益气清肝散结汤治疗桥本甲亢的临床研究
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摘要
目的：通过观察益气清肝散结汤对气虚痰凝肝旺型桥本甲亢患者甲状腺功能、甲状腺自身自身抗体及中医证候积分等的影响，探讨该方调节甲状腺功能、降低甲状腺自身抗体的治疗作用以及减轻临床症候的疗效，以探究对甲状腺功能的保护效果、改善该病预后和提高HT患者的生活质量之效。
方法：所有入选病例随机分入3个组：西药组、中药组、中西药组。观察治疗阶段为3个月。分别于治疗前后检测甲状腺体积和峡部厚度、甲状腺功能（FT3、FT4、TSH）、甲状腺自身抗体（TPOAb和TGAb），以及对临床症候积分的改善程度。
结果：（1）对甲状腺体积及甲状腺峡部厚度的影响：治疗3个月后各组间甲状腺体积无显著差异（p>0.05）。中西药组治疗3个月后较治疗前甲状腺体积明显缩小（p<0.05）；西药组、中药组在治疗后甲状腺体积有所减小，但差异无统计学意义（p>0.05）。治疗3个月后各组间甲状腺峡部厚度无显著差异（p>0.05）。中药组、中西药组治疗3个月后较治疗前甲状腺峡部厚度均有明显缩小（p<0.05）；西药组治疗前后差异无统计学意义（p>0.05）。（2）对甲状腺功能的影响：西药组、中药组和中西药组治疗3个月后FT3水平显著降低（p<0.01和p<0.05）；治疗3个月后西药组FT3水平明显低于中药组（p<0.05），中西药组疗效与西药组无显著差异（p>0.05）。西药组、中西药组治疗3个月后FT4水平显著降低（p<0.01），中药组治疗前后FT4水平无明显改变（p>0.05）；治疗3个月后三组间比较无显著性差异（p>0.05）。三个组治疗3个月后TSH水平均显著上升（p<0.01和p<0.05）；三组间疗效无显著差异（p>0.05）。（3）对甲状腺自身抗体的影响：中药组、中西药组治疗3个月后TGAb水平较治疗前明显降低（p<0.01和p<0.05）；西药组TGAb水平在治疗前后无明显改变（p>0.05）。治疗3个月后中药组、中西药组TGAb明显低于西药组（p<0.05）。中药组、中西药组组治疗3个月后TPOAb水平明显降低（p<0.05和p<0.01）；西药组治疗前后TPOAb水平无统计学差异（p>0.05）。治疗3个月后中西药组TPOAb水平明显低于西药组（p<0.05）；中药组TPOAb水平较西药组降低，但差异无统计学意义（p>0.05）。（4）对中医症候积分的影响：经3个月治疗后三个组对改善症候积分的总有效率分别为：西药组76.7%，中药组77.1%，中西药组84.4%。三组间疗效无显著差异。
结论：益气清肝散结汤具有辅助维持甲状腺功能的稳定、降低甲状腺自身抗体的作用，对减轻临床症候也有一定疗效。与西药联用可更好的促进甲状腺功能的恢复。在HT患者甲状腺尚有较好的分泌功能时，予以中药干预治疗以减轻减轻甲状腺自身免疫破坏和保护甲状腺组织，可减缓病情进一步进展，改善疾病预后。
Objective：To investigate the impact of Yiqi-Qinggan-Sanjie Decoction,an empirical formula, on hashitoxicosis belonging Qi deficiency Phlegmdepression and Liver flourish syndrome.
Methods：Patients met diagnostic criteria were divided into3groupsrandomly： Western medicine groups(G1)， Traditional Chinese medicinegroups(G2)， Chinese and Western medicine groups(G3).Volume and isthmusthickness of thyroid gland were measured by type-B ultrasonic. Parameters ofthyroid function including free Tri-iodothyronine (FT3), free Thyroid Hormone(FT4) and Thyroid Stimulating Hormone (TSH) levels were measured, as well asThyroglobulin Antibody (TGAb) and Thyroid Peroxidase Antibady (TPOAb).Questionaries were used to investigate the improvement of symptoms.
Results：1) No significant diffrence between3groups in thyroid volumeand isthmus thickness after treated for3month. Thyroid volume of G3andisthmus thickness of G2and G3were significantly smaller compared withthemselves before treatment(p<0.05).2)Level of FT3declined in all of those3groups after treatment(p<0.05&p<0.01).Compared with G2, G1was evenlower(p<0.05). Level of FT4declined in G1&G3(p<0.01).While, No significantdiffrence in FT4between3groups after treatment.3) Parameters of TGAb inG2and G3declined significantly(p<0.05&p<0.01),and was lower than G1after treatment(p<0.05). Similarly, levels of TPOAb in G2and G3declinedsignificantly(p<0.05&p<0.01). After treatment, TPOAb levels was lower in G3than G2(p<0.05).4)The improvement of symptoms, in the form of value, between3groups shows no significant diffrence.
