本文關(guān)鍵詞： 甲亢合并糖尿病 中醫(yī)證型 相關(guān)因素　出處：《湖北中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的通過搜集甲亢合并糖尿病患者的病例,與單純甲亢或單純糖尿病患者病史作一比較,并以常見中醫(yī)證型分類,研究不同證型與患者病史及某些相關(guān)檢查客觀參數(shù)之間的關(guān)系,尋求其內(nèi)在聯(lián)系,以揭示甲亢合并糖尿病病情判斷、治療用藥、預(yù)后評估及中醫(yī)辨證論治的規(guī)律。方法根據(jù)統(tǒng)一的診斷標(biāo)準(zhǔn)及疾病特點,制定納入和排除標(biāo)準(zhǔn),搜集甲亢、糖尿病或甲亢合并糖尿病患者臨床資料各42例,其中甲亢合并糖尿病患者為觀察組,單純甲亢、單純糖尿病分別為對照A組、B組。采取對照研究方法,比較甲亢合并糖尿病患者病史與單純甲亢或單純糖尿病患者的差異。并以常見中醫(yī)證型分類,觀察不同證型間患者病史及某些相關(guān)檢查客觀參數(shù)的差異。主要常見證型分為熱盛傷津、陰虛火旺和氣陰兩虛3型,而相關(guān)檢查則包括甲狀腺功能(FT3、FT4和TSH)、空腹血糖(FPG)、糖化血紅蛋白(Hb A1c)、血脂(TC、TG、LDL-C和HDL-C)及頸部血管彩超、甲狀腺彩超等。結(jié)果使用SPSS19.0統(tǒng)計軟件處理。結(jié)果(1)甲亢組與甲亢合并糖尿病組患者在性別構(gòu)成比、平均年齡等方面相比較,經(jīng)統(tǒng)計學(xué)方法檢驗,差異無顯著性(P0.05),其中甲亢較甲亢合并糖尿病患者的女性比例稍高,平均年齡稍低。糖尿病組與甲亢合并糖尿病組患者性別構(gòu)成比有統(tǒng)計學(xué)差異但不顯著(0.01P0.05),平均年齡有顯著性差異(P0.01)。其中糖尿病較甲亢合并糖尿病患者的女性比例更低,平均年齡更大。甲亢組、糖尿病組與甲亢合并糖尿病組患者相比較,在合并血脂異常、高血壓、冠心病病史比例等方面,經(jīng)統(tǒng)計學(xué)方法檢驗,差異均無顯著性(P0.05)。其中甲亢較甲亢合并糖尿病患者合并血脂異常、高血壓、冠心病病史的比例均更低;糖尿病較甲亢合并糖尿病患者的血脂異常出現(xiàn)比例稍高,合并高血壓、冠心病病史更少。(2)甲亢組與甲亢合并糖尿病組患者甲狀腺彩超在甲狀腺腫大、甲狀腺結(jié)節(jié)最大直徑1cm(大小)及低回聲(回聲性質(zhì))的檢出率等方面比較,經(jīng)統(tǒng)計學(xué)方法檢驗,差異無顯著性(P0.05)。但在甲狀腺腫大、甲狀腺結(jié)節(jié)最大直徑1cm(大小)及低回聲(回聲性質(zhì))的檢出率等方面,甲亢合并糖尿病組較甲亢組患者更高。糖尿病組與甲亢合并糖尿病組患者甲狀腺腫大檢出率有顯著性差異(P0.01),甲狀腺結(jié)節(jié)最大直徑1cm(大小)及低回聲(回聲性質(zhì))的檢出率等方面差異無顯著性(P0.05)。(3)甲亢合并糖尿病的中醫(yī)證型,以陰虛火旺為主占52.4%,其次為氣陰兩虛(占35.7%),而熱盛傷津(占11.9%)最少。(4)甲亢合并糖尿病證型中,熱盛傷津組的平均病程、BMI與其余兩組比較,有顯著性差異(P0.01),而其余兩組間比較差異無顯著性(P0.05);三組間在合并血脂異常、高血壓、冠心病病史方面,差異無顯著性(P0.05)。但熱盛傷津型病程短,BMI偏低,合并血脂異常、高血壓、冠心病病史少見。(5)甲亢合并糖尿病證型中,熱盛傷津組患者FT3、FT4、TSH、FPG和Hb A1c與其余兩組比較,有顯著性差異(P0.01),而余兩組比較差異無顯著性(P0.05)。其中,熱盛傷津型FT3、FT4、FPG和Hb A1c升高,而TSH明顯降低。(6)甲亢合并糖尿病證型中,三組間在血脂TC、TG、LDL-C和HDL-C水平方面,差異無顯著性(P0.05)。但熱盛傷津型血脂水平較余兩組要低。可見甲亢合并糖尿病對血脂有多重影響,表現(xiàn)復(fù)雜。熱盛傷津組與氣陰兩虛組IMT有差異但不顯著(0.01P0.05),而二者與陰虛火旺組比較均無差異(P0.05);三組間動脈粥樣斑塊檢出率者無顯著性差異(P0.05)。結(jié)論本研究證實,之所以糖尿病較正常人群更易合并甲亢,主要可能是由疾病本身引起,與患者病史無關(guān)。而中醫(yī)常見證型以陰虛火旺、氣陰兩虛等虛候為主,病情危重時可表現(xiàn)熱盛傷津等實證。患者甲狀腺功能、血糖紊亂、血脂異常等相關(guān)檢查客觀參數(shù),也從一定程度支持這一結(jié)論。在臨床上患者急性發(fā)病時,應(yīng)積極控制甲亢和糖尿病,待檢查結(jié)果恢復(fù)正常后,仍需繼續(xù)治療,以鞏固患者的陰虛之本。
[Abstract]:Objective to collect the patients with hyperthyroidism complicated with diabetes were compared with simple hyperthyroidism or simple diabetes history, and with the common TCM syndrome type classification, the study of the relationship between different syndromes and patient history and some related parameters of the inspection objective, to seek the internal relations, in order to reveal the severity of hyperthyroidism complicated with diabetes, drug treatment, theory treatment and prognostic assessment of TCM syndrome patterns. Methods according to the unified diagnosis standard and disease characteristics, formulate the inclusion and exclusion criteria, collect hyperthyroidism, diabetes or hyperthyroidism patients with diabetes clinical data of 42 cases, including patients with hyperthyroidism complicated with diabetes as the observation group, simple hyperthyroidism, diabetes mellitus were divided into the control group A, B group. The control study method, comparative history of hyperthyroidism complicated with diabetic patients with simple hyperthyroidism patients with diabetes or simple difference. And with the common TCM syndrome type