亞急性甲狀腺炎的中醫(yī)辨證分型及相關(guān)因素研究
發(fā)布時(shí)間：2018-09-09 11:48
【摘要】：目的亞急性甲狀腺炎是一種自限性非化膿性甲狀腺炎性疾病,其癥狀主要表現(xiàn)為頸部疼痛不適,經(jīng)常反復(fù)發(fā)作,影響患者的生存質(zhì)量,現(xiàn)通過收集病歷,分析概括其常見的中醫(yī)證型,及其證型分布與年齡、性別及相關(guān)客觀參數(shù)之間的聯(lián)系,探討亞急性甲狀腺炎的中醫(yī)證型分布與西醫(yī)分型的關(guān)系,辨證論治指導(dǎo)中醫(yī)藥治療,研究中西醫(yī)結(jié)合辨證治療亞急性甲狀腺炎的療效。方法參考《中國甲狀腺疾病診治指南》中的亞急性甲狀腺炎西醫(yī)診斷標(biāo)準(zhǔn),通過在湖北省中醫(yī)院甲狀腺門診及光谷內(nèi)分泌病房收集病歷,結(jié)合中醫(yī)四診辨證分型,陳教授主張將其分為外感風(fēng)熱證、肝郁熱毒證、陽虛痰凝證三型,予以辨證論治中藥處方加西藥治療,觀察患者用藥前后的證候積分、一般情況、客觀參數(shù)、病程時(shí)長及中醫(yī)證型與西醫(yī)分型的關(guān)系,并進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果1.亞急性甲狀腺炎在中醫(yī)證型分布上,以肝郁熱毒證為主占49.51%,其次為外感風(fēng)熱證占35.92%,而陽虛痰凝證占14.56%最少。2.證候療效:本次觀察顯示,外感風(fēng)熱證、肝郁熱毒證、陽虛痰凝證,三種證型在治療前后證候積分上,均有顯著的統(tǒng)計(jì)學(xué)差異(P0.05),且陽虛痰凝證與外感風(fēng)熱證、肝郁熱毒證有顯著的統(tǒng)計(jì)學(xué)差異(P0.05)。3.血沉、C反應(yīng)蛋白、血常規(guī)等客觀參數(shù):外感風(fēng)熱證、肝郁熱毒證、陽虛痰凝證三種證型在治療前后對(duì)比,均有顯著的統(tǒng)計(jì)學(xué)差異(P0.05),且肝郁熱毒證較其余兩組有顯著的統(tǒng)計(jì)學(xué)差異(P0.05)。4.甲狀腺功能指標(biāo):陽虛痰凝證甲狀腺功能FT3、FT4和TSH與其余兩組比較差異具有顯著性(P0.05),外感風(fēng)熱證與肝郁熱毒證比較差異沒有顯著性(P0.05)。5.病程:亞急性甲狀腺炎中醫(yī)證型中,陽虛痰凝證的平均病程與其余兩組比較,有顯著性差異(p0.05),而外感風(fēng)熱證與肝郁熱毒證比較兩者差異無顯著性(p0.05)。6.年齡、性別分布上:外感風(fēng)熱證、肝郁熱毒證、陽虛痰凝證在性別分布上,無顯著的統(tǒng)計(jì)學(xué)差異(p0.05),均以女性偏多為主,在年齡分布上陽虛痰凝證與其余兩組比較,有顯著性差異(p0.05),而其余兩組間比較差異無顯著性(p0.05),陽虛痰凝證年齡較其余兩組偏大。7.甲狀腺彩超:外感風(fēng)熱證、肝郁熱毒證、陽虛痰凝證在結(jié)節(jié)大小上,有顯著的統(tǒng)計(jì)學(xué)差異(p0.05),在結(jié)節(jié)個(gè)數(shù)上差異無顯著性(p0.05)。8.中醫(yī)證型分布與西醫(yī)分型的關(guān)系:西醫(yī)分型中以普通型占比最高,為35.9%,其次為結(jié)節(jié)型及甲亢型,均為24.2%,普通型及結(jié)節(jié)型中以外感風(fēng)熱證最多,甲亢型中以肝郁熱毒證最多,而甲狀腺炎型及混合型較少。結(jié)論1.亞急性甲狀腺炎性別分布中,三種證型均以女性占的比重較大,年齡分布上,陽虛痰凝證年齡較其余兩組偏大。2.中醫(yī)證型上分為三型,外感風(fēng)熱證、肝郁熱毒證、陽虛痰凝證,其中肝郁熱毒證的血沉、c反應(yīng)蛋白、白細(xì)胞計(jì)數(shù)、中性粒細(xì)胞高于其他兩種證型,提示肝郁熱毒證的病情較之更加嚴(yán)重,可能與甲狀腺濾泡破壞更多有關(guān)。3.亞急性甲狀腺炎外感風(fēng)熱證與肝郁熱毒證的甲功指標(biāo)常提示為ft3↑ft4↑tsh↓,說明這兩種證型的亞急性甲狀腺炎常有甲亢表現(xiàn)。4.證候積分上,陽虛痰凝證的變化小于其他兩種證型,提示陽虛痰凝證的療效較其余兩組欠佳。5.病程上,陽虛痰凝證的平均病程比其余兩組耗時(shí)更長,提示其多遷延不愈,反復(fù)發(fā)作。6.甲狀腺彩超:陽虛痰凝證的結(jié)節(jié)大小及結(jié)節(jié)個(gè)數(shù)略大于外感風(fēng)熱證及肝郁熱毒證。7.中醫(yī)證型分布與西醫(yī)分型的關(guān)系:中醫(yī)辨證外感風(fēng)熱證中以西醫(yī)分型普通型最多,其次為結(jié)節(jié)型,陽虛痰凝型中以西醫(yī)分型遷延型最多,西醫(yī)分型中以普通型占比最高,為35.9%,其次為結(jié)節(jié)型及甲亢型,均為24.2%,普通型及結(jié)節(jié)型中以外感風(fēng)熱證最多,甲亢型中以肝郁熱毒證最多,而甲狀腺炎型及混合型較少。
[Abstract]:Objective Subacute thyroiditis is a self-limited non-suppurative thyroiditis disease. Its main symptoms are pain and discomfort in the neck, frequent recurrence, affecting the quality of life of patients. Through collecting medical records, this paper analyzes and summarizes the common TCM syndromes and their distribution with age, sex and related objective parameters. To explore the relationship between the distribution of TCM syndrome types of subacute thyroiditis and the classification of Western medicine, and to study the curative effect of TCM-WM syndrome differentiation on subacute thyroiditis. Professor Chen advocated dividing the disease into three types: exogenous wind-heat syndrome, liver-depression-heat syndrome, yang-deficiency-phlegm-coagulation syndrome, and treating the patients with traditional Chinese medicine prescription plus Western medicine. Observing the syndrome integral before and after treatment, general situation, objective parameters, duration of disease and TCM syndrome type. Results 1. The distribution of subacute thyroiditis in TCM syndromes was 49.51%, followed by exogenous wind-heat syndrome (35.92%) and Yang-deficiency phlegm-coagulation syndrome (14.56%) at least. 2. Syndrome efficacy: This observation showed that exogenous wind-heat syndrome, liver-depression-heat syndrome, Yang-deficiency phlegm-coagulation syndrome, three syndromes. There were significant statistical differences in syndrome scores before and after treatment (P 0.05), and there were significant statistical differences between Yang-deficiency phlegm coagulation syndrome and exogenous wind-heat syndrome, liver-depression-heat toxicity syndrome (P 0.05). 