Conclusion： Yiqi-Qinggan-Sanjie Decoction could stabilise thyroidfunction, downgrade thyroid autoantibodies and relieve symptoms to a certainextent. Combined with western medicine is a helpful way to relieve symptoms.It is feasible that using Traditional Chinese medicine to alleviate autoimmunedestruction before deterioration of thyroid function is a mean to protectthyroid gland and improve out comes.
方法：所有入选病例随机分入3个组：西药组、中药组、中西药组。观察治疗阶段为3个月。分别于治疗前后检测甲状腺体积和峡部厚度、甲状腺功能（FT3、FT4、TSH）、甲状腺自身抗体（TPOAb和TGAb），以及对临床症候积分的改善程度。
结果：（1）对甲状腺体积及甲状腺峡部厚度的影响：治疗3个月后各组间甲状腺体积无显著差异（p>0.05）。中西药组治疗3个月后较治疗前甲状腺体积明显缩小（p<0.05）；西药组、中药组在治疗后甲状腺体积有所减小，但差异无统计学意义（p>0.05）。治疗3个月后各组间甲状腺峡部厚度无显著差异（p>0.05）。中药组、中西药组治疗3个月后较治疗前甲状腺峡部厚度均有明显缩小（p<0.05）；西药组治疗前后差异无统计学意义（p>0.05）。（2）对甲状腺功能的影响：西药组、中药组和中西药组治疗3个月后FT3水平显著降低（p<0.01和p<0.05）；治疗3个月后西药组FT3水平明显低于中药组（p<0.05），中西药组疗效与西药组无显著差异（p>0.05）。西药组、中西药组治疗3个月后FT4水平显著降低（p<0.01），中药组治疗前后FT4水平无明显改变（p>0.05）；治疗3个月后三组间比较无显著性差异（p>0.05）。三个组治疗3个月后TSH水平均显著上升（p<0.01和p<0.05）；三组间疗效无显著差异（p>0.05）。（3）对甲状腺自身抗体的影响：中药组、中西药组治疗3个月后TGAb水平较治疗前明显降低（p<0.01和p<0.05）；西药组TGAb水平在治疗前后无明显改变（p>0.05）。治疗3个月后中药组、中西药组TGAb明显低于西药组（p<0.05）。中药组、中西药组组治疗3个月后TPOAb水平明显降低（p<0.05和p<0.01）；西药组治疗前后TPOAb水平无统计学差异（p>0.05）。治疗3个月后中西药组TPOAb水平明显低于西药组（p<0.05）；中药组TPOAb水平较西药组降低，但差异无统计学意义（p>0.05）。（4）对中医症候积分的影响：经3个月治疗后三个组对改善症候积分的总有效率分别为：西药组76.7%，中药组77.1%，中西药组84.4%。三组间疗效无显著差异。
结论：益气清肝散结汤具有辅助维持甲状腺功能的稳定、降低甲状腺自身抗体的作用，对减轻临床症候也有一定疗效。与西药联用可更好的促进甲状腺功能的恢复。在HT患者甲状腺尚有较好的分泌功能时，予以中药干预治疗以减轻减轻甲状腺自身免疫破坏和保护甲状腺组织，可减缓病情进一步进展，改善疾病预后。
Objective：To investigate the impact of Yiqi-Qinggan-Sanjie Decoction,an empirical formula, on hashitoxicosis belonging Qi deficiency Phlegmdepression and Liver flourish syndrome.
Methods：Patients met diagnostic criteria were divided into3groupsrandomly： Western medicine groups(G1)， Traditional Chinese medicinegroups(G2)， Chinese and Western medicine groups(G3).Volume and isthmusthickness of thyroid gland were measured by type-B ultrasonic. Parameters ofthyroid function including free Tri-iodothyronine (FT3), free Thyroid Hormone(FT4) and Thyroid Stimulating Hormone (TSH) levels were measured, as well asThyroglobulin Antibody (TGAb) and Thyroid Peroxidase Antibady (TPOAb).Questionaries were used to investigate the improvement of symptoms.
Results：1) No significant diffrence between3groups in thyroid volumeand isthmus thickness after treated for3month. Thyroid volume of G3andisthmus thickness of G2and G3were significantly smaller compared withthemselves before treatment(p<0.05).2)Level of FT3declined in all of those3groups after treatment(p<0.05&p<0.01).Compared with G2, G1was evenlower(p<0.05). Level of FT4declined in G1&G3(p<0.01).While, No significantdiffrence in FT4between3groups after treatment.3) Parameters of TGAb inG2and G3declined significantly(p<0.05&p<0.01),and was lower than G1after treatment(p<0.05). Similarly, levels of TPOAb in G2and G3declinedsignificantly(p<0.05&p<0.01). After treatment, TPOAb levels was lower in G3than G2(p<0.05).4)The improvement of symptoms, in the form of value, between3groups shows no significant diffrence.
Conclusion： Yiqi-Qinggan-Sanjie Decoction could stabilise thyroidfunction, downgrade thyroid autoantibodies and relieve symptoms to a certainextent. Combined with western medicine is a helpful way to relieve symptoms.It is feasible that using Traditional Chinese medicine to alleviate autoimmunedestruction before deterioration of thyroid function is a mean to protectthyroid gland and improve out comes.
引文
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