黄芪酸枣仁汤治疗甲状腺功能亢进症
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摘要
目的:观察黄芪酸枣仁汤治疗甲状腺功能亢进症的临床评疗效对甲状腺体积的影响。方法:90例甲状腺功能亢进症患者作随机分为观察组(n=45)和对照组(n=45)。对照组根据病情程度,每日口服30～60 mg甲巯咪唑;观察组在对照组治疗基础上给予黄芪酸枣仁汤治疗。两组患者均连续治疗8周。比较两组患者治疗前后血清甲状腺素、甲状腺体积、中医证候积分,并比较两组治疗后临床疗效和治疗过程中的不良反应。结果:治疗后,两组患者血清游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)均显著降低,促甲状腺激素(thyrotropic hormone,TSH)显著升高,差异均有统计学意义(P<0.05);观察组血清FT3、FT4均低于对照组,TSH高于对照组,差异均有统计学意义(P<0.05)。治疗后,两组患者甲状腺体积均显著小于治疗前(P<0.05);观察组甲状腺体积明显小于对照组[(7.83±1.15) mm~2vs(14.75±2.16) mm~2],差异有统计学意义(P<0.05)。与治疗前比较,两组患者治疗后各中医证候积分均显著降低(P<0.05),观察组心悸、汗多、恶热、善食易饥等积分均显著低于对照组,差异均有统计学意义(P<0.05)。观察组有效率明显高于对照组[95.56%(43/45)vs 71.11%(32/45)],差异有统计学意义(P<0.05)。观察组恶心呕吐、白细胞减少、肝酶升高总发生率明显低于对照组[4.44%(2/45)vs 20.00%(9/45)],差异有统计学意义(P<0.05)。结论:黄芪酸枣仁汤治疗甲状腺功能亢进症疗效显著,可降低FT3、FT4水平,升高TSH水平,缩小甲状腺体积,降低中医证候积分,减少不良反应。
Objective:To observe the effect of clinical evaluation of jaundice jujube decoction on hyperthyroidism on thyroid volume.Methods:90 patients with hyperthyroidism were randomly divided into observation group(n=45) and control group(n=45).According to the severity of the disease,the control group received 30-60 mg of methimazole per day.The observation group was treated with Huangqi Suanzaoren Decoction on the basis of the control group.Both groups of patients were treated continuously for 8 weeks.The serum thyroxine,thyroid volume and TCM syndrome scores of the two groups were compared before and after treatment,and the clinical effects and adverse reactions during the treatment were compared between the two groups.Results:After treatment,serum free triiodothyronine(FT3) and free thyroxine(FT4) were significantly decreased in both groups,and thyroid-stimulating hormone(TSH) was significantly increased.There were statistical significance(P<0.05).Serum FT3 and FT4 in the observation group were lower than those in the control group,and TSH was higher than the control group,the difference was statistically significant(P<0.05).After treatment,the thyroid volume of the two groups was significantly less than that before treatment(P<0.05);the thyroid volume of the observation group was significantly smaller than that of the control group [(7.83±1.15) mm~2 vs(14.75±2.16) mm~2],the difference was statistically significant(P<0.05).Compared with before treatment,the scores of TCM syndromes in the two groups were significantly lower after treatment(P<0.05).The scores of palpitations,hyperhidrosis,dyscrasia,and hunger were significantly lower in the observation group than in the control group(P<0.05).The effective rate of the observation group was significantly higher than that of the control group [95.56%(43/45) vs 71.11%(32/45)],and the difference was statistically significant(P<0.05).The incidence of nausea and vomiting,leukopenia and elevated liver enzymes in the observation group was significantly lower than that in the control group [4.44%(2/45) vs 20.00%(9/45)],and the difference was statistically significant(P<0.05).Conclusion:The treatment of hyperthyroidism with Huangqi Suanzaoren Decoction is effective,which can reduce the levels of FT3 and FT4,increase the level of TSH,reduce the volume of thyroid,reduce the score of TCM syndrome,and reduce adverse reactions.
