發(fā)布時(shí)間：2018-06-21 02:24

  本文選題：橋本一過(guò)性甲狀腺毒癥 + 橋本甲亢�。� 參考：《湖北中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:本研究采用回顧性分析方法,選取經(jīng)臨床確診為橋本一過(guò)性甲狀腺毒癥病例、橋本甲亢病例各32例為研究對(duì)象,比較橋本一過(guò)性甲狀腺毒癥與橋本甲亢在發(fā)病特點(diǎn)、臨床癥狀、體征以及實(shí)驗(yàn)室檢查等方面的異同,并分析使用復(fù)方消癭甲亢片、復(fù)方甲亢片治療橋本一過(guò)性甲狀腺毒癥的特點(diǎn),對(duì)本病的臨床識(shí)別和處理進(jìn)行初步探討,以期為橋本一過(guò)性甲狀腺毒癥的診治提供新的認(rèn)識(shí)。方法:收集湖北省中醫(yī)院甲狀腺�？崎T(mén)診收治的經(jīng)臨床確診為橋本一過(guò)性甲狀腺毒癥的患者32例(A組),確診為橋本甲亢的患者32例(B組)。分別統(tǒng)計(jì)A、B兩組患者在發(fā)病年齡、性別,臨床癥狀,甲狀腺腫大程度、質(zhì)地,血清FT3、FT4、TSH、FT3/FT4、TGAb、TPOAb、TRAb測(cè)定結(jié)果及合并癥的異同。分析使用復(fù)方消癭甲亢片、復(fù)方甲亢片治療前后各時(shí)間點(diǎn)典型臨床癥狀及實(shí)驗(yàn)室指標(biāo)的差異,并進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:1.兩組發(fā)病年齡均集中在18-50歲之間,且均以女性占比更高,兩組年齡、性別比率無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。2.橋本一過(guò)性毒癥組在中醫(yī)證候積分、心率水平均較橋本甲亢組低(P0.05),說(shuō)明橋本一過(guò)性毒癥發(fā)病時(shí)臨床癥狀較輕。3.兩組間甲狀腺腫大各分度所占比例有統(tǒng)計(jì)學(xué)差異(P0.05),橋本一過(guò)性毒癥組以Ⅰ°腫大及以內(nèi)占比最多。4.兩組間甲狀腺不同質(zhì)地所占比例差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),均以質(zhì)地中或質(zhì)地韌占比為多。5.血清FT3升高各幅度所占比例在兩組間差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01),FT4升高各幅度所占比例在兩組間差異有統(tǒng)計(jì)學(xué)意義(P0.05)。橋本一過(guò)性毒癥組以FT3、FT4輕度升高者最為多見(jiàn)。TSH水平比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。橋本一過(guò)性毒癥組FT3/FT4值低于橋本甲亢組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。6.兩組間TGAb、TPOAb陰性、陽(yáng)性、強(qiáng)陽(yáng)性率比較差異均有顯著統(tǒng)計(jì)學(xué)意義(P0.01),且橋本一過(guò)性毒癥組兩抗體陽(yáng)性水平較橋本甲亢更低。單、雙抗體強(qiáng)陽(yáng)性率比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。7.橋本一過(guò)性毒癥組TRAb陰性率顯著高于橋本甲亢組(96.9%),差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。8.橋本一過(guò)性毒癥組無(wú)合并癥比例更大(75.0%),差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。9.橋本一過(guò)性甲狀腺毒癥組的甲亢(亞甲亢)病程以1-3月占比最高(65.6%),在6月內(nèi)恢復(fù)的比例均顯著高于橋本甲亢組,差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。10.復(fù)方消癭甲亢片、復(fù)方甲亢片治療本病前后各時(shí)間點(diǎn)中醫(yī)證候積分、各實(shí)驗(yàn)室指標(biāo)整體差異均有統(tǒng)計(jì)學(xué)意義(P0.05),療效隨著治療時(shí)間而穩(wěn)步增加。11.橋本一過(guò)性甲狀腺毒癥組治療后甲功恢復(fù)更快,一般可在1個(gè)療程內(nèi)恢復(fù),2個(gè)療程內(nèi)病情穩(wěn)定。經(jīng)2個(gè)療程的鞏固治療后兩組治愈率均明顯高于1個(gè)療程者。結(jié)論:1.橋本一過(guò)性甲狀腺毒癥一般為青、中年發(fā)病,女性比例較男性大。2.橋本一過(guò)性甲狀腺毒癥患者的臨床典型甲亢癥狀、體征均較輕。甲狀腺腫大程度對(duì)本病鑒別診斷有意義,一般表現(xiàn)為甲腫Ⅰ°及以內(nèi)。甲狀腺質(zhì)地對(duì)本病與橋本甲亢鑒別無(wú)意義,甲狀腺質(zhì)地中或質(zhì)地韌僅作為識(shí)別的參考依據(jù)。3.橋本一過(guò)性甲狀腺毒癥的甲狀腺功能,以FT3、FT4輕度升高,FT3/FT4比值較低為特點(diǎn),且存在FT3、FT4正常的亞臨床甲亢者,可作為本病診斷依據(jù),TSH水平高低尚不能作為診斷依據(jù)。4.橋本一過(guò)性甲狀腺毒癥的TGAb、TPOAb陽(yáng)性水平較橋本甲亢為低,單、雙抗體強(qiáng)陽(yáng)性對(duì)本病鑒別意義不大。5.TRAb陰性可作為本病的診斷依據(jù),但也存在個(gè)別(3.1%)可疑陽(yáng)性結(jié)果。6.橋本一過(guò)性甲狀腺毒癥一般不出現(xiàn)甲亢常見(jiàn)合并癥,但若出現(xiàn)合并癥,需在控制甲亢的同時(shí)積極治療合并癥。7.本病甲狀腺毒癥表現(xiàn)為一過(guò)性,治療后甲亢期一般不超過(guò)3個(gè)月,臨床癥狀也在3個(gè)月內(nèi)明顯緩解。8.使用復(fù)方消癭甲亢片治療橋本一過(guò)性甲狀腺毒癥甲功表現(xiàn)為亞甲亢者,使用復(fù)方甲亢片治療甲功表現(xiàn)為甲亢者,具體劑量遵循個(gè)體化原則,初治后需嚴(yán)密監(jiān)測(cè)甲狀腺功能,適時(shí)調(diào)整劑量,并以3個(gè)月為1個(gè)療程,甲功一般可在1個(gè)療程內(nèi)恢復(fù),2個(gè)療程內(nèi)穩(wěn)定。9.本病診斷性治療后應(yīng)重視隨訪,若甲功波動(dòng)較大,必要時(shí)仍需行FNAC病理學(xué)檢查重新確診。
