本文關鍵詞： 橋本甲狀腺炎甲減期 育齡期女性 芪夏消癭合劑 泌乳素 雌二醇 孕酮　出處：《安徽中醫(yī)藥大學》2016年碩士論文　論文類型：學位論文

【摘要】：目的:以芪夏消癭合劑(原名“夏芍消癭合劑”)為基本方治療育齡期女性橋本甲狀腺炎甲減期患者,觀察其臨床療效及患者性激素的改善情況,并探索性激素與橋本甲減的相關性,以引起臨床對育齡期女性甲狀腺疾病患者的生殖內分泌功能的關注,為中醫(yī)藥治療本病提供新的思路和方法。方法:(1)選取30例無甲狀腺疾病的健康育齡期女性體檢者作為健康體檢組,與60例符合納入條件的育齡期女性橋本甲狀腺炎甲減患者組,比較兩組患者的月經(jīng)第3-5天性激素水平,根據(jù)統(tǒng)計學處理分析兩組是否存在差異性。(2)根據(jù)隨機對照臨床觀察原則,將60例符合納入條件的育齡期女性橋本甲狀腺炎甲減期同時中醫(yī)辨證屬肝郁脾虛兼夾腎虛證的患者分為治療組和對照組。對照組給予左旋甲狀腺素鈉進行常規(guī)治療;治療組在進行左旋甲狀腺素鈉治療的基礎上加服芪夏消癭合劑,一日一劑,療程三個月經(jīng)周期。觀察治療后兩組的甲狀腺激素水平、甲狀腺抗體水平、月經(jīng)第3-5天性激素水平的變化及中醫(yī)癥候積分的變化,經(jīng)統(tǒng)計學處理后評定臨床療效。結果:(1)經(jīng)對比發(fā)現(xiàn),橋本甲狀腺炎甲減組泌乳素(Prolactin,PRL)較健康體檢組升高,雌二醇(Estradiol,E2)、孕酮(Progesterone,PROG)較健康體檢組降低,兩組差異均具有統(tǒng)計學意義(P0.01)。(2)(1)橋本甲狀腺炎甲減患者經(jīng)治療后,對照組與治療組FT3、FT4均較治療前上升,TSH較治療前下降,甲狀腺球蛋白抗體(TGAb)和甲狀腺過氧化物酶(TPOAb)抗體滴度分別較治療前下降,兩組治療前后FT3、FT4、TSH、TPOAb、TGAb抗體滴度均有顯著性差異(P0.01);組間比較,治療組血清FT3、FT4升高水平,血清TSH及TPOAb、TGAb抗體滴度降低水平均優(yōu)于對照組(P0.05),芪夏消癭合劑在改善FT3、FT4、TSH及TPOAb、TGAb抗體滴度方面優(yōu)于單純西藥。(2)橋本甲狀腺炎甲減患者經(jīng)治療后,兩組PRL均有下降,但治療組泌乳素降低較對照組顯著(P0.01);兩組雌二醇(Estradiol,E2)治療后均有增高,但治療組比對照組雌二醇增高顯著(P0.05)。(3)橋本甲狀腺炎甲減患者經(jīng)治療之后,臨床療效進行比較,芪夏消癭治療組的總有效率達93.33%,常規(guī)治療對照組的總有效率達76.67%,治療組總有效率高于對照組(P0.05)。(4)芪夏消癭合劑在安全性方面,本方不良反應較少,安全性及依從性好。結論:(1)育齡期女性橋本甲狀腺炎甲減期患者與健康女性相比存在一定程度的性激素水平紊亂。(2)在替代療法基礎上加用芪夏消癭合劑進行治療之后,可以明顯改善育齡期女性橋本甲狀腺炎甲減期患者的甲狀腺激素水平,有效減低患者的甲狀腺自身抗體TGAb、TPOAb滴度,調節(jié)異常的女性生殖內分泌激素,減輕甲狀腺組織的破壞,恢復甲狀腺功能,從而改善女性生殖內分泌功能,緩解臨床癥狀,提高治愈率。芪夏消癭合劑治療組的各項指標均優(yōu)于對照組。本方不良反應較少,依從性好。
[Abstract]:Objective: to treat female Hashimoto thyroiditis patients with hypothyroidism by using Qi-Xia Xiao-ying mixture (formerly named "Xia Shao Xiao Ying mixture") as the basic prescription, and to observe the clinical effect and the improvement of sex hormone in the patients. And to explore the correlation between sex hormone and Hashimoto hypothyroidism in order to arouse clinical attention to reproductive endocrine function of female patients with thyroid disease of childbearing age. Methods 30 healthy women of childbearing age without thyroid disease were selected as the healthy physical examination group, and 60 women with Hashimoto's thyroiditis of childbearing age who were eligible for inclusion were selected as the healthy physical examination group, and 60 patients with Hashimoto's thyroiditis of childbearing age were included in the study. To compare the sex hormone levels at day 3-5 of menstruation between the two groups, and to analyze whether there was any difference between the two groups according to statistical analysis) according to the principle of randomized controlled clinical observation, Sixty cases of female Hashimoto's thyroiditis of childbearing age were divided into treatment group and control group according to syndrome differentiation of liver stagnation and spleen deficiency and kidney deficiency, and the control group was given routine treatment with levothyroxine sodium. The treatment group was treated with levothyroxine sodium plus Qixia Xiaoying mixture, one dose on 1st for three menstrual cycles. The thyroid hormone level and thyroid antibody level were observed in the two groups after treatment. The changes of sex hormone level on the 3-5 day of menstruation and the change of TCM symptom score were evaluated after statistical treatment. Results: compared with the control group, Prolactinus prolactinus PRL in Hashimoto