classification, observation The difference between patients with syndromes of history and some relevant inspection objective parameters. The main common syndromes are divided into heat injury Tianjin, Yindeficiency and Qi and yin deficiency type 3, and the relevant examination included thyroid function (FT3, FT4 and TSH), fasting blood glucose (FPG), glycosylated hemoglobin (Hb A1c), blood lipid (TC, TG, LDL-C and HDL-C) and neck vascular ultrasound, thyroid ultrasound. Results using SPSS19.0 statistical software. Results (1) in hyperthyroid group and hyperthyroidism combined with diabetes mellitus group in sex ratio, average age, comparison, statistics test, there was no significant difference (P0.05), including hyperthyroidism the proportion of women with diabetes than hyperthyroidism with slightly higher, the average age of less than. There were significant differences but not significant in diabetic group and hyperthyroidism combined with diabetes mellitus group (0.01P0.05), the average age of sex had significant difference (P0.01). The diabetes is associated with hyperthyroidism The proportion of women with diabetes is lower, the average age of greater. Hyperthyroidism group, diabetes group and hyperthyroidism combined with diabetes mellitus group compared with dyslipidemia, hypertension, coronary heart disease and other aspects of proportion, by statistical test, there were no significant differences (P0.05). The diabetic patients with hyperthyroidism complicated with hyperthyroidism with dyslipidemia hypertension, history of coronary heart disease were lower than diabetes; hyperthyroidism complicated with diabetic dyslipidemia appears slightly higher proportion of hypertension, coronary heart disease less. (2) the hyperthyroid group and hyperthyroidism and thyroid ultrasound in diabetic patients with goiter, thyroid nodule maximum diameter of 1cm (size) and low echo (echo property comparison) the detection rate, the statistical analysis, no significant difference (P0.05). But in goiter, thyroid nodule maximum diameter of 1cm (size) and low echo ( The detection rate of echo property), hyperthyroidism combined with diabetes mellitus group than in hyperthyroidism group were higher. The diabetic group and hyperthyroidism combined with diabetes mellitus group goiter rate had significant difference (P0.01), thyroid nodule maximum diameter of 1cm (size) and low echo (echo character) the differences in detection rate was not significantly of (P0.05). (3) TCM Syndromes of hyperthyroidism complicated with diabetes, with hyperactivity of fire due to yin deficiency accounted for 52.4%, followed by Qi and yin deficiency (35.7%), and heat injury Tianjin (11.9%) at least. (4) with diabetes syndromes of hyperthyroidism, the average duration of heat injury Tianjin group, and BMI the other two groups, there was significant difference (P0.01), while the remaining two were no significant differences between the three groups (P0.05); in patients with dyslipidemia, hypertension, coronary heart disease, there was no significant difference (P0.05). But the heat injury Tianjin type of short duration, low BMI, dyslipidemia., hypertension, crown 蹇冪梾鐥呭彶灝戣.(5)鐢蹭孩鍚堝茍緋栧翱鐥呰瘉鍨嬩腑,鐑洓浼ゆ觸緇勬?zhèn)ｈ�匜T3,FT4,TSH,FPG鍜孒b A1c涓庡叾浣欎袱緇勬瘮杈，

本文編號：1520736