FT4)升高,晚期最終會(huì)發(fā)展成為甲狀腺功能減退,I-131的攝取率降低,基礎(chǔ)代謝率也會(huì)降低,追究其原因,可能是由于甲狀腺實(shí)質(zhì)逐漸被淋巴細(xì)胞或是纖維組織取代。橋本病及其復(fù)雜的病理性過程使該病確診有一定的難度,并且誤診率極高,更關(guān)鍵的是目前沒有安全快捷有效的治療方法,本研究擬對通過觀察聯(lián)合貞芪扶正膠囊治療伴甲狀腺功能減退型橋本病的療效來探索該病的新型療法的研究進(jìn)行回顧性總結(jié),進(jìn)行以貞芪為主的中西醫(yī)結(jié)合治療橋本甲狀腺炎的Meta分析,以便為該病的新型療法提供有力證據(jù)。方法:將符合研究標(biāo)準(zhǔn)的甲減型橋本病患者60例隨機(jī)平均分為兩組,試驗(yàn)組和對照組,試驗(yàn)組給予左甲狀腺素鈉片聯(lián)合貞芪扶正膠囊治療,對照組采用常規(guī)單純左甲狀腺素鈉給藥治療,通過觀察患者血清中各種甲狀腺激素水平(TSH,FT3,FT4)和相關(guān)抗體的水平(TPOAb,TGAb)以及臨床癥狀的改善情況研究兩種不同療法的效果。對已有的研究結(jié)果進(jìn)行檢索匯總,并利用Meta分析的方法和SATAT軟件(Version 13.0)及統(tǒng)計(jì)學(xué)的方法對中藥聯(lián)合西藥治療效果進(jìn)行評估。結(jié)果:治療結(jié)束后試驗(yàn)組和對照組的患者血清中游離三碘甲狀腺氨酸(FT3),游離甲狀腺素(FT4)水平差異具有統(tǒng)計(jì)學(xué)差異(P0.05);甲狀腺過氧化物酶抗體(TPOAb),抗甲狀腺球蛋白抗體(TGAb)水平差異也具有統(tǒng)計(jì)學(xué)差異(P0.05)。納入標(biāo)準(zhǔn)的研究共計(jì)11個(gè),試驗(yàn)組與對照組在用藥有效率方面OR=1.35,95%CI(1.28~1.51),總體效應(yīng)檢驗(yàn)Z=7.90,P0.05,具有統(tǒng)計(jì)學(xué)意義。試驗(yàn)組與對照組在改善病人TGAb水平方面SMD=-1.25,95%CI(-1.42~-1.08),總體效應(yīng)檢驗(yàn)Z=14.10,P0.05,具有統(tǒng)計(jì)學(xué)意義,試驗(yàn)組與對照組在改善病人TPOAb方面SMD=-1.72,95%CI(-1.90~-1.54),總體效應(yīng)檢驗(yàn)Z=17.52,P0.05,具有統(tǒng)計(jì)學(xué)意義。結(jié)論:本研究表明聯(lián)合貞芪扶正膠囊用于橋本病的治療與單純藥物治療相比,聯(lián)合貞芪扶正膠囊改善橋本病臨床癥狀效果更好,療效更穩(wěn)定,更能改善患者的生存質(zhì)量。第二部分的Meta分析結(jié)果表明聯(lián)合貞芪扶正膠囊用于橋本病的治療與單純應(yīng)用西藥左甲狀腺素治療相比,聯(lián)合貞芪扶正膠囊改善橋本病臨床癥狀效果更好。
[Abstract]:Objective: Hashimoto's disease is the most common disease in the disease's thyroiditis, but the incidence of occult, and early clinical symptoms was not obvious and nonspecific. Due to the incidence of most patients is relatively slow, often asymptomatic thyroid nodules or masses, few patients have shortness of breath, shortness of breath, fatigue the neck, neck pain, strange feeling. The physical examination revealed diffuse enlargement of the thyroid gland, or in the presence of multiple lobulated mass, nodules, uneven surface, hard texture. The disease is mainly based on the serological parameters of thyroid function. Because of the thyroid function in different stages of early indication, thyroid function may be normal, but the I-131 uptake rate may be slightly increased, while the serum free triiodothyronine three (FT3), free thyroxine (FT4) in the normal range with thyroid. Gland iodine uptake test (RAIU) and protein bound iodine (PBI) elevated thyroid function reserve will be reduced, serum TSH increased. Thus the performance of serum hyperthyroidism in patients with Hashimoto's disease free three triiodothyronine (FT3), free thyroxine (FT4) rise, late will eventually become hypothyroid, I-131 uptake, basal metabolic rate will be reduced, for the reason, may be due to thyroid parenchyma was gradually replaced with fibrous tissue or lymphocytes. The pathological process of Hashimoto's disease and complicated the disease diagnosis is difficult, and the misdiagnosis rate is high, but the key is that there is currently no effective treatment method is safe and efficient, were retrospectively summarized this research study model through the observation of combined therapy on the curative effect of Zhenqifuzheng capsule in the treatment of hypothyroidism type of Hashimoto's disease to explore the disease, Combined treatment of Hashimoto's thyroiditis Meta analysis to Zhenqi traditional Chinese and Western medicine, so as to provide evidence for the new treatment of the disease. Methods: according to the standard of bridge type hypothyroidism patients 60 cases were randomly divided into two groups, experimental group and control group. The experimental group was given combined with Zhenqifuzheng Levothyroxine Sodium Tablets capsule treatment, the control group using conventional pure levothyroxine sodium treatment, by observing the various levels of thyroid hormone in the serum of patients with (TSH, FT3, FT4) and the related antibody levels (TPOAb, TGAb) and the effect of the improvement of clinical symptoms in two different treatments. The existing research results of retrieval summary and using the method of Meta analysis and SATAT software (Version 13) methods and statistics to evaluate the therapeutic effect of traditional Chinese medicine combined with western medicine. Results: the patients in experimental group and control group after treatment. In the three free triiodothyronine (FT3), free thyroxine (FT4) levels had a significant difference (P0.05); thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TGAb) level difference was statistically difference (P0.05). The inclusion criteria of a total of 11, the experimental group and the control groups in terms of efficiency of OR=1.35,95%CI (1.28~1.51), the overall effect of test Z=7.90, P0.05, with statistical significance. The experimental group and the control group in improving the level of TGAb in patients with SMD=-1.25,95%CI (-1.42~-1.08), the overall effect of test Z=14.10, P0.05, have statistical significance, the experimental group and the control group in improving patients with TPOAb SMD=-1.72,95%CI (-1.90~-1.54). The overall effect of Z=17.52 test, P0.05, with statistical significance. Conclusion: This study showed that the combined Zhenqifuzheng capsule for the treatment of Hashimoto's disease and simple drug treatment compared with Zhenqi Fuzheng Capsule improve clinical symptoms of Hashimoto's disease curative effect, more stable, more can improve the quality of life in patients with Meta. The second part of the analysis results show that the combined Zhenqifuzheng capsule for the treatment of Hashimoto's disease and the simple application of Western medicine levothyroxine treatment compared with Zhenqifuzheng capsule can improve the clinical symptoms of Hashimoto's disease.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R581

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