本文選題：益腎健脾方 + 橋本甲狀腺炎��； 參考：《南京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:觀察育齡期橋本甲減女性使用益腎健脾方進行孕前調(diào)理后在甲狀腺功能、甲狀腺自身抗體水平、甲狀腺體積大小及峽部厚度及中醫(yī)證候等方面的臨床療效,并評估其安全性。為臨床使用中醫(yī)中藥對育齡期的橋本甲減女性患者進行孕前調(diào)理提供理論依據(jù)。方法:根據(jù)橋本甲狀腺炎合并甲狀腺功能減退的西醫(yī)診斷標準,中醫(yī)辨證屬腎陽虧虛、脾虛痰凝證,選取臨床上符合以上兩個診斷標準的20～40歲育齡期備孕女性患者60例進行觀察,采用隨機對照方法將60例患者分為治療組和對照組。對照組30例患者單純予常規(guī)優(yōu)甲樂治療;治療組30例患者在予常規(guī)優(yōu)甲樂治療的基礎(chǔ)上,加用益腎健脾方水煎劑,早晚口服,兩組均觀察12周。主要觀察指標:甲狀腺激素水平(FT3、FT4、TSH),甲狀腺相關(guān)抗體水平(TGAb、TMAb),甲狀腺彈性B超(甲狀腺體積、峽部厚度)以及中醫(yī)臨床癥狀、體征的變化,同時評價患者的不良反應(yīng)和依從性情況。結(jié)果:基線比較,治療前兩組的年齡和病程等經(jīng)統(tǒng)計學(xué)分析無顯著差異(P0.05),有可比性。①甲狀腺激素水平:治療前后組內(nèi)比較,治療后兩組血清TSH水平較治療前顯著下降,血清FT3、FT4水平較治療前顯著上升,差異均有統(tǒng)計學(xué)意義(P0.01);組間比較,治療組FT3、FT4水平升高幅度明顯高于對照組(P0.01),血清TSH水平降低程度較對照組更為顯著(P0.01),差異均有統(tǒng)計學(xué)意義。②甲狀腺抗體水平:治療前后組內(nèi)比較,治療后治療組與對照組TGAb水平和TMAb水平較治療前均顯著降低,差異有統(tǒng)計學(xué)意義(P0.01);組間比較,治療組TGAb水平下降幅度顯著優(yōu)于對照組(P0.01),治療組TMAb水平下降幅度顯著優(yōu)于對照組,差異均有統(tǒng)計學(xué)意義(P0.01)。③甲狀腺體積和峽部厚度:治療前后組內(nèi)比較,治療后甲狀腺體積及峽部厚度較治療前均顯著下降(P0.01);組間比較,治療組甲狀腺體積及峽部厚度改變程度均優(yōu)于對照組(P0.05或0.01),均有統(tǒng)計學(xué)意義。④證候療效:治療組總有效率86.67%;對照組總有效率53.33%,治療組證候改善顯著優(yōu)于對照組(P0.05)。⑤安全性:兩組患者的血、尿、糞常規(guī)以及肝腎功能均在正常水平范圍內(nèi),安全性良好,服藥后未見明顯副作用。結(jié)論:使用益腎健脾方對育齡期橋本甲減女性患者進行孕前調(diào)理,能明顯改善患者的甲狀腺功能及甲狀腺抗體滴度水平,減小甲狀腺體積和峽部厚度,并能顯著改善患者的臨床癥狀和體征,未出現(xiàn)明顯不良反應(yīng),療效確切,安全可靠。
[Abstract]:Objective: to observe the clinical effects of Yishen Jianpi recipe on thyroid function, thyroid autoantibody level, thyroid volume size, isthmus thickness and TCM syndromes in women of childbearing age. And evaluate its safety. To provide a theoretical basis for the clinical use of traditional Chinese medicine for the reproductive age of female patients with Hashimoto hypothyroidism before pregnancy. Methods: according to the diagnostic criteria of Hashimoto's thyroiditis combined with hypothyroidism, TCM syndrome differentiation is deficiency of kidney yang, spleen deficiency and phlegm coagulation syndrome. Sixty pregnant women aged 20 ~ 40 years old who met the above two diagnostic criteria were selected for observation, and 60 cases were divided into treatment group and control group by randomized control method. 30 patients in the control group were treated with routine euthyroidism alone, and 30 patients in the treatment group were treated with Yishen Jianpi decoction on the basis of routine treatment. Both groups were observed for 12 weeks. Main outcome measures: thyroid hormone level FT3 / FT4 / TSHN, thyroid associated antibody level / TGAbT / TMAbA, thyroid elasticity B ultrasound (thyroid volume, isthmus thickness), and changes of clinical symptoms and signs of TCM. Adverse reactions and compliance of the patients were evaluated at the same time. Results: compared with baseline, there was no significant difference in age and course of disease between the two groups before treatment (P 0.05). 1 thyroid hormone level was comparable. 1 the serum TSH level of the two groups decreased significantly after treatment compared with that before and after treatment. The serum FT _ 3 FT _ 4 level was significantly higher than that before treatment, and the difference was statistically significant (P 0.01). The level of FT3 FT-4 in the treatment group was significantly higher than that in the control group (P 0.01), and the decrease of serum TSH level was more significant than that in the control group (P 0.01). The difference was statistically significant. 2. The level of thyroid antibody in the treatment group was higher than that in the control group before and after treatment. After treatment, the levels of TGAb and TMAb in the treatment group and the control group were significantly lower than those before the treatment, and the difference was statistically significant (P 0.01). Compared with the control group, the TGAb level in the treatment group was significantly lower than that in the control group (P 0.01), and the TMAb level in the treatment group was significantly lower than that in the control group. There were significant differences in thyroid volume and isthmus thickness before and after treatment. The thyroid volume and isthmus thickness decreased significantly after treatment. The changes of thyroid volume and isthmus thickness in the treatment group were better than those in the control group (P0.05 or 0.01), and there were statistically significant effects on the syndromes of the treatment group: the total effective rate of the treatment group was 86.67, the total effective rate of the control group was 53.33, and the improvement of the syndrome in the treatment group was significantly better than that in the control group. Safety of P0.05: blood from two groups of patients, Urine, fecal routine and liver and kidney function were in normal range, safety was good, no side effects were observed after taking medicine. Conclusion: using Yishen Jianpi recipe to regulate the thyroid function and thyroid antibody titer of female patients with Hashimoto hypothyroidism during childbearing period can obviously improve the thyroid function and thyroid antibody titer and decrease the thyroid volume and isthmus thickness. It can significantly improve the clinical symptoms and signs of the patients, no obvious adverse reactions, the curative effect is accurate, safe and reliable.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R259