3. Objective parameters such as erythrocyte sedimentation, C-reactive protein, blood routine: exogenous wind-heat syndrome, liver-depression-heat toxicity syndrome, yang-deficiency-phlegm coagulation syndrome were compared before and after treatment. Significant statistical differences (P 0.05), and liver stagnation-heat toxicity syndrome than the other two groups had significant statistical differences (P 0.05). 4. Thyroid function indicators: Yang deficiency-phlegm coagulation syndrome thyroid function FT3, FT4 and TSH and the other two groups were significantly different (P 0.05), exogenous wind-heat syndrome and liver stagnation-heat toxicity syndrome difference was not significant (P 0.05). 5. Course of disease: sub-acute: heat syndrome The average course of disease of Yang-deficiency phlegm-coagulation syndrome was significantly different from the other two groups (p0.05), but there was no significant difference between exogenous wind-heat syndrome and liver-depression-heat-toxicity syndrome (p0.05). 6. Age, gender distribution: exogenous wind-heat syndrome, liver-depression-heat syndrome, yang-deficiency-phlegm-coagulation syndrome in gender distribution, there was no significant difference. The difference (p0.05), are mainly female, in the age distribution of Yang deficiency phlegm coagulation syndrome compared with the other two groups, there is a significant difference (p0.05), but there is no significant difference between the other two groups (p0.05), Yang deficiency phlegm coagulation syndrome is older than the other two groups.7. Significant statistical difference (p0.05), there was no significant difference in the number of nodules (p0.05). 8. The relationship between the distribution of TCM syndrome types and the classification of Western medicine: the common type accounted for the highest proportion, 35.9%, followed by nodular type and hyperthyroidism type, 24.2%, the common type and nodular type of exogenous wind-heat syndrome was the most, hyperthyroidism type of liver depression-heat syndrome was the most. Conclusion 1. In the sex distribution of subacute thyroiditis, the proportion of the three syndrome types is larger in women, and the age distribution of Yang-deficiency-phlegm-coagulation syndrome is older than the other two groups. 2. TCM syndrome types are divided into three types: exogenous wind-heat syndrome, liver-depression-heat syndrome, Yang-deficiency-phlegm-coagulation syndrome, in which the blood sedimentation rate of liver-depression-heat-toxin syndrome, and C-reflex syndrome. Albumin, white blood cell count and neutrophils were higher than the other two syndrome types, suggesting that the condition of liver depression-heat syndrome was more serious than that of the other two syndrome types, which may be related to the destruction of thyroid follicles. Adenitis often has hyperthyroidism. 4. Syndrome integral, Yang deficiency phlegm coagulation syndrome changes less than the other two types, suggesting that the effect of Yang deficiency phlegm coagulation syndrome is less than the other two groups. The number of small and nodules was slightly larger than that of exogenous wind-heat syndrome and liver-stagnation-heat syndrome. Type A and hyperthyroidism were 24.2%. External wind-heat syndrome was the most common type and nodular type, liver depression-heat toxicity syndrome was the most common type of hyperthyroidism, while thyroiditis type and mixed type were less.
