隔姜灸联合糖皮质激素治疗亚急性甲状腺炎:随机对照研究
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摘要
目的:比较隔姜灸联合糖皮质激素口服与单纯糖皮质激素口服治疗亚急性甲状腺炎的临床疗效差异。方法:将81例患者随机分为观察组(41例)和对照组(40例)。观察组采用隔姜灸联合激素治疗,灸法穴位选取局部阿是穴、足三里、关元、气海,采用隔姜灸,每穴灸6壮,隔日1次,每周3次;配合口服甲泼尼龙片24mg/d,2周后为16mg/d,4周后减量为8mg/d,6周后减量为4mg/d。对照组单纯口服甲泼尼龙片,剂量、用法、治疗时间与观察组相同,均观察8周。观察两组治疗前后血沉(ESR)、三碘甲状腺原氨酸(T3)、甲状腺素(T4)、超敏促甲状腺激素(TSH);发热、甲状腺疼痛、肿大消退时间及不良反应发生状况。结果:观察组甲状腺疼痛消退时间早于对照组[(3.07±0.78)天vs(3.62±0.92)天,P<0.05)。治疗后两组T3、T4、ESR均有显著下降(均P<0.01),TSH显著上升(均P<0.01);治疗2周后,观察组ESR低于对照组(P<0.05);治疗4周后,观察组T3、T4、TSH、ESR均优于对照组(均P<0.05);治疗8周后,观察组各指标仍有优于对照组趋势,但组间差异无统计学意义(均P>0.05)。治疗2周、4周、8周后观察组疗效均优于对照组(均P<0.05),且观察组治愈患者总疗程短于对照组(P<0.05)。观察组不良反应发生率低于对照组[4.9%(2/41)vs 22.5%(9/40),P<0.05];治疗结束3个月后对治愈患者进行随访,观察组病情控制良好,无复发,对照组有3例复发,但组间差异无统计学意义(P>0.05)。结论:隔姜灸联合糖皮质激素治疗亚急性甲状腺炎疗效优于单纯糖皮质激素口服治疗,且不良反应少,显示出中西医结合的临床优势。
Objective To compare the clinical effects between ginger-partition moxibustion combined with glucocorticoid and simple oral glucocorticoid for thyreoitis at subacute stage.Methods Eighty-one patients were randomly divided into an observation group(41cases)and a control group(40cases).In the observation group,ginger-partition moxibustion and hormone were applied.Moxa cones were used at local ashi points,Zusanli(ST 36),Guanyuan(CV 4)and Qihai(CV 6),six cones every point,once every other day and three times a week.Besides,24 mg methylprednisolone tablets were adopted orally every day,and in two weeks the dose was 16mg/d,in four weeks 8mg/d,in six weeks 4mg/d;all the patients were observed for 8week.In the control group,simple methylprednisolone was prescribed orally,and the dose,the usage and treatment time were the same as those in the observation group.Erythrocyte sedimentation rate(ESR),triiodothyronine(T3),thyroxin(T4)and ultra-sensitive thyroid stimulating hormone(TSH)before and after treatment were observed in the two groups,as well as fever,the pain of thyroid gland,the regression time of swelling and adverse reaction.Results The time of thyroid gland pain relieved of the observation group was earlier than that of the control group [(3.07±0.78)days vs(3.62±0.92)days,P<0.05].After treatment,T3,T4 and ESR were declined apparently(all P<0.01),and TSH was obviously increased in the two groups(both P<0.01).After 2-week treatment,ESR in the observation group was lower than that in the control group(P<0.05).After 4-week treatment,T3,T4,TSH and ESR in the observation group were better than those in the control group(all P<0.05).After 8weeks,all indices in the observation group were superior to those in the control group,without statistical significance between the two groups(all P>0.05).The effects of the observation group in 2weeks,4weeks and 8weeks were better than those in the control group(all P<0.05).The cured course was shorter in the observation group than that in the control group(P<0.05).The adverse reaction rate in the observation group was lower than that in the control group[4.9%(2/41)vs 22.5%(9/40),P<0.05].Three months later after treatment,the cured patients were followed.There was no recrudescence in the observation group and three patients caught the disease again in the control group,but there was no statistical significance between the two groups(P>0.05).Conclusion Ginger-partition moxibustion combined with glucocorticoid achieves better effect than simple oral glucocorticoid for thyreoitis at subacute stage,and the adverse reaction is less,which presents the clinical advantages of the integration of Chinese and western medicine.
