中西医结合治疗对甲状腺功能亢进患者甲状腺上动脉血流动力学的影响
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摘要
目的:分析与探讨采用中西医结合治疗对甲状腺功能亢进患者的临床疗效,并研究彩色多普勒超声对甲状腺上动脉血流动力学的评价。方法:将2015年11月—2017年11月期间诊疗94例甲状腺功能亢进患者作为研究病例,采用数字表法根据用药治疗方案不同分成两组,每组47例。对照组给予常规西药他巴唑治疗,观察组给予他巴唑联合中药自拟嘱方治疗。观察两组甲状腺功能功能情况、甲状腺上动脉血流动力学变化情况以及临床治疗效果。结果:观察组治疗后TSH(4.95±1.51)mIU/L、TRAb(3.04±1.03)U/L、V_(max)(0.37±0.07)m/s、V_(min)(0.16±0.02)m/s、临床总有效率(93.62%)等均明显优于对照组TSH(4.18±1.85)mIU/L、TRAb(4.71±1.02)U/L、V_(max)(0.57±0.11)m/s、V_(min)(0.34±0.04)m/s、临床总有效率(76.60%),差异有统计学意义(P<0.05)。两组不良反应发生情况比较无差异(P>0.05)。结论:采用中西医结合治疗甲状腺功能亢进的患者,能够促进其甲状腺功能相关指标恢复,彩色多普勒超声观察患者甲状腺上动脉血流动力学指标显著改善,甲状腺明显缩小,临床应用效果较好,有助于患者预后。
Objective: To analyze and discuss the clinical efficacy of integrated traditional Chinese and Western medicine in the treatment of hyperthyroidism and evaluate the hemodynamics of superior thyroid artery by color Doppler ultrasound. Methods: From November 2015 to November 2017, 94 patients with hyperthyroidism treated in our hospital were enrolled in the study. They were divided into two groups based on the digital table method and 47 cases in each group. The control group was treated with conventional western medicine tazopazole and the observation group was treated with triazole combined with Chinese medicine. The thyroid glands function, the hemodynamic changes of the superior thyroid artery and the effect of clinical treatment of the two groups were observed. Results: After treatment,the observation group's TSH(4.95±1.51)mIU/L, TRAb(3.04±1.03)U/L, Vmax(0.37±0.07)m/s, Vmin(0.16±0.02)m/s and the total clinical efficiency(93.62%) were significantly better than the control group's TSH(4.18±1.85)mIU/L, TRAb(4.71±1.02)U/L, Vmax(0.57±0.11)m/s, Vmin(0.34±0.04)m/s and the total clinical efficiency(76.60%), and the difference was statistically significant(P<0.05). There was no difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion: Traditional Chinese medicine combined with western medicine treatment of hyperthyroidism can promote the recovery of relevant indicators of thyroid function. The color Doppler ultrasound showed patients' thyroid artery hemodynamic parameters improved significantly, thyroid significantly reduced. It has good clinical effect, contribute to the prognosis of patients.
Objective: To analyze and discuss the clinical efficacy of integrated traditional Chinese and Western medicine in the treatment of hyperthyroidism and evaluate the hemodynamics of superior thyroid artery by color Doppler ultrasound. Methods: From November 2015 to November 2017, 94 patients with hyperthyroidism treated in our hospital were enrolled in the study. They were divided into two groups based on the digital table method and 47 cases in each group. The control group was treated with conventional western medicine tazopazole and the observation group was treated with triazole combined with Chinese medicine. The thyroid glands function, the hemodynamic changes of the superior thyroid artery and the effect of clinical treatment of the two groups were observed. Results: After treatment,the observation group's TSH(4.95±1.51)mIU/L, TRAb(3.04±1.03)U/L, Vmax(0.37±0.07)m/s, Vmin(0.16±0.02)m/s and the total clinical efficiency(93.62%) were significantly better than the control group's TSH(4.18±1.85)mIU/L, TRAb(4.71±1.02)U/L, Vmax(0.57±0.11)m/s, Vmin(0.34±0.04)m/s and the total clinical efficiency(76.60%), and the difference was statistically significant(P<0.05). There was no difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion: Traditional Chinese medicine combined with western medicine treatment of hyperthyroidism can promote the recovery of relevant indicators of thyroid function. The color Doppler ultrasound showed patients' thyroid artery hemodynamic parameters improved significantly, thyroid significantly reduced. It has good clinical effect, contribute to the prognosis of patients.
