本文選題：橋本甲狀腺炎伴甲減 + 健脾益腎化濁法��； 參考：《云南中醫(yī)學院》2017年碩士論文

【摘要】：研究目的本研究采用健脾益腎化濁法治療證型屬脾腎不足兼痰濁的橋本合并甲減的患者,通過對患者治療前后的甲狀腺抗體、甲狀腺功能、血脂、臨床癥狀及甲腫程度情況的觀察,了解該法對本病的療效,為本病今后的預防和治療提供新的方法和思路。研究方法1.選取共計64例于2015年12月--2016年9月在云南省中醫(yī)醫(yī)院內(nèi)分泌科、紅會醫(yī)院中醫(yī)科住院和門診的本病患者。治療組和對照組被隨機各分為32例。2.服藥方法(1)對照組:使用常規(guī)劑量的左甲狀腺素鈉片(優(yōu)甲樂(Euthyrox);50μg*100片;批準文號:注冊證號H20100523;德國默克公司)進行治療(根據(jù)患者的具體情況,在醫(yī)生指導下,起始劑量為每天服用1/4片,逐漸增加劑量至1/2片,間隔2-4周,最大增加到每天1-2片)。(2)治療組:在常規(guī)使用左甲狀腺素鈉片(同對照組)的基礎上加服中藥二仙參草湯,每日一劑。二仙參草湯服法:每劑冷水煎450ml,水煎20min,分三次溫服,每天一付。3.療程:治療組和對照組都以4周為一療程,共治療兩個療程。4.主要觀察內(nèi)容:治療前后甲狀腺相關免疫學指標、甲狀腺激素水平、血脂、甲狀腺彩超及癥狀等變化情況。研究結果1.橋本甲狀腺炎并甲狀腺功能減退癥屬脾腎虧虛兼痰濁證的患者共64例。男性11例(17.19%),女性53例(82.81%),男女之比約為1:4.8;年齡在16-75歲,平均54.97±15.95歲。2.治療前:兩組的年齡、性別、甲狀腺激素水平、甲狀腺相關免疫學指標、血脂、甲狀腺腫大情況、癥狀和療效經(jīng)統(tǒng)計學處理(49)0.05,無顯著性差異,有可比性。3.治療后:(1)降低甲狀腺抗體方面:治療組治療前后比較有明顯差異((49)0.01),對照組治療前后比較無統(tǒng)計學意義((49)0.05)。治療后兩組組間比較(49)0.01,說明治療組在降低甲狀腺抗體方面較對照組有明顯治療效果。(2)改善甲狀腺功能方面:治療組治療后FT3、FT4水平與治療前比較顯著升高((49)0.01),治療后TSH水平與治療前比較顯著下降((49)0.01)。說明治療組能顯著改善甲狀腺功能;對照組治療后FT3和FT4都有升高,(49)0.01,TSH水平與治療前比較顯著降低,(49)0.01。說明對照組也能有效改善甲狀腺功能;治療后兩組組間甲狀腺功能比較:TSH(49)0.05,FT3(49)0.05,無統(tǒng)計學差異;FT4(49)0.05,有差異,說明在甲狀腺功能改善方面治療組和對照組無差異性。(3)降脂方面:治療組治療前后比較:TG、CHOL、HDL-C、LDL-C方面均有明顯改善((49)0.01)。而對照組在改善TG、CHOL、HDL-C、LDL-C均無顯著差異((49)0.05)。治療后兩組血脂比較:治療組明顯優(yōu)于對照組((49)0.01)。(4)在臨床癥狀改善方面:治療組治療后臨床癥狀改善較治療前顯著治療后與治療前的差值分別為-9.91±5.81和-0.33±1.45,治療組對癥狀的改善作用明顯優(yōu)于對照組((49)0.01)。(5)在甲狀腺腫大程度改善方面:治療組和對照組在改善甲狀腺腫大方面無明顯差異,均沒有顯著療效((49)0.05)。(6)療效評價:按橋本甲減療效評定標準、中醫(yī)癥候療效評定標準對所有實驗對象進行評價:治療組顯效19列,有效13列,對照組顯效10例,有效22例,治療組療效好于對照組(?2=4.661,P=0.031)(7)治療組患者在服藥后無明顯不良反應。研究結論橋本甲減屬脾腎不足兼痰濁型患者,通過運用二仙參草湯治療,并與對照組比較,發(fā)現(xiàn)可以調(diào)節(jié)異常甲狀腺功能水平,降低甲狀腺抗體及血脂,緩解和改善臨床癥狀,臨床療效顯著,安全可靠,擁有廣闊的應用前景;但在縮小甲狀腺腫大情況方面,暫未發(fā)現(xiàn)有明顯療效,這可能以觀察的時間及數(shù)量有限有關。
[Abstract]:Objective to study the treatment of Hashimoto with hypothyroidism with spleen and kidney deficiency and phlegm turbidity by strengthening spleen and kidney and turbidity method. Through observation of thyroid antibody, thyroid function, blood lipid, clinical symptoms and degree of swelling of the patients before and after treatment, the effect of this method on the disease is understood and provided for the prevention and treatment of the disease in the future. New methods and ideas. Method 1. a total of 64 cases were selected in the Department of Endocrinology, Yunnan traditional Chinese medicine hospital, Yunnan Province, September December 2015, and the patients in the hospital and outpatient department of Honghui hospital. The treatment group and the control group were randomly divided into 32 cases of.2. medicine (1) control group: Levothyroxine Sodium Tablets (Euth) with regular dose (Euth Yrox); 50 mu g*100 tablets; Approval Number: registration number H20100523; German Merck Co) for treatment (according to the patient's specific circumstances, under the guidance of a doctor, the initial dose of 1/4 tablets daily, gradually increased to 1/2 tablets, interval 2-4 weeks, maximum to 1-2 tablets per day). (2) treatment group: in the routine use of Levothyroxine Sodium Tablets (control group) On the basis of the traditional Chinese medicine Erxian Shen grass soup, a daily dose of Erxian Shen Cao Decoction: each dose of cold water decoction 450ml, water decocted 20min, three times warm clothes, one day for a period of.3. treatment: the treatment group and the control group are 4 weeks for a course of treatment, a total of two courses of treatment of the main contents of the thyroid immunology indexes, thyroid hormone levels before and after treatment. Research results 1. Hashimoto's thyroiditis and hypothyroidism are 64 cases of spleen and kidney deficiency and phlegm syndrome. 