調(diào)神針刺結(jié)合甲巰咪唑治療初發(fā)Graves病的臨床研究
發(fā)布時間：2018-10-22 20:27
【摘要】：目的：Graves病(以下簡稱GD)是甲狀腺功能亢進癥中最常見的類型,是嚴重危害人類健康的常見病�，F(xiàn)代已有學(xué)者證實多數(shù)的GD患者在發(fā)病前有精神刺激或創(chuàng)傷的病史。中醫(yī)學(xué)認為情志內(nèi)傷與癭病的發(fā)病關(guān)系密切,是導(dǎo)致其致病的重要誘因。近年來針灸治療甲亢取得了不錯的療效,而調(diào)神針刺更能明顯改善患者的精神、軀體癥狀,因此,應(yīng)該伴隨GD治療的始終。本研究從臨床上最后成功收取了58例的GD患者,分為治療組28例與對照組30例,觀察調(diào)神針刺聯(lián)合甲巰咪唑治療初發(fā)GD患者,對Graves病患者抑郁、焦慮癥狀、甲功三項及甲狀腺大小的影響。從而為針刺調(diào)神能緩解Graves病患者的精神、軀體征狀提供臨床依據(jù)。方法：對照組患者每天予西藥甲巰咪唑片(賽治)對癥治療,初始的劑量為30mg/d,每天頓服,此后每月后復(fù)查患者的甲功3項,并按GD治療指南中的治療,常規(guī)調(diào)整甲巰咪唑劑量。而治療組在對照組治療的基礎(chǔ)上予以一周三次的針刺治療,主穴：定神針、四神針、四關(guān)穴,配穴方面,若痰氣郁結(jié)者配豐隆穴、陰陵泉穴；若肝火旺盛者配手智針(內(nèi)關(guān)穴、神門穴、勞宮穴)、行間穴；若心肝陰虛者配太溪穴、足三里穴。每次留針時間為1小時,其中每15分鐘予患者行提插捻轉(zhuǎn)補瀉手法1次,兩組患者均連續(xù)干預(yù)3個月。在治療前后分別予以甲功三項檢測、甲狀腺彩超檢查、漢密爾頓抑郁量表(HAMD)、漢密爾頓焦慮量表(HAMA)評定。結(jié)果：①治療組比對照組更能緩解患者的抑郁、焦慮狀態(tài),差異具有統(tǒng)計學(xué)意義；②治療組患者在改善患者FT3激素水平比對照組佳,差異顯著,而在減少FT4、增加TSH方面兩組差異不明顯；③治療組比對照組更能改善患者甲狀腺腺體腫大的問題,差異具有統(tǒng)計學(xué)意義。結(jié)論：①調(diào)神針刺聯(lián)合甲巰咪唑片治療GD患者比單純甲巰咪唑治療更能緩解患者精神上的抑郁、焦慮狀態(tài)；②調(diào)神針刺聯(lián)合甲巰咪唑片治療GD患者比單純甲巰咪唑治療更能減少患者FT3激素水平,而在減少FT4、增加TSH方面兩組差異不明顯；③調(diào)神針刺聯(lián)合甲巰咪唑片治療GD患者比單純甲巰咪唑治療更能明顯改善患者甲狀腺腺體腫大的問題。
[Abstract]:Objective: Graves disease (hereinafter referred to as GD) is the most common type of hyperthyroidism. Modern scholars have confirmed that most GD patients have a history of mental stimulation or trauma before onset. Chinese medicine thinks that the internal injury of emotion is closely related to the occurrence of gall disease, which is an important inducement to cause the disease. In recent years, acupuncture and moxibustion have achieved a good effect in treating hyperthyroidism, and the acupuncture of regulating the mind can improve the mental and physical symptoms of the patients significantly. Therefore, it should be accompanied with the treatment of GD all the time. In this study, 58 patients with GD were successfully received from the clinic. They were divided into treatment group (n = 28) and control group (n = 30). The symptoms of depression and anxiety in patients with Graves disease were observed. The effects of three items of thyroid function and the size of thyroid gland. Therefore, acupuncture can relieve the mental and somatic symptoms of patients with Graves disease. Methods: the patients in the control group were treated with methimazole tablets every day. The initial dose was 30 mg / d. After that, 3 items of thyroid function were reexamined after each month. The dosage of methimazole was adjusted according to the treatment guidelines of GD. On the basis of the treatment in the control group, the treatment group was treated with acupuncture three times a week. The main points were as follows: Dingshen acupuncture, Siguan points, and points matching points, such as phlegm and qi stagnation, Fenglong points and Yin Lingquan points; if liver-fire patients had strong liver-fire points, they were matched with hand intelligence acupuncture points (Neiguan point). Shenmen acupoint, Laogong point), Xingjian acupoint; if the heart and liver yin with Taixi point, Zusanli point. The time of needle retention was 1 hour, in which every 15 minutes the patients were treated with lifting, twisting, twisting and reducing manipulation once, and the patients in both groups were intervened continuously for 3 months. Before and after treatment, three items of thyroid function were tested, thyroid ultrasonography, Hamilton depression scale (HAMD),) and Hamilton anxiety scale (HAMA). Results: 1 the treatment group can relieve the depression and anxiety more than the control group, and the difference is statistically significant, 2 the treatment group can improve the FT3 hormone level of the patients better than the control group, the difference is significant. However, there was no significant difference between the two groups in reducing FT4, and increasing TSH. 3 the treatment group improved the thyroid gland enlargement more than the control group, and the difference was statistically significant. Conclusion: (1) Tiaoshen Acupuncture combined with methimazole tablet can relieve the mental depression and anxiety of GD patients more than that of simple methimazole alone. 2Tiaoshen acupuncture combined with mercapto tablet can reduce the level of FT3 hormone in patients with GD more than that in patients with GD alone, but there is no significant difference between the two groups in decreasing FT4, and increasing TSH. 3Tiaoshen Acupuncture combined with methimazole tablet can significantly improve the thyroid gland enlargement in patients with GD as compared with simple methimazole therapy.
