發(fā)布時(shí)間：2018-07-25 07:30

【摘要】：目的:探討瀉火消癭方聯(lián)合甲巰咪唑治療甲亢(Graves病)初治期心肝火旺證的臨床療效。方法:納入2015年7月—2016年10月期間在南京中醫(yī)藥大學(xué)附屬中西醫(yī)結(jié)合醫(yī)院內(nèi)分泌門診診治的初治或復(fù)發(fā)再就診初治患者80例,所有患者均符合西醫(yī)Graves病初治期和中醫(yī)心肝火旺證診斷標(biāo)準(zhǔn)。根據(jù)隨機(jī)數(shù)字表法分為對(duì)照組和治療組,每組40例。對(duì)照組予甲巰咪唑(賽治,德國默克公司)10-30mg/d,癥狀控制后逐漸減量至2.5-10mg/d。治療組在對(duì)照組基礎(chǔ)上加用瀉火消癭方,每日1劑,水煎服,分早晚兩次溫服。中藥以4周為1個(gè)療程,共觀察3個(gè)療程。結(jié)果:共有61例患者完成本研究,兩組患者基線心率、體重、FT3、FT4、TSH、TRAb水平具有可比性(p0.05)。治療后,兩組心率及體重較各組治療前均有明顯改善(p0.01),治療組治療后心率低于對(duì)照組(65.00±12.00bpmvs.74.00±14.00bpm,p=0.021),體重相比無明顯差異。治療后,FT3、FT4、TRAb水平均顯著低于各組治療前水平,TSH水平顯著高于各組治療前水平,且有統(tǒng)計(jì)學(xué)差異(p0.01)。治療組在第1、2月時(shí)FT3和FT4 下降幅度大于對(duì)照組(治療 1 月后 FT3:5.56±2.46pmol/l vs.8.00士3.95pmol/l,p=0.001;治療 1 月后 FT4:19.90±8.28pmol/l vs.23.37±9.42pmol,p=0.019;治療 2 月后FT3:3.94±1.57pmol/l vs.4.96±2.187Pmol/l,p=0.010;治療 2 月后 FT4:13.52±4.69pmol/l vs.16±7.59pmol/l,p=0.043),療程結(jié)束(第3月)時(shí),兩組甲狀腺功能無明顯差異;第1個(gè)療程結(jié)束后,治療組FT3、FT4水平恢復(fù)正常比例優(yōu)于對(duì)照組(FT3恢復(fù)正常比例:19(63.33%)vs.11(35.48%),p=0.03;FT4 恢復(fù)正常比例:21(70.00%)vs.12(38.70%),p=0.014);FT3、FT4恢復(fù)至正常水平所需平均時(shí)間亦少于對(duì)照組(FT3平均恢復(fù)時(shí)間:1.00±1.00月v.2.00±2.00 月,p=0.014;FT4 平均恢復(fù)時(shí)間:1.00±1.00月 s 2.00±1.00 月,p=0.008)。兩組患者起始甲巰咪唑劑量無明顯區(qū)別(30.0±15.0mg vs.30.0±15.0mg,p=0.620),在療程期間,治療組使用甲巰咪唑劑量均小于對(duì)照組(治療1月后:15.00±6.25mgvs.20.00±15.00mg,p=0.03;治療 2 月后:10.00±8.13mgvs.15.00±10.00mg,p=0.04;治療3月后:5.00±5.75mg vs.10.00±10.00mg,p=0.015)。兩組患者治療后中醫(yī)癥候積分明顯小于各組間治療前(p0.01);治療組治療后中醫(yī)癥候積分低于對(duì)照組(5.38±4.00 vs.11.09±5.46,p0.0001)。治療組不良反應(yīng)事件少于對(duì)照組,但無統(tǒng)計(jì)學(xué)差異。結(jié)論:瀉火消癭方聯(lián)合甲巰咪唑治療甲亢(Graves病)初治期療效顯著,可更快降低激素水平、縮短激素恢復(fù)正常的時(shí)間、提高恢復(fù)率、減少甲巰咪唑劑量,且不良反應(yīng)更少,有重要的臨床研究價(jià)值。
[Abstract]:Objective: to investigate the clinical effect of Xiehuoxiaoying recipe combined with mercaptopril in the treatment of hyperthyroidism (Graves disease). Methods: from July 2015 to October 2016, 80 newly treated or relapsed patients were enrolled in the endocrine clinic of Nanjing University of traditional Chinese Medicine (TCM) affiliated Hospital of Integrated traditional Chinese and Western Medicine (TCM). All the patients were in accordance with the diagnostic criteria of Graves's disease and the syndrome of heart-liver-fire flourishing in traditional Chinese medicine. According to the random digital table method, the patients were divided into control group and treatment group with 40 cases in each group. The control group was given methimazole 10-30 mg / d, which was gradually reduced to 2.5-10 mg / d after symptom control. The treatment group in the control group on the basis of Xiehuoxiaoying prescription, 1 dose per day, water decoction, divided into morning and evening twice warm. Four weeks as a course of treatment, a total of three courses of observation. Results: a total of 61 patients completed the study. The baseline heart rate and body weight of the two groups were comparable (p0.05). After treatment, the heart rate and body weight of the two groups were significantly improved (p0.01). After treatment, the heart rate in the treatment group was lower than that in the control group (65.00 鹵14.00 12.00bpmvs.74.00 鹵14.00 bpmmP0.021), and there was no significant difference in body weight between the two groups. After treatment, the levels of FT3 / FT4TRAb were significantly lower than those before treatment and TSH levels were significantly higher than those before treatment (p0.01). 娌葷枟緇勫湪絎，

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