引文
[1] 白红玲.甲硫咪唑联合左甲状腺素治疗小儿甲状腺功能亢进症的疗效及不良反应分析[J].中国全科医学,2017,20(7):168-170.
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[8] 景良洪,陈琼科,宋凤萍,等.甲巯咪唑联合穴位敷贴治疗贴对甲状腺功能亢进症患者激素水平及骨代谢指标的影响[J].中国药房,2017,28(21):2905-2908.
[9] 潘竞霞,何小莲,张瑾,等.甲状腺功能亢进症中医辨证与彩色多普勒超声影像特征的相关性研究[J].四川中医,2017,35(8):35-37.
[10] Yoon JH,Kwon HJ,Kim EK,et al.The follicular variant of papillary thyroid carcinoma:characteristics of preoperativeultrasonography andcytology[J].Ultrasonography,2016,35(1):47-54.
[11] 韦丽,张进,张建军,等.甲状腺癌多普勒血流动力学指标与肿瘤增殖、血管新生指标的相关性分析[J].海南医学院学报,2016,22(13):1402-1405.
[12] 张晋.彩色多普勒超声对甲状腺功能亢进的诊断价值[J].山西医药杂志,2017,46(20):2454-2455.
[13] 杨贺.彩色多普勒超声成像及定量参数在甲状腺结节鉴别诊断中的价值分析[J].河北医药,2017,39(2):230-233,235.
[14] Kyrilli A,Tang BN,Huyge V,et al.Thiamazole pretreatment lowers the131 I activity needed to cure hyperthyroidism in patients with nodular goiter[J].J Clin Endocrinol Metab,2015,100(6):2261-2267.
[15] 宋云,闵苏,程波,等.帕瑞昔布钠与氟比洛芬酯用于甲状腺术后的镇痛效果及对血流动力学与炎性细胞因子的影响比较[J].现代生物医学进展,2017,17(13):2459-2462,
[16] 王少强,魏松洋,郑庆杰,等.术前抗甲亢治疗对心脏病合并甲亢患者心内直视术后并发症及血流动力学的影响[J].山东医药,2017,57(5):81-83.
[17] Spoelstra-de Man AM,Smit B,Oudemans-van Straaten HM,et al.Cardiovascular effects of hyperoxia during and after cardiac surgery[J].Anaesthesia,2015,70(11):1307-1319.
[18] Asker ME,Hassan WA,El-Kashlan AM.Experimentally induced hyperthyroidism influences oxidant and antioxidant status and impairs male gonadal functions in adultrats[J].Andrologia,2015,47(6):644-654.
[19] 李雪,李靖,吴欣莉,等.高菁主任医师中西医结合治疗甲状腺功能亢进症的经验[J].世界中医药,2015,10(8):1219-1221.
[20] Aydin B,Aksu O,Tamer M N,et al. Methimazole-induced insulin autoimmune syndrome in graves’disease: Case report[J].Acta Medica Mediterranea,2016,32(2): 457-461.
[21] 范尧夫,刘克冕,张会峰,等.中西医结合治疗桥本甲状腺炎甲状腺功能减退的Meta分析[J].中国实验方剂学杂志,2016,22(3):221-224.
[2] 熊慧丽,周庆元,赵晓宏,等.甲巯咪唑联合131I治疗甲状腺功能亢进的疗效及安全性分析[J].药物评价研究,2017,40(2):245-248.