thyroiditis hypothyroidism group was higher than that in healthy control group. Estradiol estradiol (Estradiolol), Progesterone prog (prog) were significantly lower than those in the control group (P 0.01). After treatment, the TSH levels in the control group and the treatment group were higher than those before treatment, and the levels of TSH in both the control group and the treatment group were lower than those before treatment, and the difference between the two groups was statistically significant (P < 0.01) after treatment, FT3 / FT4 levels in the control group and the treatment group were higher than those before treatment. The titers of TGAband TPOAb-thyroid peroxidase (TPOB) antibody were lower than those before and after treatment, and there were significant differences in the titer of TGAband TPOAbb antibody between the two groups before and after treatment (P < 0.01), and the serum FT _ 3 / FT _ 4 level in the treatment group was higher than that in the control group, and there was a significant difference between the two groups in the titer of TGAband TPO-TGAb before and after treatment (P < 0.05). The titers of serum TSH and TPOAb TGAb antibody were higher than those of control group (P 0.05). Qi-Xia Xiao Ying mixture was superior to western medicine. After treatment, the PRL in both groups was lower than that in the control group in improving the titer of FT _ 3, FT _ 4, TGA _ (4) and TPO _ (2) TGA _ (2) after treatment, the levels of PRL in both groups were significantly lower than those in control group (P < 0.05). However, the prolactin level in the treatment group was significantly lower than that in the control group (P 0.01), and the estradiol estradiol E2 (Estradiolol E2) in both groups was higher than that in the control group (P < 0.05. 3) after treatment, the clinical efficacy of the patients with Hashimoto's thyroiditis was compared. The total effective rate of Qixia Xiaoying treatment group was 93.33 and that of routine treatment control group was 76.67. The total effective rate of treatment group was higher than that of control group (P0.05P0.05P.P0.05.P0. 4) the safety of Qixia Xiaoying mixture was less than that of routine treatment group, and the side effect of Qxixiaoxiaoying mixture was less than that of control group. Conclusion there is a certain degree of sex hormone disorder in female patients with Hashimoto's thyroiditis during hypothyroidism compared with that of healthy women. [conclusion] after the treatment of Qixia Xiaoying mixture on the basis of substitution therapy, there is a certain degree of sex hormone disorder in female patients with Hashimoto's thyroiditis. It can obviously improve the thyroid hormone level of female patients with Hashimoto's thyroiditis at the stage of hypothyroidism, reduce the titer of thyroid autoantibody TGAb-TPOAb, regulate the abnormal female reproductive endocrine hormone, and alleviate the destruction of thyroid tissue. Restore thyroid function, improve female reproductive endocrine function, alleviate clinical symptoms, improve the cure rate. Qi-Xia Xiao-ying mixture treatment group is superior to the control group, the side effect of this prescription is less, compliance is good.
【學位授予單位】：安徽中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R259

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