【參考文獻】

相關(guān)期刊論文 前10條

1 孫瀟瀟;周峰峰;莊瑞斐;王旭;;王旭辨治橋本甲狀腺炎經(jīng)驗總結(jié)[J];上海中醫(yī)藥雜志;2016年12期

2 岳晨;劉小利;;硒酵母聯(lián)合左旋甲狀腺素片治療橋本甲狀腺炎的臨床效果[J];中外醫(yī)學(xué)研究;2016年27期

3 常偉勤;李鳳;吳書瑩;張琨;;圍絕經(jīng)期女性雌激素水平與橋本氏甲狀腺炎的相關(guān)性研究[J];中國實驗診斷學(xué);2016年09期

4 高莉囡;淡以銳;張慧;;肝炎病毒感染致甲狀腺功能受損的臨床分析[J];吉林醫(yī)藥學(xué)院學(xué)報;2016年04期

5 許鋮鋮;鄭婷婷;吳菲;卜玲;毛朝明;牟笑;劉紅利;周月鵬;;過量碘抑制甲狀腺細胞自噬并誘導(dǎo)凋亡與橋本甲狀腺炎有關(guān)[J];細胞與分子免疫學(xué)雜志;2015年07期

6 馬媛媛;趙志剛;;橋本甲狀腺炎甲狀腺功能與氧化應(yīng)激狀態(tài)的關(guān)系研究[J];醫(yī)學(xué)與哲學(xué)(B);2015年03期

7 王秋虹;魏軍平;王師菡;;林蘭教授中西醫(yī)結(jié)合治療橋本甲狀腺炎經(jīng)驗擷菁[J];環(huán)球中醫(yī)藥;2015年03期

8 韓英;陳玉娟;李詠梅;江雁瓊;張少峰;;骨化三醇治療對橋本甲狀腺炎合并甲狀腺功能減退的影響[J];中國臨床研究;2015年01期

9 陳雪梅;劉q，

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