Objective:To observe the effect of clinical evaluation of jaundice jujube decoction on hyperthyroidism on thyroid volume.Methods:90 patients with hyperthyroidism were randomly divided into observation group(n=45) and control group(n=45).According to the severity of the disease,the control group received 30-60 mg of methimazole per day.The observation group was treated with Huangqi Suanzaoren Decoction on the basis of the control group.Both groups of patients were treated continuously for 8 weeks.The serum thyroxine,thyroid volume and TCM syndrome scores of the two groups were compared before and after treatment,and the clinical effects and adverse reactions during the treatment were compared between the two groups.Results:After treatment,serum free triiodothyronine(FT3) and free thyroxine(FT4) were significantly decreased in both groups,and thyroid-stimulating hormone(TSH) was significantly increased.There were statistical significance(P<0.05).Serum FT3 and FT4 in the observation group were lower than those in the control group,and TSH was higher than the control group,the difference was statistically significant(P<0.05).After treatment,the thyroid volume of the two groups was significantly less than that before treatment(P<0.05);the thyroid volume of the observation group was significantly smaller than that of the control group [(7.83±1.15) mm~2 vs(14.75±2.16) mm~2],the difference was statistically significant(P<0.05).Compared with before treatment,the scores of TCM syndromes in the two groups were significantly lower after treatment(P<0.05).The scores of palpitations,hyperhidrosis,dyscrasia,and hunger were significantly lower in the observation group than in the control group(P<0.05).The effective rate of the observation group was significantly higher than that of the control group [95.56%(43/45) vs 71.11%(32/45)],and the difference was statistically significant(P<0.05).The incidence of nausea and vomiting,leukopenia and elevated liver enzymes in the observation group was significantly lower than that in the control group [4.44%(2/45) vs 20.00%(9/45)],and the difference was statistically significant(P<0.05).Conclusion:The treatment of hyperthyroidism with Huangqi Suanzaoren Decoction is effective,which can reduce the levels of FT3 and FT4,increase the level of TSH,reduce the volume of thyroid,reduce the score of TCM syndrome,and reduce adverse reactions.
引文
[1]范亚丽.中西医结合治疗甲状腺功能亢进症近期疗效及远期复发率观察[J].世界中医药,2014,9(2):193-195.
[2]OH H J,YOON S M,OH J S,et al.Severe Cerebral Vasospasm in Patients with Hyperthyroidism[J].J Cerebrovasc Endovasc Neurosurg,2016,18(4):385-390.
[3]陈红森.中西医结合治疗甲状腺功能亢进症的临床疗效观察[J].光明中医,2014,29(8):1717-1718.
[4]赵悦.丙基硫氧嘧啶联合不同剂量普萘洛尔治疗甲亢合并房颤的临床疗效与安全性研究[J].河北医学,2014,20(2):198-202.
[5]李艳婷,崔云竹,邵红雨,等.甲状腺功能亢进症的中医药治疗进展[J].湖南中医杂志,2014,30(7):191-192.
[6]YANG H,CONG Y,WU T,et al.Clinical efficacy of Yingliu mixture combined with metimazole for treating diffuse goitre with hyperthyroidism and its impact on related cytokines[J].Pharm Biol,2017,55(1):258-263.
[7]戴自英.实用内科学[M].北京:人民卫生出版社,1994:1941-1942.
[8]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:462-466.
[9]张木勋.甲状腺疾病诊疗学[M].北京:中国医药科技出版社,2006:196-207.
[10]SINGH I,HERSHMAN J M.Pathogenesis of Hyperthyroidism[J].Compr Physiol,2016,7(1):67-79.
[11]赵恒强,黄韬.尿碘与甲状腺疾病的关系及其发病机制的研究进展[J].医学综述,2014,20(23):4261-4264.
[12]应爱华,高天舒.丙硫氧嘧啶与甲巯咪唑对甲状腺功能亢进症肝功能影响情况的对比研究[J].中国医药导报,2014,11(4):71-73,77.
[13]OHARA N,KANEKO M,KITAZAWA M,et al.Persistent Graves′ hyperthyroidism despite rapid negative conversion of thyroid-stimulating hormone-binding inhibitory immunoglobulin assay results:a case report[J].J Med Case Rep,2017,11(1):32.
[14]柯雅思,赵进喜,曲志成,等.赵进喜教授辨体质-辨病-辨证治疗甲状腺功能亢进症经验[J].世界中医药,2014,9(1):69-70.
[15]程岩,于勇.中医治疗甲亢的历史沿革及临床用药心得[J].中国地方病防治杂志,2014,29(5):394.
[16]刘德林.中医辨证治疗甲状腺功能亢进症的疗效评价研究[J].中国中医基础医学杂志,2014,20(7):951-953.
[17]周跃,吕珊,王瑞芳,等.甲状腺功能亢进症中医药外治法的临床最新研究进展[J].中国医药指南,2014,12(22):76-77.
[18]刘焕斌.大补阴丸加减治疗甲状腺功能亢进症阴虚火旺型[J].陕西中医,2013,8(9):85-86.
[19]杨淑萍.柴栀舒郁汤合小剂量丙硫氧嘧啶治疗甲状腺功能亢进症56例[J].中药药理与临床,2016,32(4):115-118.
[20]NIU C,ZHANG J.Quantitative analysis and chromatographic fingerprinting of the semen zizyphi spinosae by ultra-high-performance liquid chromatography coupled with diode-array detector[J].J Sep Sci,2011,34(21):2989-2996.
