本文關(guān)鍵詞：清解軟堅(jiān)法治療亞急性甲狀腺炎熱盛證臨床療效及證型轉(zhuǎn)變的觀(guān)察　出處：《南京中醫(yī)藥大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 清解軟堅(jiān)法 地塞米松 熱盛證 亞急性甲狀腺炎 治療后的辨證分析

【摘要】：目的:觀(guān)察清解軟堅(jiān)法治療熱盛證亞急性甲狀腺炎的臨床療效,并對(duì)治療后的患者進(jìn)行辨證分型,觀(guān)察其治療后證型轉(zhuǎn)歸的分布情況及不同證型與相關(guān)理化指標(biāo)的聯(lián)系,以期為今后中醫(yī)藥治療亞急性甲狀腺炎提供更多的辨證用藥思路和理論依據(jù)。方法:收集符合納入標(biāo)準(zhǔn)的亞急性甲狀腺炎患者68例,隨機(jī)分為觀(guān)察組35例,對(duì)照組33例,由于出現(xiàn)病例脫落(觀(guān)察組2例,對(duì)照組3例),實(shí)際完成病例總數(shù)63例,其中觀(guān)察組33例,對(duì)照組30例。在保證相同一般治療的前提下,觀(guān)察組采用以清熱解毒軟堅(jiān)法為治療原則擬定的清解軟堅(jiān)方,對(duì)照組則予地塞米松局部注射治療,4周為1個(gè)療程,治療3個(gè)療程后停藥。兩組治療停藥后,均繼續(xù)對(duì)患者進(jìn)行為期半年的跟蹤隨訪(fǎng)。并根據(jù)治療后的中醫(yī)診斷及辨證分型標(biāo)準(zhǔn)對(duì)患者進(jìn)行辨證分型,觀(guān)察不同證型的分布情況及其與相關(guān)理化指標(biāo)之間的聯(lián)系。結(jié)果:1.疾病療效:經(jīng)統(tǒng)計(jì)學(xué)分析,兩組疾病療效無(wú)顯著差別(P0.05)。2.證候療效:經(jīng)統(tǒng)計(jì)學(xué)分析,兩組證候療效無(wú)顯著差別(P0.05)。3.癥狀、體征積分變化:治療前兩組癥狀、體征積分經(jīng)統(tǒng)計(jì)學(xué)分析無(wú)顯著差異,可以比較(P0.05);治療后兩組癥狀、體征積分較治療前均有明顯改善,且觀(guān)察組改善優(yōu)于對(duì)照組(P0.05)。4.血沉變化:治療前兩組ESR經(jīng)統(tǒng)計(jì)學(xué)分析無(wú)顯著差異,可以比較(P0.05);治療后兩組ESR均顯著下降,組間比較無(wú)差異(P0.05),表明兩組均可顯著降低患者ESR,且療效相當(dāng)。5.甲狀腺功能比較:治療前兩組甲狀腺功能經(jīng)統(tǒng)計(jì)學(xué)分析無(wú)顯著差異,可以比較(P0.05);治療后兩組FT3、FT4均較治療前有所下降,TSH較治療前有所上升,組間比較無(wú)差異(P0.05),表明兩組均可改善患者的甲狀腺功能,且療效相當(dāng)。6.血糖變化:治療前兩組FBG經(jīng)統(tǒng)計(jì)學(xué)分析無(wú)顯著差異,可以比較(P0.05);治療后觀(guān)察組血糖較對(duì)照組下降明顯,且有統(tǒng)計(jì)學(xué)差異(P0.05)。7.復(fù)發(fā)率比較:觀(guān)察組復(fù)發(fā)率明顯低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。8.治療后的辨證分型:對(duì)照組治療后的辨證分型顯示,毒結(jié)未消證所占比例最高,其次為陰平陽(yáng)秘證,氣陰兩虛證和陽(yáng)氣虧虛證;觀(guān)察組治療后的辨證分型顯示,氣陰兩虛證所占比例最高,其次為陰平陽(yáng)秘證,陽(yáng)氣虧虛證和毒結(jié)未消證。9.無(wú)論是觀(guān)察組還是對(duì)照組,甲狀腺B超提示存在結(jié)節(jié)者,均以毒結(jié)未消證最為多見(jiàn)。10.陽(yáng)氣虧虛證TSH值與陰平陽(yáng)秘證相比偏高,且差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.清解軟堅(jiān)法和地塞米松局部注射療法對(duì)亞甲炎熱盛證患者均有良好療效。但清解軟堅(jiān)法在改善患者臨床癥狀方面更具優(yōu)勢(shì),且復(fù)發(fā)率低。2.清解軟堅(jiān)法可改善糖耐量異�；颊叩难�,適用于亞急性甲狀腺炎熱盛證合并糖耐量異常的患者。3.兩種方法治療亞急性甲狀腺炎熱盛證均可能出現(xiàn)陰平陽(yáng)秘證、氣陰兩虛證、陽(yáng)氣虧虛證、毒結(jié)未消證四種證型的轉(zhuǎn)歸。其中地塞米松局部注射療法以毒結(jié)未消證最為多見(jiàn),清解軟堅(jiān)法以氣陰兩虛證最為多見(jiàn)。在四種證型中,復(fù)查甲狀腺B超提示有結(jié)節(jié)者以毒結(jié)未消證最為多見(jiàn)。陽(yáng)氣虧虛證患者的TSH值較陰平陽(yáng)秘證高,類(lèi)似亞急性甲狀腺炎甲減期,當(dāng)注意在扶正祛邪的基礎(chǔ)上治以溫補(bǔ)脾腎。
[Abstract]:Objective: To observe the clinical effect of treatment of Qingjie Ruanjian heat Zhengya acute thyroiditis, and after treatment with syndrome differentiation, syndrome type distribution of outcome after treatment and observe the different syndromes and physicochemical indices linked to the future of traditional Chinese medicine in the treatment of subacute thyroiditis with more TCM treatment ideas and theoretical basis. Methods: to collect with 68 subacute thyroiditis patients included were randomly divided into observation group 35 cases, control group 33 cases, due to the emergence of cases (2 cases in the observation group, 3 cases in the control group), the actual completion of the total number of cases in 63 cases, the observation group of 33 cases 30 cases of the control group. Under the premise of ensuring the same general treatment, the observation group used to detoxify Ruanjian method for the treatment of the principle proposed clear solution Ruanjian decoction, while the control group to the local injection of dexamethasone treatment, 4 weeks for 1 courses, 3 courses of treatment after the stop Drug treatment in the two groups. After treatment, all were followed up to half a year for patients. According to TCM diagnosis and treatment after the classification of patients of different syndrome types between the distribution of observation of different syndromes and its correlation with the physicochemical index of contact. Results: 1.: the curative effect of disease statistical analysis, no significant difference between the two groups (P0.05) clinical disease.2. syndrome