【摘要】：目的：探討血清前白蛋白(PA)與甲狀腺功能亢進(jìn)癥伴肝功能損傷患者甲狀腺免疫學(xué)指標(biāo)、肝功能指標(biāo)的相關(guān)性。同時(shí),通過(guò)對(duì)單純西藥、單純中藥、中西醫(yī)結(jié)合治療方案的對(duì)比研究,客觀評(píng)價(jià)自擬清肝養(yǎng)陰方治療甲亢伴肝功能損傷肝火旺盛證的療效及安全性。 方法：1.采用病例對(duì)照研究方法,選取2011年1月1日至2013年12月31日期間,在江蘇省中醫(yī)院內(nèi)分泌科住院甲狀腺功能亢進(jìn)癥伴肝功能損傷患者60例,正常對(duì)照組隨機(jī)選取同期甲狀腺功能亢進(jìn)癥非肝功能損傷患者60例,對(duì)血清前白蛋白及甲狀腺免疫學(xué)指標(biāo)、肝功能指標(biāo)進(jìn)行統(tǒng)計(jì)學(xué)分析。2.選取2012年12月1日-2013年12月31日在江蘇省中醫(yī)院內(nèi)分泌科住院甲狀腺功能亢進(jìn)伴肝損傷患者共90例,根據(jù)治療方法,分為對(duì)照組30例,中西醫(yī)結(jié)合治療組(治療組1)30例,中醫(yī)治療組(治療組2)30例。觀測(cè)治療前后臨床癥狀、甲狀腺免疫學(xué)指標(biāo)、肝功能、甲狀腺腫大程度等,以及不良反應(yīng)、依從性。全部數(shù)據(jù)使用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果： (1)相關(guān)性分析： 經(jīng)過(guò)對(duì)照組、甲亢肝損組的統(tǒng)計(jì)學(xué)分析,提出推測(cè)：PA與ALT、FT3、FT4呈負(fù)向直線關(guān)系。 (2)癥狀改善： 組內(nèi)比較,治療后0.5月與治療前相比,對(duì)照組煩躁、胸脅脹痛、口干口苦、少寐多夢(mèng)、消瘦、大便頻數(shù)癥狀較前好轉(zhuǎn)(P0.05),除治療組1、2甲狀腺腫、治療組2神疲乏力外余癥狀均較前好轉(zhuǎn)(P0.05)；治療后3月與治療前相比,三組中除對(duì)照組甲狀腺腫、心悸未見(jiàn)明顯好轉(zhuǎn),余癥狀較前均有明顯好轉(zhuǎn)(P0.05)；治療后3月與治療后0.5月相比,三組神疲乏力、胸脅脹痛、口干口苦、大便頻數(shù)、震顫癥狀均有明顯改善(P0.05)。 組間比較,治療后0.5月,治療組1與對(duì)照組相比,除煩躁、大便頻數(shù)、消瘦癥狀無(wú)顯著性統(tǒng)計(jì)學(xué)意義外,余癥狀均明顯改善(P0.05)；治療組2與對(duì)照組比,除煩躁、大便頻數(shù)、消瘦、多汗惡熱癥狀無(wú)顯著性統(tǒng)計(jì)學(xué)意義外,余癥狀均明顯改善(P0.05)；治療組1與治療組2比較,癥狀改善均無(wú)顯著性統(tǒng)計(jì)學(xué)意義(P0.05)。治療后3月,三組間癥狀比較均無(wú)顯著性統(tǒng)計(jì)學(xué)意義(P0.05)。 (3)中醫(yī)臨床證候積分： 經(jīng)治療后,3組患者癥狀較前均明顯改善(P0.01)。組間比較,3月后,治療組2較對(duì)照組癥狀改善(P0.05),治療組1較對(duì)照組改善有非常顯著性統(tǒng)計(jì)學(xué)意義(P0.01)。治療組1較治療組2改善效果更佳,但組間無(wú)顯著性統(tǒng)計(jì)學(xué)意義(P0.05)。 (4)實(shí)驗(yàn)室指標(biāo)： 治療后0.5月,三組PA均較治療前升高(P0.05)。ALT、AST、γ-GT、ALP均較治療前下降(P0.05),其中,對(duì)照組及治療組1PA、ALT、γ-GT;治療組2ALT、AST、γ-GT較治療前明顯改善(P0.01)。 治療后3月,對(duì)照組PA、ALT、AST、γ-GT、ALP較治療前及治療后0.5月改善(P0.05),其中ALT較治療前及治療后0.5月、AST較治療前、γ-GT較治療前及治療后0.5月明顯改善(P0.01)。治療組1PA、ALT、AST、ALP較治療前,治療組2PA、ALT、ALP較治療前及治療后0.5月、AST、γ-GT較治療前改善(P0.05),其中治療組1ALT較治療前及治療后0.5月、AST較治療前、ALP較治療后0.5月,治療組2ALT較治療前及治療后0.5月、AST、γ-GT較治療前有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。 組間比較,治療后0.5月,治療組1PA、ALT、AST、γ-GT較對(duì)照組,均有顯著性統(tǒng)計(jì)學(xué)意義(P0.05)。治療組2與對(duì)照組比較,PA上升較對(duì)照組明顯,有顯著性統(tǒng)計(jì)學(xué)意義(P0.05)。治療組1與治療組2比較,治療組1PA較治療組2明顯上升,ALT、γ-GT明顯下降(P0.05)。 治療后3月,治療組1與對(duì)照組PA上升幅度相比,有顯著統(tǒng)計(jì)學(xué)意義(P0.01)；ALT、AST、γ-GT、ALP降低幅度均有統(tǒng)計(jì)學(xué)意義(P0.05)。治療組1與治療組2比較,治療組1PA、ALT、AST下降較治療組2明顯,有統(tǒng)計(jì)學(xué)意義(P0.05)。 (5)疾病療效比較： 治療組1療效顯著優(yōu)于對(duì)照組(P0.01)。 (6)治療前后肝功能指標(biāo)恢復(fù)正常時(shí)間比較： 治療組1肝功能恢復(fù)時(shí)間與對(duì)照組及治療組2相比有統(tǒng)計(jì)學(xué)意義(P0.05)。 (7)安全性： 三組安全性比較無(wú)顯著性統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論： (1)甲狀腺功能亢進(jìn)癥伴肝功能損傷患者血清前白蛋白水平明顯降低。 (2)血清前白蛋白水平可伴隨患者肝損恢復(fù)而恢復(fù),有助于病情進(jìn)展的判斷。 (3)清肝養(yǎng)陰方可明顯緩解甲亢伴肝損患者的癥狀、縮短肝功能恢復(fù)時(shí)間。中西醫(yī)結(jié)合治療可縮短病程,對(duì)降低復(fù)發(fā)率有一定意義。此方安全、有效、無(wú)嚴(yán)重不良反應(yīng)。
[Abstract]:Objective : To study the correlation between serum prealbumin ( PA ) and thyroid function injury in patients with liver function impairment .