[Abstract]:Objective: in this study, 32 cases of Hashimoto hyperthyroidism were selected by retrospective analysis, and 32 cases of Hashimoto hyperthyroidism were selected to compare the similarities and differences of Hashimoto's hyperthyroidism and Hashimoto hyperthyroidism in the characteristics, clinical symptoms, physical signs and laboratory examination, and to analyze the use of compound elimination. Gall hyperthyroidism tablets, compound hyperthyroidism tablets in the treatment of Hashimoto hyperthyroidism, the clinical identification and treatment of this disease are preliminarily discussed in order to provide a new understanding of the diagnosis and treatment of Hashimoto hyperthyroidism. Methods: the clinical diagnosis of Hashimoto hyperthyroidism in the Hubei Provincial Traditional Chinese Medical Hospital of the thyroid specialist clinic was collected. 32 cases (group A) and 32 cases (group B) were diagnosed as hyperthyroidism (group B). The age of onset, sex, clinical symptoms, thyroid enlargement, texture, serum FT3, FT4, TSH, FT3/FT4, TGAb, TPOAb, TRAb determination and the similarities and differences between the A, B two groups were analyzed. The difference between the typical clinical symptoms and the laboratory indexes at the time point, and the statistical analysis. Results: 1. the age of the 1. two groups were all concentrated between 18-50 years, and both were higher in women, two groups of age, sex ratio was not statistically significant (P0.05).2. Hashimoto hypertoxic group in TCM syndrome score, heart rate level was lower than the Hashimoto hyperthyroidism group (P 0.05), it shows that there is a statistical difference in the proportion of the degrees of thyroid enlargement between the.3. two groups and the.3. two groups. There is no statistically significant difference in the proportion of the thyroid dissimilarity between the two groups of.4. and two groups, which are not statistically significant in texture or texture. The proportion of the increase in the proportion of.5. serum FT3 was significantly different between the two groups (P0.01), and the proportion of the FT4 increased in the two groups was statistically significant (P0.05). There was no statistical significance (P0.05) for the most common.TSH water level in the patients with Hashimoto transient toxicity (FT3), and there was no statistical significance (P0.05). The FT3/FT4 value of the drug group was lower than the Hashimoto hyperthyroidism group, the difference was statistically significant (P0.05).6. two groups TGAb, TPOAb negative, positive, the difference of strong positive rate had significant statistical significance (P0.01), and the positive level of the pashimoto hypertoxic group was lower than that of the Hashimoto hyperthyroidism. The difference of the strong positive rate of double antibody was not statistically significant (P0.05). The negative rate of TRAb in.7. bridge hypertoxic group was significantly higher than that of Hashimoto hyperthyroidism group (96.9%), the difference was significant (P0.01), the proportion of.8. Hashimoto hypertoxic group was greater (75%), and the difference was statistically significant (P0.01).9. bridge hyperthyroidism group hyperthyroidism (Ya Jiakang) course