本文選題：活血消癭片　切入點(diǎn)：夏枯草膠囊　出處：《湖北中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的從中醫(yī)學(xué)角度探討結(jié)節(jié)性甲狀腺腫的病因、病機(jī),觀察活血消癭片聯(lián)合夏枯草膠囊治療痰結(jié)血瘀型結(jié)節(jié)性甲狀腺腫的臨床療效,探討其治療結(jié)甲的作用機(jī)制,評(píng)價(jià)其對(duì)甲狀腺結(jié)節(jié)、甲狀腺形態(tài)等方面的作用,了解其對(duì)中醫(yī)臨床癥狀、體征的改善情況,評(píng)價(jià)其臨床應(yīng)用價(jià)值。方法選取自2016年4月至2016年10月至湖北省中醫(yī)院甲狀腺專(zhuān)科門(mén)診就診,符合西醫(yī)結(jié)甲的診斷、中醫(yī)痰結(jié)血瘀型癭瘤的患者66例,在治療過(guò)程中,脫落6例,按隨機(jī)對(duì)照法將入組的60例分為治療組30例,對(duì)照組30例。治療組予以口服活血消癭片,每次4片,每日3次;夏枯草膠囊,每次2粒,每日2次;對(duì)照組予以口服優(yōu)甲樂(lè)片,每次25μg~50μg,每日1次;3個(gè)月為一個(gè)治療療程,觀察周期為3個(gè)月。比較兩組患者的甲狀腺結(jié)節(jié)、甲狀腺形態(tài)、結(jié)節(jié)惡變高危因素積分、中醫(yī)證候積分等方面在治療前后的變化情況。結(jié)果(1)治療前,將兩組患者的性別、年齡、病程等進(jìn)行對(duì)比,P0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義,具有可比性。(2)治療前后兩組臨床療效比較:一個(gè)療程后,治療組的總有效率為73.33%,對(duì)照組為36.67%,兩者比較,有顯著性差異,說(shuō)明治療組療效明顯優(yōu)于對(duì)照組。(3)治療前后兩組中醫(yī)證候積分比較:治療組治療前后中醫(yī)證候積分比較,P0.01,有顯著性差異;對(duì)照組治療前后中醫(yī)證候積分比較,P0.05,差異有統(tǒng)計(jì)學(xué)意義;治療后,兩組中醫(yī)證候積分均下降,兩組比較,P0.01,有顯著性差異,說(shuō)明治療組在改善中醫(yī)癥狀、體征方面優(yōu)于對(duì)照組。(4)治療前后兩組中醫(yī)證候療效比較:治療組的總有效率為90.0%,對(duì)照組為33.3%,兩者比較,有顯著性差異。(5)治療前后兩組結(jié)節(jié)惡變高危因素積分比較:治療組治療前后對(duì)比,P0.01,有顯著性差異;對(duì)照組治療前后對(duì)比,P0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義;治療后兩組間比較,P0.01,有顯著性差異,即治療組惡變高危因素積分明顯低于對(duì)照組。(6)治療前后兩組甲狀腺結(jié)節(jié)最大直徑比較:治療組治療前后比較,P0.05,治療后結(jié)節(jié)的最大直徑小于治療前,差異有統(tǒng)計(jì)學(xué)意義;對(duì)照組治療前后對(duì)比,P0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義;治療后兩組間比較,P0.05,即治療組甲狀腺結(jié)節(jié)減小程度大于對(duì)照組。(7)治療前后兩組甲狀腺體積比較:治療組治療前后比較,P0.05,治療后甲狀腺體積小于治療前,差異有統(tǒng)計(jì)學(xué)意義;對(duì)照組治療前后對(duì)比,P0.05,治療后甲狀腺體積小于治療前,差異有統(tǒng)計(jì)學(xué)意義;治療后,兩組間比較,P0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義。(8)毒副作用:兩組治療前后甲狀腺功能、甲狀腺自身免疫性抗體比較,P0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義;兩組治療前后血常規(guī)、尿常規(guī)、肝功能、腎功能等檢查未見(jiàn)異常,均在正常范圍內(nèi)。結(jié)論活血消癭片聯(lián)合夏枯草膠囊治療結(jié)節(jié)性甲狀腺腫療效顯著,可以明顯改善患者的癥狀、體征,縮小腫大的甲狀腺及結(jié)節(jié)的最大直徑,且可以降低結(jié)節(jié)惡變的可能性,毒副作用小,值得臨床推廣。
[Abstract]:Objective to investigate the etiology and pathogenesis of nodular goiter from the perspective of traditional Chinese medicine (TCM), to observe the clinical effect of Huoxue Xiaoying tablet combined with Xiucucao capsule in treating nodular goiter of phlegm and blood stasis type, and to explore its mechanism of treating nodular goiter. To evaluate its effect on thyroid nodule and thyroid shape, and to understand the improvement of clinical symptoms and signs of TCM. Methods from April 2016 to October 2016, from April 2016 to October 2016, 66 patients with sputum and blood stasis type gall tumor of traditional Chinese medicine were selected. Six cases of shedding were divided into treatment group (30 cases) and control group (30 cases) according to the method of random control. The treatment group was given 4 tablets of Huoxue Xiaoying tablet 3 times a day, 2 capsules of Prunella subtilis capsule twice a day; The control group was treated with Utrel tablets, 25 渭 g / time, 50 渭 g / day, 3 months as a course of treatment, and the observation period was 3 months. The thyroid nodule, thyroid shape and the score of high risk factors of nodular malignancy were compared between the two groups. Results before and after treatment, the sex, age and course of disease of the two groups were compared and compared with P0.05. the difference was not