curative effect: by statistical analysis, no significant difference between the clinical syndromes of two groups (P0.05).3. symptoms, signs integral change: before treatment, two groups of symptoms, signs integral statistical analysis showed no significant difference, can be compared after treatment (P0.05); two groups of symptoms, signs score were significantly improved compared with before treatment, and the observation group was better than the control group (P0.05).4. ESR: two groups before treatment ESR statistical analysis showed no significant difference, can be compared (P0.05); ESR in the two groups after treatment were significantly decreased, compared between groups No difference (P0.05), showed that the two groups were significantly lower in patients with ESR,.5. and thyroid function efficacy comparison: two groups of thyroid function before and after the treatment showed no significant difference compared (P0.05); the two groups after treatment FT3, FT4 were decreased after treatment compared with before treatment, TSH increased, compared with no significant difference between groups (P0.05), showed that the two groups can improve the thyroid function of the patients, and the curative effect is.6. blood glucose change: before treatment, two groups of FBG statistical analysis showed no significant difference, can be compared (P0.05); the observation group after treatment of blood glucose decreased significantly than the control group, and there was statistical difference (P0.05) rate of.7. the recurrence, the recurrence rate of the observation group was significantly lower than the control group, the difference was statistically significant (P0.05) syndrome after treatment of.8. type: the control group after treatment, the syndrome differentiation typing showed that poison knot disappeared which accounting for the highest proportion, followed by Yin Pingyang constipation syndrome, two Qi and yin deficiency syndrome And Qi deficiency syndrome; observation group after treatment of the type of display, with the highest proportion of Qi and yin deficiency, followed by Yin Pingyang constipation syndrome, Qi deficiency syndrome and poison knot disappeared.9. either observation group or control group, suggesting the presence of ultrasound on thyroid nodules, the poison knot disappeared symptoms..10. Qi deficiency TSH value compared with the Yin Pingyang constipation syndrome is high, and the difference was statistically significant (P0.05). Conclusion: 1. clear solution softening method and local injection of dexamethasone therapy on methylene hot syndrome patients had good curative effect. But the clear solution Ruanjian method is more advantage in improving the clinical symptoms of patients. And the recurrence rate is low.2. clear solution Ruanjian method can improve patients with abnormal glucose tolerance of blood glucose, suitable for subacute thyroiditis and heat syndrome with abnormal glucose tolerance in patients with.3. two methods in the treatment of subacute thyroiditis and heat syndrome may appear constipation syndrome of Qi Yin Yin Pingyang, two Deficiency syndrome, Qi deficiency syndrome, prognosis of poison knot disappeared four syndromes. The local injection of dexamethasone therapy to poison the node consumer card is the most common, clear solution Ruanjian method with two Qi and yin deficiency syndrome is the most common. In the four card, review of thyroid ultrasound suggesting nodules in poison knot disappeared syndrome is the most common. Qi deficiency in patients with TSH compared with Yin Pingyang constipation syndrome, similar to subacute thyroiditis hypothyroidism, when attention to reinforcing the spleen and kidney in Fuzhengquxie Wen Zhi basis.

【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】：2017
【分類(lèi)號(hào)】：R259

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