[3] Dobruch-Sobczak K,Guminska A,Bakui a-Zalewska E,et al.Shear wave elastography in medullary thyroid carcinoma diagnostics[J].J Ultrason,2015,15(63):358-367.
[4] 张颖,申晶.中药内服治疗甲状腺功能亢进症的临床研究[J].世界中西医结合杂志,2017,12(5):703-706.
[5] 张晓军.柴胡疏肝散加味联合甲巯咪唑片治疗甲状腺功能亢进症疗效观察[J].现代中西医结合杂志,2017,26(30):3396-3399.
[6] Agrawal C,Guthrie L,Sturm MS,et al.Comparison of thyroid nodule prevalence by ultrasound in childhood cancer survivors with and without thyroid radiation exposure[J].J Pediatr Hematol Oncol,2016,38(1):43-48.
[7] 梁绮婷.柴胡栀子汤治疗甲状腺功能亢进症的临床疗效观察[J].四川中医,2017,25(5):128-131.
[8] 景良洪,陈琼科,宋凤萍,等.甲巯咪唑联合穴位敷贴治疗贴对甲状腺功能亢进症患者激素水平及骨代谢指标的影响[J].中国药房,2017,28(21):2905-2908.
[9] 潘竞霞,何小莲,张瑾,等.甲状腺功能亢进症中医辨证与彩色多普勒超声影像特征的相关性研究[J].四川中医,2017,35(8):35-37.
[10] Yoon JH,Kwon HJ,Kim EK,et al.The follicular variant of papillary thyroid carcinoma:characteristics of preoperativeultrasonography andcytology[J].Ultrasonography,2016,35(1):47-54.
[11] 韦丽,张进,张建军,等.甲状腺癌多普勒血流动力学指标与肿瘤增殖、血管新生指标的相关性分析[J].海南医学院学报,2016,22(13):1402-1405.
[12] 张晋.彩色多普勒超声对甲状腺功能亢进的诊断价值[J].山西医药杂志,2017,46(20):2454-2455.
[13] 杨贺.彩色多普勒超声成像及定量参数在甲状腺结节鉴别诊断中的价值分析[J].河北医药,2017,39(2):230-233,235.
[14] Kyrilli A,Tang BN,Huyge V,et al.Thiamazole pretreatment lowers the131 I activity needed to cure hyperthyroidism in patients with nodular goiter[J].J Clin Endocrinol Metab,2015,100(6):2261-2267.
[15] 宋云,闵苏,程波,等.帕瑞昔布钠与氟比洛芬酯用于甲状腺术后的镇痛效果及对血流动力学与炎性细胞因子的影响比较[J].现代生物医学进展,2017,17(13):2459-2462,
[16] 王少强,魏松洋,郑庆杰,等.术前抗甲亢治疗对心脏病合并甲亢患者心内直视术后并发症及血流动力学的影响[J].山东医药,2017,57(5):81-83.
[17] Spoelstra-de Man AM,Smit B,Oudemans-van Straaten HM,et al.Cardiovascular effects of hyperoxia during and after cardiac surgery[J].Anaesthesia,2015,70(11):1307-1319.
[18] Asker ME,Hassan WA,El-Kashlan AM.Experimentally induced hyperthyroidism influences oxidant and antioxidant status and impairs male gonadal functions in adultrats[J].Andrologia,2015,47(6):644-654.
[19] 李雪,李靖,吴欣莉,等.高菁主任医师中西医结合治疗甲状腺功能亢进症的经验[J].世界中医药,2015,10(8):1219-1221.
[20] Aydin B,Aksu O,Tamer M N,et al. Methimazole-induced insulin autoimmune syndrome in graves’disease: Case report[J].Acta Medica Mediterranea,2016,32(2): 457-461.
[21] 范尧夫,刘克冕,张会峰,等.中西医结合治疗桥本甲状腺炎甲状腺功能减退的Meta分析[J].中国实验方剂学杂志,2016,22(3):221-224.