【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】：2015
【分類號】：R581.1
本文編號：2288222
[Abstract]:Objective: Graves disease (hereinafter referred to as GD) is the most common type of hyperthyroidism. Modern scholars have confirmed that most GD patients have a history of mental stimulation or trauma before onset. Chinese medicine thinks that the internal injury of emotion is closely related to the occurrence of gall disease, which is an important inducement to cause the disease. In recent years, acupuncture and moxibustion have achieved a good effect in treating hyperthyroidism, and the acupuncture of regulating the mind can improve the mental and physical symptoms of the patients significantly. Therefore, it should be accompanied with the treatment of GD all the time. In this study, 58 patients with GD were successfully received from the clinic. They were divided into treatment group (n = 28) and control group (n = 30). The symptoms of depression and anxiety in patients with Graves disease were observed. The effects of three items of thyroid function and the size of thyroid gland. Therefore, acupuncture can relieve the mental and somatic symptoms of patients with Graves disease. Methods: the patients in the control group were treated with methimazole tablets every day. The initial dose was 30 mg / d. After that, 3 items of thyroid function were reexamined after each month. The dosage of methimazole was adjusted according to the treatment guidelines of GD. On the basis of the treatment in the control group, the treatment group was treated with acupuncture three times a week. The main points were as follows: Dingshen acupuncture, Siguan points, and points matching points, such as phlegm and qi stagnation, Fenglong points and Yin Lingquan points; if liver-fire patients had strong liver-fire points, they were matched with hand intelligence acupuncture points (Neiguan point). Shenmen acupoint, Laogong point), Xingjian acupoint; if the heart and liver yin with Taixi point, Zusanli point. The time of needle retention was 1 hour, in which every 15 minutes the patients were treated with lifting, twisting, twisting and reducing manipulation once, and the patients in both groups were intervened continuously for 3 months. Before and after treatment, three items of thyroid function were tested, thyroid ultrasonography, Hamilton depression scale (HAMD),) and Hamilton anxiety scale (HAMA). Results: 1 the treatment group can relieve the depression and anxiety more than the control group, and the difference is statistically significant, 2 the treatment group can improve the FT3 hormone level of the patients better than the control group, the difference is significant. However, there was no significant difference between the two groups in reducing FT4, and increasing TSH. 3 the treatment group improved the thyroid gland enlargement more than the control group, and the difference was statistically significant. Conclusion: (1) Tiaoshen Acupuncture combined with methimazole tablet can relieve the mental depression and anxiety of GD patients more than that of simple methimazole alone. 2Tiaoshen acupuncture combined with mercapto tablet can reduce the level of FT3 hormone in patients with GD more than that in patients with GD alone, but there is no significant difference between the two groups in decreasing FT4, and increasing TSH. 3Tiaoshen Acupuncture combined with methimazole tablet can significantly improve the thyroid gland enlargement in patients with GD as compared with simple methimazole therapy.
【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】：2015
【分類號】：R581.1
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