本文關(guān)鍵詞： 良性非毒性甲狀腺結(jié)節(jié) 結(jié)甲平膏 外治　出處：《北京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:評(píng)價(jià)以化瘀散結(jié)為治法的"結(jié)甲平"膏外治氣滯血瘀痰凝型良性非毒性甲狀腺結(jié)節(jié)的臨床療效,以期獲得該病有效的中醫(yī)外治方案,指導(dǎo)臨床治療和用藥。方法:1.在北京中醫(yī)藥大學(xué)東直門醫(yī)院2013年11月至2017年4月的內(nèi)分泌科門診病人中,納入符合中西醫(yī)診斷的氣滯血瘀痰凝型良性非毒性甲狀腺結(jié)節(jié)患者44例。2.研究采用隨機(jī)對(duì)照法,分為治療組22例和對(duì)照組22例,治療組在基礎(chǔ)治療上予中藥"結(jié)甲平"膏外敷聯(lián)合"結(jié)甲湯"內(nèi)服,對(duì)照組予基礎(chǔ)治療加"結(jié)甲湯"內(nèi)服。治療6個(gè)月,統(tǒng)計(jì)分析治療前后兩組中醫(yī)癥狀體征積分、左右葉最大結(jié)節(jié)直徑、結(jié)節(jié)個(gè)數(shù)及結(jié)節(jié)惡性風(fēng)險(xiǎn)積分變化,對(duì)比內(nèi)外合治與內(nèi)治法的優(yōu)效性,評(píng)價(jià)"結(jié)甲平"膏外治氣滯血瘀痰凝型良性非毒性甲狀腺結(jié)節(jié)的臨床療效。結(jié)果:1.一般資料比較:治療前兩組一般資料(包括性別、年齡、病程、甲狀腺疾病家族史、最大結(jié)節(jié)直徑、中醫(yī)癥狀體征積分、結(jié)節(jié)惡性風(fēng)險(xiǎn)積分)無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),具有可比性。2.兩組治療前后中醫(yī)癥狀體征積分比較:治療組、對(duì)照組在治療后的中醫(yī)癥狀體征積分與治療前相比有顯著性差異(P0.01),兩組治療后的中醫(yī)癥狀體征積分組間相比無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),但治療組治療前后的積分差值與對(duì)照組相比有統(tǒng)計(jì)學(xué)差異(P0.05)。3.兩組治療前后最大結(jié)節(jié)直徑、結(jié)節(jié)個(gè)數(shù)比較:治療組、對(duì)照組治療后的最大結(jié)節(jié)直徑與治療前相比無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),兩組治療后的最大結(jié)節(jié)直徑相比無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),兩組治療前后最大結(jié)節(jié)直徑差值相比無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),兩組治療后的結(jié)節(jié)個(gè)數(shù)減少比例相比亦無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。4.兩組治療前后結(jié)節(jié)惡性風(fēng)險(xiǎn)積分比較:治療組治療后的惡性風(fēng)險(xiǎn)積分與治療前相比有顯著性差異(P0.01),對(duì)照組治療后的惡性風(fēng)險(xiǎn)積分與治療前相比無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。兩組治療后的惡性風(fēng)險(xiǎn)積分組間對(duì)比有統(tǒng)計(jì)學(xué)差異(P0.05)。5.兩組療效比較:根據(jù)癥狀體征療效判定標(biāo)準(zhǔn),治療組總有效率為72.73%,臨床治愈0例,顯效0例,有效16例,無(wú)效6例;對(duì)照組總有效率為40.91%,臨床治愈0例,顯效0例,有效9例,無(wú)效13例。兩組間總有效率有統(tǒng)計(jì)學(xué)差異(P0.05)。根據(jù)甲狀腺B超的療效判定標(biāo)準(zhǔn),治療組總有效率為22.73%,臨床治愈0例,顯效4例,有效1例,無(wú)效17例,對(duì)照組總有效率為13.64%,臨床治愈0例,顯效1例,有效2例,無(wú)效19例。兩組間總有效率無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。6.兩組治療前后安全性指標(biāo)比較:治療組、對(duì)照組治療后的甲狀腺功能(FT3、FT4、TT3、TT4、TSH)、肝功能(ALT、AST)和腎功能(Scr、BUN)與治療前相比無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:"結(jié)甲平"膏外敷聯(lián)合中藥"結(jié)甲湯"內(nèi)服及單純"結(jié)甲湯"內(nèi)服治療氣滯血瘀痰凝型良性非毒性甲狀腺結(jié)節(jié),在改善癥狀、體征方面療效顯著,兩相比較,內(nèi)外合治法療效優(yōu)于內(nèi)治法。內(nèi)外合治及內(nèi)治法治療半年后結(jié)節(jié)大小保持穩(wěn)定,未見(jiàn)增長(zhǎng),但內(nèi)外合治法降低結(jié)節(jié)惡性風(fēng)險(xiǎn)療效顯著,內(nèi)治法不能降低惡性風(fēng)險(xiǎn)。綜上,以化瘀散結(jié)為治法的"結(jié)甲平"膏外治氣滯血癌痰凝型良性非毒性甲狀腺結(jié)節(jié),在改善癥狀體征及降低結(jié)節(jié)惡性風(fēng)險(xiǎn)方面療效較好,且無(wú)毒副作用,安全可靠,值得臨床推廣和深入研究。