Methods : 1 . A case - control study was used to select 60 patients with hyperthyroidism complicated with liver function during the period from January 1 , 2011 to December 31 , 2013 .

Results :

( 1 ) Correlation analysis :

Through the statistical analysis of the control group and the liver loss group of hyperthyroidism , it is suggested that PA is in negative linear relation with ALT , FT3 and FT4 .

( 2 ) Improvement of symptoms :

In the treatment group , the symptoms of fatigue and fatigue were better than those in the treatment group ( P0.05 ) .
Compared with the control group , there was no obvious improvement in the three groups except that in the control group before and after the treatment ( P0.05 ) .
Compared with 0 . 5 months after treatment , three groups of mental fatigue , chest pain , dry mouth , stool frequency and tremor were significantly improved ( P0.05 ) .

Compared with the control group , compared with the control group , there was no significant difference between treatment group 1 and the control group except for the symptoms of irritability , stool frequency and thin - thin symptom , and the residual symptoms were obviously improved ( P0.05 ) .
Compared with control group , there was no significant difference between treatment group 2 and control group than that in control group ( P0.05 ) .
No significant difference was found between treatment group 1 and treatment group 2 ( P0.05 ) .

( 3 ) Clinical syndrome integration of traditional Chinese medicine :

After treatment , the symptoms of the three groups were significantly improved ( P0.01 ) . After 3 months , the symptoms of the treatment group were improved compared with those in the control group ( P0.05 ) . The improvement of the treatment group 1 was better than that of the control group ( P0.01 ) .

( 4 ) Laboratory index :

ALT , AST , 緯 - GT and ALP decreased before treatment ( P0.05 ) .

ALT , AST , 緯 - GT and ALP were significantly improved before and after treatment ( P0.05 ) .

Compared with the control group , the level of PA in the treatment group was significantly higher than that in the control group ( P0.05 ) .

Compared with control group , there was significant difference between treatment group and control group ( P0.01 ) .
The levels of ALT , AST , 緯 - GT and ALP decreased significantly ( P0.05 ) . Compared with the treatment group , the decrease of 1PA , ALT and AST in the treatment group was significantly higher than that in the treatment group ( P0.05 ) .

( 5 ) Comparison of curative effect :

The curative effect of the treatment group was significantly better than that of the control group ( P0.01 ) .

( 6 ) Before and after treatment , the liver function indexes were returned to normal time :

The recovery time of liver function in the treatment group was significantly higher than that of the control group and the treatment group ( P0.05 ) .

( 7 ) Safety :

There was no significant difference between the three groups ( P0.05 ) .

Conclusion :

( 1 ) The levels of serum prealbumin in patients with hyperthyroidism accompanied with liver function were significantly lower .

( 2 ) The level of serum prealbumin can be recovered with the recovery of liver loss of the patient , which can help to judge the progress of the disease .

( 3 ) Clearing the liver and nourishing yin can obviously relieve the symptoms of the patients with hyperthyroidism and liver loss , shorten the recovery time of the liver function , shorten the course of the treatment by combining the traditional Chinese medicine and western medicine , and have a certain meaning to reduce the recurrence rate .
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R581.1;R575

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