【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
【分類號(hào)】：R259
本文編號(hào)：2232284
[Abstract]:Objective Subacute thyroiditis is a self-limited non-suppurative thyroiditis disease. Its main symptoms are pain and discomfort in the neck, frequent recurrence, affecting the quality of life of patients. Through collecting medical records, this paper analyzes and summarizes the common TCM syndromes and their distribution with age, sex and related objective parameters. To explore the relationship between the distribution of TCM syndrome types of subacute thyroiditis and the classification of Western medicine, and to study the curative effect of TCM-WM syndrome differentiation on subacute thyroiditis. Professor Chen advocated dividing the disease into three types: exogenous wind-heat syndrome, liver-depression-heat syndrome, yang-deficiency-phlegm-coagulation syndrome, and treating the patients with traditional Chinese medicine prescription plus Western medicine. Observing the syndrome integral before and after treatment, general situation, objective parameters, duration of disease and TCM syndrome type. Results 1. The distribution of subacute thyroiditis in TCM syndromes was 49.51%, followed by exogenous wind-heat syndrome (35.92%) and Yang-deficiency phlegm-coagulation syndrome (14.56%) at least. 2. Syndrome efficacy: This observation showed that exogenous wind-heat syndrome, liver-depression-heat syndrome, Yang-deficiency phlegm-coagulation syndrome, three syndromes. There were significant statistical differences in syndrome scores before and after treatment (P 0.05), and there were significant statistical differences between Yang-deficiency phlegm coagulation syndrome and exogenous wind-heat syndrome, liver-depression-heat toxicity syndrome (P 0.05). 3. Objective parameters such as erythrocyte sedimentation, C-reactive protein, blood routine: exogenous wind-heat syndrome, liver-depression-heat toxicity syndrome, yang-deficiency-phlegm coagulation syndrome were compared before and after treatment. Significant statistical differences (P 0.05), and liver stagnation-heat toxicity syndrome than the other two groups had significant statistical differences (P 0.05). 4. Thyroid function indicators: Yang deficiency-phlegm coagulation syndrome thyroid function FT3, FT4 and TSH and the other two groups were significantly different (P 0.05), exogenous wind-heat syndrome and liver stagnation-heat toxicity syndrome difference was not significant (P 0.05). 5. Course of disease: sub-acute: heat syndrome The average course of disease of Yang-deficiency phlegm-coagulation syndrome was significantly different from the other two groups (p0.05), but there was no significant difference between exogenous wind-heat syndrome and liver-depression-heat-toxicity syndrome (p0.05). 6. Age, gender distribution: exogenous wind-heat syndrome, liver-depression-heat syndrome, yang-deficiency-phlegm-coagulation syndrome in gender distribution, there was no significant difference. The difference (p0.05), are mainly female, in the age distribution of Yang deficiency phlegm coagulation syndrome compared with the other two groups, there is a significant difference (p0.05), but there is no significant difference between the other two groups (p0.05), Yang deficiency phlegm coagulation syndrome is older than the other two groups.7. Significant statistical difference (p0.05), there was no significant difference in the number of nodules (p0.05). 8. The relationship between the distribution of TCM syndrome types and the classification of Western medicine: the common type accounted for the highest proportion, 35.9%, followed by nodular type and hyperthyroidism type, 24.2%, the common type and nodular type of exogenous wind-heat syndrome was the most, hyperthyroidism type of liver depression-heat syndrome was the most. Conclusion 1. In the sex distribution of subacute thyroiditis, the proportion of the three syndrome types is larger in women, and the age distribution of Yang-deficiency-phlegm-coagulation syndrome is older than the other two groups. 2. TCM syndrome types are divided into three types: exogenous wind-heat syndrome, liver-depression-heat syndrome, Yang-deficiency-phlegm-coagulation syndrome, in which the blood sedimentation rate of liver-depression-heat-toxin syndrome, and C-reflex syndrome. Albumin, white blood cell count and neutrophils were higher than the other two syndrome types, suggesting that the condition of liver depression-heat syndrome was more serious than that of the other two syndrome types, which may be related to the destruction of thyroid follicles. Adenitis often has hyperthyroidism. 4. Syndrome integral, Yang deficiency phlegm coagulation syndrome changes less than the other two types, suggesting that the effect of Yang deficiency phlegm coagulation syndrome is less than the other two groups. The number of small and nodules was slightly larger than that of exogenous wind-heat syndrome and liver-stagnation-heat syndrome. Type A and hyperthyroidism were 24.2%. External wind-heat syndrome was the most common type and nodular type, liver depression-heat toxicity syndrome was the most common type of hyperthyroidism, while thyroiditis type and mixed type were less.
【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
【分類號(hào)】：R259
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