statistically significant. Comparison of the two groups before and after treatment: after a course of treatment, the total effective rate of the treatment group was 73.33 and that of the control group was 36.67. There was a significant difference between the two groups. The results showed that the therapeutic effect of the treatment group was significantly better than that of the control group. (3) the comparison of TCM syndrome score before and after treatment in the treatment group was significant (P 0.01). After treatment, the scores of TCM syndromes in the two groups were all decreased, and there was significant difference between the two groups (P 0.01), indicating that the treatment group was improving the symptoms of traditional Chinese medicine. The total effective rate of the treatment group was 90.0 and that of the control group was 33.3.Compared with the control group, it was better than the control group before and after the treatment. There was significant difference between the two groups before and after treatment. The scores of high risk factors of nodule malignancy in the treatment group were significantly higher than those in the control group before and after treatment, and there was no significant difference between the treatment group and the control group before and after treatment, and there was no significant difference between the two groups before and after treatment. There was significant difference between the two groups after treatment. That is, the score of high risk factors of malignant change in the treatment group was significantly lower than that in the control group.) the maximum diameter of thyroid nodule in the treatment group was significantly lower than that in the control group before and after treatment (P 0.05), and the maximum diameter of the nodule after treatment was smaller than that before treatment, and the difference was statistically significant. There was no significant difference between control group and control group before and after treatment (P 0.05). After treatment, the thyroid volume of the treatment group was lower than that of the control group (P 0.05), the thyroid volume of the treatment group was smaller than that of the control group (P 0.05). After treatment, the volume of thyroid gland in the control group was smaller than that before and after treatment, and the difference was statistically significant; after treatment, there was no significant difference between the two groups in terms of thyroid function, and there was no significant difference between the two groups before and after treatment. There was no significant difference in thyroid autoimmune antibodies between the two groups before and after treatment, and no abnormality was found in the examination of blood routine, urine routine, liver function, renal function and so on before and after treatment. Conclusion the curative effect of Huoxue Xiaoying tablet combined with Xixucao capsule on nodular goiter is remarkable, which can obviously improve the symptoms and signs of the patients and reduce the maximum diameter of the enlarged thyroid gland and nodule. And can reduce the possibility of nodule malignancy, the toxicity and side effect is small, worthy of clinical promotion.
【學(xué)位授予單位】：湖北中醫(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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