[21]朱晓丹,安超,李泉旺,等.中药浙贝母药用源流及发展概况[J].世界中医药,2017,12(1):211-216,221.
[22]崔体圣,苗明三.夏枯草的化学、药理及临床应用探讨[J].中医学报,2014,29(3):386-388.
[23]卢芳,于卉,张宁,等.玄参保护心血管系统的药理作用研究进展[J].中国药房,2016,27(22):3148-3150.
[24]范亚丽.中西医结合治疗甲状腺功能亢进症近期疗效及远期复发率观察[J].世界中医药,2014,9(2):193-195.
[25]郭景丽.酸枣仁汤合小柴胡汤治疗甲状腺功能亢进症50例[J].河南中医,2015,35(2):234-236.
[2]OH H J,YOON S M,OH J S,et al.Severe Cerebral Vasospasm in Patients with Hyperthyroidism[J].J Cerebrovasc Endovasc Neurosurg,2016,18(4):385-390.
[3]陈红森.中西医结合治疗甲状腺功能亢进症的临床疗效观察[J].光明中医,2014,29(8):1717-1718.
[4]赵悦.丙基硫氧嘧啶联合不同剂量普萘洛尔治疗甲亢合并房颤的临床疗效与安全性研究[J].河北医学,2014,20(2):198-202.
[5]李艳婷,崔云竹,邵红雨,等.甲状腺功能亢进症的中医药治疗进展[J].湖南中医杂志,2014,30(7):191-192.
[6]YANG H,CONG Y,WU T,et al.Clinical efficacy of Yingliu mixture combined with metimazole for treating diffuse goitre with hyperthyroidism and its impact on related cytokines[J].Pharm Biol,2017,55(1):258-263.
[7]戴自英.实用内科学[M].北京:人民卫生出版社,1994:1941-1942.
[8]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:462-466.
[9]张木勋.甲状腺疾病诊疗学[M].北京:中国医药科技出版社,2006:196-207.
[10]SINGH I,HERSHMAN J M.Pathogenesis of Hyperthyroidism[J].Compr Physiol,2016,7(1):67-79.
[11]赵恒强,黄韬.尿碘与甲状腺疾病的关系及其发病机制的研究进展[J].医学综述,2014,20(23):4261-4264.
[12]应爱华,高天舒.丙硫氧嘧啶与甲巯咪唑对甲状腺功能亢进症肝功能影响情况的对比研究[J].中国医药导报,2014,11(4):71-73,77.
[13]OHARA N,KANEKO M,KITAZAWA M,et al.Persistent Graves′ hyperthyroidism despite rapid negative conversion of thyroid-stimulating hormone-binding inhibitory immunoglobulin assay results:a case report[J].J Med Case Rep,2017,11(1):32.
[14]柯雅思,赵进喜,曲志成,等.赵进喜教授辨体质-辨病-辨证治疗甲状腺功能亢进症经验[J].世界中医药,2014,9(1):69-70.
[15]程岩,于勇.中医治疗甲亢的历史沿革及临床用药心得[J].中国地方病防治杂志,2014,29(5):394.
[16]刘德林.中医辨证治疗甲状腺功能亢进症的疗效评价研究[J].中国中医基础医学杂志,2014,20(7):951-953.
[17]周跃,吕珊,王瑞芳,等.甲状腺功能亢进症中医药外治法的临床最新研究进展[J].中国医药指南,2014,12(22):76-77.
[18]刘焕斌.大补阴丸加减治疗甲状腺功能亢进症阴虚火旺型[J].陕西中医,2013,8(9):85-86.
[19]杨淑萍.柴栀舒郁汤合小剂量丙硫氧嘧啶治疗甲状腺功能亢进症56例[J].中药药理与临床,2016,32(4):115-118.
[20]NIU C,ZHANG J.Quantitative analysis and chromatographic fingerprinting of the semen zizyphi spinosae by ultra-high-performance liquid chromatography coupled with diode-array detector[J].J Sep Sci,2011,34(21):2989-2996.
[21]朱晓丹,安超,李泉旺,等.中药浙贝母药用源流及发展概况[J].世界中医药,2017,12(1):211-216,221.
[22]崔体圣,苗明三.夏枯草的化学、药理及临床应用探讨[J].中医学报,2014,29(3):386-388.
[23]卢芳,于卉,张宁,等.玄参保护心血管系统的药理作用研究进展[J].中国药房,2016,27(22):3148-3150.
[24]范亚丽.中西医结合治疗甲状腺功能亢进症近期疗效及远期复发率观察[J].世界中医药,2014,9(2):193-195.
[25]郭景丽.酸枣仁汤合小柴胡汤治疗甲状腺功能亢进症50例[J].河南中医,2015,35(2):234-236.
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