[Abstract]:Objective: To evaluate the Huayusanjie for treatment of "knot a flat" cream treating phlegm stagnation and blood stasis type of benign thyroid nodules clinical curative effect, in order to obtain the effective treatment of traditional Chinese medicine disease, clinical treatment and medication. Methods: 1. in Dongzhimen Hospital of Beijing University of Chinese Medicine from November 2013 to April 2017 in the outpatient department of endocrinology in patients with traditional Chinese medicine and Western medicine diagnosis of qi stagnation and blood stasis and phlegm of benign thyroid nodules in patients with non.2. toxicity study of 44 cases randomly divided into treatment group of 22 cases and 22 cases in the control group, the treatment group was treated by traditional Chinese medicine "Jia Ping" paste and "a soup" orally on the basis of the treatment, control group were treated with "ng Decoction" orally. After 6 months of treatment, statistical analysis of the two groups before and after treatment the symptom scores, left lobe nodule maximum diameter, number of nodules and nodular malignant risk product changes, and contrast Effective treatment and treatment, clinical evaluation of "Jia Ping" cream treating phlegm stagnation and blood stasis type of benign thyroid nodules. Results: 1. general information: two groups before treatment (data including gender, age, course of disease, family history of thyroid disease, the nodule diameter. The symptom scores, nodule risk score) no significant difference (P0.05), which can be compared with the symptom scores before and after.2. treatment in the two groups: the treatment group, Chinese medicine symptom control and treatment group after treatment than before there was significant difference (P0.01), the symptom scores of two groups after treatment, the comparison between no statistical difference (P0.05), compared with the control group, but the difference between integral treatment group before and after treatment there was significant difference (P0.05) before and after.3. treatment in the two groups compared the number of maximum diameter of nodules, nodules: treatment group and control group after treatment The maximum diameter of the nodules compared with before treatment there was no significant difference (P0.05), the two groups after treatment the maximum diameter of nodules had no statistical difference (P0.05), the two groups before and after treatment the maximum nodule diameter difference had no statistical difference (P0.05), the number of nodes of the two groups after treatment decreased compared to the proportion also had no significant difference (P0.05 comparison of the risk of malignancy nodules).4. score before and after treatment in the two groups: the treatment of malignant risk score and treatment group after treatment than before there was significant difference (P0.01), the control of malignant risk score and treatment group after treatment than before no statistical difference (P0.05). The malignant risk score two groups after treatment compared there were significant differences (P0.05) between.5. two groups: according to the criteria of symptoms and signs of efficacy, the total effective rate of treatment group was 72.73%, 0 cases were cured, 0 cases markedly effective in 16 cases, 6 cases were ineffective; the total efficiency of the control group was 40.91%, clinical 娌繪剤0渚，

本文編號(hào)：1478551