of 1-3 months was the highest (65.6%). The proportion of recovery in June was significantly higher than that of Hashimoto hyperthyroidism group, the difference was statistically significant (P0.01).10. compound gall gall hyperthyroidism tablets, compound hyperthyroidism tablets were treated with TCM syndrome scores at each time point before and after the disease, and the overall difference in the laboratory indexes was statistically significant (P0.05). The curative effect increased steadily with the time of treatment of.11. Hashimoto. After treatment, the recovery of thyroid function was faster in the group of sexual thyroidism, generally within 1 courses of treatment and stable in 2 courses. After 2 courses of consolidation treatment, the cure rate of two groups was obviously higher than that of 1 courses. Conclusion: 1. Hashimoto hyperthyroidism is generally green, middle-aged and female, and the proportion of women is larger than male.2. Hashimoto and hyperthyroidism The typical symptoms and signs of hyperthyroidism in the patients with toxic disease are lighter. The degree of thyroid enlargement is significant to the differential diagnosis of this disease. The thyroid texture is not significant for the identification of the disease and the hyperthyroidism. The thyroid texture or texture is only a reference basis for the identification of.3. Hashimoto hyperthyroidism. Gland function, with FT3, FT4 mild elevation, low FT3/FT4 ratio, and FT3, FT4 normal subclinical hyperthyroidism, can be used as a diagnostic basis for this disease. The level of TSH can not be used as a diagnostic basis for.4. Hashimoto hyperthyroidism TGAb, TPOAb positive level is lower than Hashimoto hyperthyroidism, single, double antibody strongly positive for this disease identification meaning .5.TRAb negative can be used as the basis for diagnosis of this disease, but there are also individual (3.1%) suspected positive results of.6. bridge, hyperthyroidism usually do not appear hyperthyroidism common complication, but if there is a combination of hyperthyroidism, it is necessary to take active treatment of hyperthyroidism at the same time that the.7. is a hyperthyroidism, after treatment, hyperthyroidism is a period of one period. The clinical symptoms were not more than 3 months, and the clinical symptoms were obviously relieved within 3 months..8. used compound Xiaoying hyperthyroidism in the treatment of Hashimoto hyperthyroidism and hyperthyroidism. The use of compound hyperthyroidism to treat Jia Gong was hyperthyroidism. The specific dose followed the individualized principle. After the initial treatment, the thyroid function should be closely monitored and the dose was adjusted in time. And in 3 months as a course of 1, a general recovery work in the 1 treatment period, 2 treatment in stable.9. treatment should pay attention to the follow-up after the diagnosis of the disease, if a power fluctuations, when necessary, still need FNAC pathological examination were diagnosed again.
【學(xué)位授予單位】：湖北中醫(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

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