發(fā)布時間：2018-10-07 20:48

【摘要】：目的:觀察理氣消癭方治療結節(jié)性甲狀腺腫的臨床療效,探討結節(jié)性甲狀腺腫的病因病機及理氣消癭方治療結甲的作用機制,為治療結甲提供更為優(yōu)化的方案,從而發(fā)揮中醫(yī)藥在辨證治療結甲方面的特色和優(yōu)勢。方法:收集70例符合診斷標準的結甲病例,采用治療前后自身對照研究,于實驗入組當天給予理氣消癭方口服治療,3個月為1個療程,共治療2個療程。觀察統計治療前后相關指標(如患者臨床癥狀、體征,甲狀腺及結節(jié)的大小,實驗室指標等),進行療效判定及數據分析比較。結果:(1)治療前與治療后中醫(yī)癥候積分比較:治療3個月及6個月的中醫(yī)癥候總積分與治療前癥候總積分對比均有明顯改變,有顯著統計差異(p0.01);個別癥狀(如甲狀腺腫大)在1個療程結束后沒有明顯變化(p0.05),但隨著療程的增加,癥狀亦逐漸好轉,有明顯的差異(p0.01);(2)結節(jié)大小與中醫(yī)癥候積分關系的比較:結節(jié)直徑為2-3cm與直徑小于2cm比較,在吞咽梗阻、咽喉異物感癥候方面有顯著性差異(p0.01);結節(jié)直徑大于3cm與結節(jié)直徑小于2cm比較,在咽喉異物感、吞咽梗阻癥候方面亦有顯著統計學意義(p0.01),在呼吸不暢癥候方面有統計學意義(p0.05);除此之外在其他癥候方面,結節(jié)大小互相間的比較無統計學意義,結果說明結節(jié)大小主要引起患者呼吸、吞咽及咽喉的不適,且大于2cm以上的結節(jié)引起上述癥狀更常見。(3)三種類型結節(jié)的療效及與療程的比較:囊性、實性及囊實性三種結節(jié)在治療1個療程后總有效率分別為:80%、45%、67.5%;治療2個療程后總有效率分別為100%、75%、92.5%。在同一療程,囊實性結節(jié)與實性結節(jié)療效比較均有統計差異(p0.05),同時結果顯示每種類型的結節(jié),2個療程后的總有效率分別高于1個療程;(4)治療前與治療后甲狀腺體積及結節(jié)最大直徑比較:治療2個療程后,甲狀腺的體積及結節(jié)的最大直徑較治療前具有顯著統計學意義(p0.01),治療2個療程后甲狀腺體積及結節(jié)的最大直徑與治療1個療程比較,有統計意義(p0.05),治療1個療程后甲狀腺的體積及結節(jié)的最大直徑較治療前無顯著性差異(p0.05);(5)甲狀腺結節(jié)大小與療效關系:與治療前結節(jié)的直徑小于2cm、2-3cm和3cm以上相比,在2個療程結束后不同直徑結節(jié)的總有效率分別為95.74%、87.23%、68.75%;治療1個療程后不同直徑結節(jié)總有效分別為76.6%、48.94%、62.5%,對同一范圍直徑的結節(jié),2個療程結束后的總有效率均較1個療程的總有效率高;(6)毒副作用:治療前后甲狀腺功能(FT3、FT4、TSH、TGAb、TPOAb)、血常規(guī)(WBC)及肝腎功能(ALT、AST、BUN、CREA)無顯著差異(p0.05)。結論:理氣消癭方可以有效改善結甲患者的臨床癥狀、縮小甲狀腺體積及結節(jié)的大小,且毒副作用小。表明理氣消癭方在辨證治療結甲方面具有顯著的特色和優(yōu)勢。
[Abstract]:Objective: to observe the clinical effect of Liqi Xiaoying recipe in the treatment of nodular goiter, to explore the etiology and pathogenesis of nodular goiter and the mechanism of Liqi Xiaoying prescription in the treatment of nodular goiter, so as to provide a better scheme for the treatment of nodular goiter. So as to give play to the characteristics and advantages of traditional Chinese medicine in the treatment of syndrome differentiation. Methods: 70 cases of nodular A were collected and treated by self-control study before and after treatment. The patients were treated orally with Liqi Xiaoying recipe on the day of experiment, 3 months as a course of treatment, 2 courses of treatment. The clinical symptoms, signs, size of thyroid and nodule, laboratory indexes were observed before and after treatment, and the curative effect and data were analyzed and compared. Results: (1) comparison of TCM symptom scores before and after treatment: the total scores of TCM symptoms after 3 and 6 months of treatment were significantly different from those before treatment. There were significant statistical differences (p0.01), individual symptoms (such as goiter) did not change significantly after one course of treatment (p0.05), but with the increase of the course of treatment, the symptoms gradually improved. There was a significant difference (p0.01); (2) in the relationship between nodule size and TCM symptom score: the diameter of nodules was 2-3cm and smaller than that of 2cm, and the diameter of the nodules was less than that of 2cm in the patients with dysphagia. There was significant difference in the symptoms of foreign body in throat (p0.01), the diameter of nodule was larger than that of 3cm and the diameter of nodule was smaller than that of 2cm. There was also significant difference in the symptoms of swallowing obstruction (p0.01), and in the symptoms of dyspnea (p0.05). In addition, there was no significant difference between nodule size and size in other symptoms. The results showed that the nodule size mainly caused the discomfort of breathing, swallowing and throat in the patients, and the above symptoms were more common in the nodules larger than 2cm. (3) the curative effect of the three types of nodules and the comparison with the course of treatment: cystic, or not. After one course of treatment, the total effective rates of solid and cystic nodules were 67.50.The total effective rates after two courses of treatment were 1000.75 and 92.5, respectively. In the same course, The results showed that the total effective rate of each type of nodules was higher than that of one course of treatment. (4) the thyroid volume and nodule were the largest before and after treatment. Diameter comparison: after 2 courses of treatment, The volume of thyroid gland and the maximum diameter of nodule were significantly higher than those before treatment (p0.01). After two courses of treatment, the volume of thyroid and the maximum diameter of nodule were compared with that of one course of treatment. There was statistical significance (p0. 05). There was no significant difference between the volume of thyroid gland and the maximum diameter of thyroid nodules after one course of treatment (p0. 05); (5). The size of thyroid nodules was correlated with the curative effect. The diameter of the nodules before treatment was less than 2 cm ~ 2 ~ 3 cm and the diameter of 3cm was more than 2 cm ~ 3 cm. After two courses of treatment, the total effective rate of different diameter nodules was 95.7447.23and 68.75.The total effective rate of different diameter nodules after one course of treatment was 76.6n 48.94 and 62.5, respectively. For nodules of the same diameter, the total effective rate after two courses of treatment was all higher than that after one course of treatment. (6) side effects: thyroid function (FT3,FT4,TSH,TGAb,TPOAb), blood routine (WBC) and liver and kidney function (ALT,AST,BUN,CREA) had no significant difference before and after treatment (p0.05). Conclusion: Liqi Xiaoying prescription can effectively improve the clinical symptoms, reduce the volume of thyroid gland and the size of nodule, and the toxic side effect is small. It shows that Liqi Xiaoying prescription has remarkable characteristics and advantages in treating nail knot by differentiation of symptoms and signs.
【學位授予單位】：湖北中醫(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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