Objective To compare the clinical effects between ginger-partition moxibustion combined with glucocorticoid and simple oral glucocorticoid for thyreoitis at subacute stage.Methods Eighty-one patients were randomly divided into an observation group(41cases)and a control group(40cases).In the observation group,ginger-partition moxibustion and hormone were applied.Moxa cones were used at local ashi points,Zusanli(ST 36),Guanyuan(CV 4)and Qihai(CV 6),six cones every point,once every other day and three times a week.Besides,24 mg methylprednisolone tablets were adopted orally every day,and in two weeks the dose was 16mg/d,in four weeks 8mg/d,in six weeks 4mg/d;all the patients were observed for 8week.In the control group,simple methylprednisolone was prescribed orally,and the dose,the usage and treatment time were the same as those in the observation group.Erythrocyte sedimentation rate(ESR),triiodothyronine(T3),thyroxin(T4)and ultra-sensitive thyroid stimulating hormone(TSH)before and after treatment were observed in the two groups,as well as fever,the pain of thyroid gland,the regression time of swelling and adverse reaction.Results The time of thyroid gland pain relieved of the observation group was earlier than that of the control group [(3.07±0.78)days vs(3.62±0.92)days,P<0.05].After treatment,T3,T4 and ESR were declined apparently(all P<0.01),and TSH was obviously increased in the two groups(both P<0.01).After 2-week treatment,ESR in the observation group was lower than that in the control group(P<0.05).After 4-week treatment,T3,T4,TSH and ESR in the observation group were better than those in the control group(all P<0.05).After 8weeks,all indices in the observation group were superior to those in the control group,without statistical significance between the two groups(all P>0.05).The effects of the observation group in 2weeks,4weeks and 8weeks were better than those in the control group(all P<0.05).The cured course was shorter in the observation group than that in the control group(P<0.05).The adverse reaction rate in the observation group was lower than that in the control group[4.9%(2/41)vs 22.5%(9/40),P<0.05].Three months later after treatment,the cured patients were followed.There was no recrudescence in the observation group and three patients caught the disease again in the control group,but there was no statistical significance between the two groups(P>0.05).Conclusion Ginger-partition moxibustion combined with glucocorticoid achieves better effect than simple oral glucocorticoid for thyreoitis at subacute stage,and the adverse reaction is less,which presents the clinical advantages of the integration of Chinese and western medicine.
引文
[1]崔鹏,高天舒,梅兰.中药内服外敷治疗亚急性甲状腺炎临床疗效观察[J].中华中医药学刊,2012,30(9):2032-2034.
[2]高莹,高燕明.亚急性甲状腺炎[J].国际内分泌代谢杂志,2009(5):358-360.
[3]张木勋.甲状腺疾病诊疗学[M].北京:中国医药科技出版社,2005:145.
[4]中华医学会内分泌学分会.中国甲状腺疾病诊治指南[J].中华内科杂志,2008,47(9):784-785.
[5]罗敏.临床诊疗指南:内分泌及代谢性疾病分册[M].北京:人民卫生出版社,2005:23.
[6]Luotola K,Mantula P,Salmi J,et al.Allele 2of interleukin-1receptor antagonistgene increases the risk of thyroidperoxidaseantibodies in subacute thyroiditis[J].APMIS,2001,109(6):454-460.
[7]Volta C,Carano N,Street ME,et al.Atypical subacute thyroiditis caused by Epstein-Barrvirusinfection in a three-year-old girl[J].Thyroid,2005,15(10):1189-1190.
[8]顾明君,沈玉美,李翔,等.甲状腺内注射地塞米松和口服泼尼松治疗亚急性甲状腺炎[J].第二军医大学学报,2003,24(3):321-323.
[9]陈安芳.亚急性甲状腺炎106例临床分析[J].南京医科大学学报,2001,21(5):463.
[10]杨锋.糖皮质激素治疗亚急性甲状腺炎的临床疗效分析[J].中国医学工程,2013,21(5):116.
[11]杨坤,廖有乔.激素治疗亚急性甲状腺炎不同停药指征的疗效观察[J].临床内科杂志,2007,24(8):527-529.
[12]雷晓燕,李丙蓉.甲泼尼龙冲击治疗亚急性甲状腺炎的疗效观察[J].西部医学,2013,25(7):1002-1006.
[13]Poncin S,Gérard AC,Boucquey M,et al.Oxidative stress in the the thyroid gland:from harn lessness to hazard depending on the iodine content[J].Endocrinology,2008,149(1):424-433.
[14]夏勇,夏鸣喆,李艺,等.艾灸配合药物改善桥本氏甲状腺炎患者生活质量的观察[J].上海针灸杂志,2012,31(4):219-221.
[15]白如鑫,李沛.温和灸对中老年部分雄激素缺乏综合征大鼠模型影响的实验研究[J].针刺研究,2007,32(4):229-233.
[16]唐照亮,宋小鸽,李俊,等.艾灸抗炎免疫作用中松果腺褪黑素高位调节的研究[J].中国针灸,2001,21(7):429-431.
[17]Li XH,Han C,Zhang LF,et al.Effect of moxibustion at point Dazhui on expression of brain-derived neurotrophic factor in chronic stress rats[J].Chin J Clin Rehabili,2004,8(1):194-196.