11 men (17.19%), 53 women (82.81%), women and men are about 1:4.8; age 16-75, and before.2. treatment of 54.97 + 15.95 years old: two groups of age, sex, thyroid gland Hormone level, thyroid related immunological index, blood lipid, goiter, symptoms and curative effect were statistically treated (49) 0.05, no significant difference, (1) reduction of thyroid antibody: the treatment group before and after treatment was significantly different (49) 0.01 ((49)) before and after treatment (49) 0.05 (49). After treatment, the comparison between the two groups (49) was 0.01, indicating that the treatment group had obvious therapeutic effect in reducing thyroid antibody compared with the control group. (2) to improve the thyroid function, the level of FT3 in the treatment group was significantly higher ((49) 0.01) after treatment ((49) 0.01). The level of TSH in the treatment group was significantly decreased after treatment (49) 0.01. The thyroid function was improved; FT3 and FT4 in the control group were increased, (49) 0.01, and the level of TSH was significantly lower than before treatment. (49) 0.01. showed that the control group could also effectively improve the thyroid function. The thyroid function of the two groups after treatment: TSH (49) 0.05, FT3 (49) 0.05, FT4 (49) 0.05, there were differences, indicating thyroid gland in the thyroid gland. There was no difference between the treatment group and the control group. (3) in the treatment group, there was a significant improvement in TG, CHOL, HDL-C, and LDL-C before and after treatment ((49) 0.01). The control group had no significant difference (49) in the improvement of TG, CHOL, HDL-C, LDL-C (0.05). The treatment group was significantly better than the control group (49) 0.01. (4) in the treatment group. The improvement of bed symptoms: the difference between the clinical symptoms after treatment and before treatment was -9.91 + 5.81 and -0.33 + 1.45, respectively. The improvement of the symptoms in the treatment group was significantly better than that of the control group (49) 0.01. (5) the improvement of the thyroid enlargement: the treatment group and the control group were in the improvement of the thyroid enlargement. There was no significant difference (49) ((6) 0.05). (6) the evaluation of curative effect: according to the evaluation standard of hypothyroidism, the evaluation standard of TCM syndrome effect was evaluated: 19 in the treatment group, 13 in effective, 10 in the control group and 22 in the control group. The curative effect of the treatment group was better than that of the control group (2=4.661, P=0.031) (7) in the treatment group. There is no obvious adverse reaction after taking the medicine. Conclusion Hashimoto hypothyroidism is the patients with spleen and kidney deficiency and phlegm turbid type. By using Erxian Shen Cao Decoction and compared with the control group, it is found that it can regulate abnormal thyroid function level, reduce thyroid antibody and blood lipid, alleviate and improve clinical symptoms. The clinical effect is significant, safe and reliable, and has broad and safe clinical effect. Application prospects; however, no significant effect has been found in reducing the size of thyroid enlargement, which may be related to the limited time and quantity of observation.
【學位授予單位】：云南中醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259

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