[18]Zhang JF,Wu YC.Modern progress of mechanism of moxibustion therapy[J].J Acu Tuina Sci,2006,4(5):257-260.
[19]王华,梁凤霞.腧穴配伍研究思路和展望[J].中国针灸,2012,32(4):359-362.
[20]郝青,吴松,刘建民,等“标本配穴”电针对老年阳虚模型大鼠垂体-靶腺轴的影响[J].中国针灸,2014,34(10):993-997.
[21]徐芬,梁凤霞,陈瑞,等.标本配穴电针对胰岛素抵抗大鼠胰岛素敏感性及骨骼肌SIRT1蛋白表达的影响[J].中医杂志,2014,55(4):328-332.
[22]李强,徐芬,梁凤霞,等.“标本配穴”电针对胰岛素抵抗大鼠股四头肌线粒体超微结构和生物合成功能的影响[J].中国针灸,2014,34(6):578-582.
[23]路玫,张丽繁,袁晔,等.“标本配穴”灸、悬灸对不同穴位各时段热感度的对比研究[J].中国针灸,2011,31(3):232-235.
[2]高莹,高燕明.亚急性甲状腺炎[J].国际内分泌代谢杂志,2009(5):358-360.
[3]张木勋.甲状腺疾病诊疗学[M].北京:中国医药科技出版社,2005:145.
[4]中华医学会内分泌学分会.中国甲状腺疾病诊治指南[J].中华内科杂志,2008,47(9):784-785.
[5]罗敏.临床诊疗指南:内分泌及代谢性疾病分册[M].北京:人民卫生出版社,2005:23.
[6]Luotola K,Mantula P,Salmi J,et al.Allele 2of interleukin-1receptor antagonistgene increases the risk of thyroidperoxidaseantibodies in subacute thyroiditis[J].APMIS,2001,109(6):454-460.
[7]Volta C,Carano N,Street ME,et al.Atypical subacute thyroiditis caused by Epstein-Barrvirusinfection in a three-year-old girl[J].Thyroid,2005,15(10):1189-1190.
[8]顾明君,沈玉美,李翔,等.甲状腺内注射地塞米松和口服泼尼松治疗亚急性甲状腺炎[J].第二军医大学学报,2003,24(3):321-323.
[9]陈安芳.亚急性甲状腺炎106例临床分析[J].南京医科大学学报,2001,21(5):463.
[10]杨锋.糖皮质激素治疗亚急性甲状腺炎的临床疗效分析[J].中国医学工程,2013,21(5):116.
[11]杨坤,廖有乔.激素治疗亚急性甲状腺炎不同停药指征的疗效观察[J].临床内科杂志,2007,24(8):527-529.
[12]雷晓燕,李丙蓉.甲泼尼龙冲击治疗亚急性甲状腺炎的疗效观察[J].西部医学,2013,25(7):1002-1006.
[13]Poncin S,Gérard AC,Boucquey M,et al.Oxidative stress in the the thyroid gland:from harn lessness to hazard depending on the iodine content[J].Endocrinology,2008,149(1):424-433.
[14]夏勇,夏鸣喆,李艺,等.艾灸配合药物改善桥本氏甲状腺炎患者生活质量的观察[J].上海针灸杂志,2012,31(4):219-221.
[15]白如鑫,李沛.温和灸对中老年部分雄激素缺乏综合征大鼠模型影响的实验研究[J].针刺研究,2007,32(4):229-233.
[16]唐照亮,宋小鸽,李俊,等.艾灸抗炎免疫作用中松果腺褪黑素高位调节的研究[J].中国针灸,2001,21(7):429-431.
[17]Li XH,Han C,Zhang LF,et al.Effect of moxibustion at point Dazhui on expression of brain-derived neurotrophic factor in chronic stress rats[J].Chin J Clin Rehabili,2004,8(1):194-196.
[18]Zhang JF,Wu YC.Modern progress of mechanism of moxibustion therapy[J].J Acu Tuina Sci,2006,4(5):257-260.
[19]王华,梁凤霞.腧穴配伍研究思路和展望[J].中国针灸,2012,32(4):359-362.
[20]郝青,吴松,刘建民,等“标本配穴”电针对老年阳虚模型大鼠垂体-靶腺轴的影响[J].中国针灸,2014,34(10):993-997.
[21]徐芬,梁凤霞,陈瑞,等.标本配穴电针对胰岛素抵抗大鼠胰岛素敏感性及骨骼肌SIRT1蛋白表达的影响[J].中医杂志,2014,55(4):328-332.
[22]李强,徐芬,梁凤霞,等.“标本配穴”电针对胰岛素抵抗大鼠股四头肌线粒体超微结构和生物合成功能的影响[J].中国针灸,2014,34(6):578-582.
[23]路玫,张丽繁,袁晔,等.“标本配穴”灸、悬灸对不同穴位各时段热感度的对比研究[J].中国针灸,2011,31(3):232-235.