加味参苓白术散治疗桥本氏甲状腺炎的临床观察
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摘要
目的:观察加味参苓白术散联合甲状腺素片治疗桥本氏甲状腺炎(Hashimoto’s thyroiditis,HT)的临床疗效。方法:68例HT患者根据随机数字表法,随机分为治疗组与对照组,每组34例。对照组单独采用甲状腺素片治疗临床方案,治疗组在对照组治疗的基础上,给予加味参苓白术散汤剂治疗。观察2组HT患者治疗前后游离三碘甲状腺原氨酸(free triiodothyronine,FT_3),游离甲状腺素(free Thyroxine,FT4),促甲状腺激素(thyroid stimulating hormone,TSH),免疫学指标血清甲状腺过氧化物酶抗体(thyroidperoxidase antibody,TPOAb),甲状腺球蛋白抗体(thyroglobulin antibody,Tg Ab),中医证候积分的变化,并观察中药组方的安全性。结果:经过3个月的治疗后,治疗组有效率(91. 2%)明显高于对照组(70. 6%)(P <0. 05);两组中医证候积分经3个月治疗后较本组治疗前明显下降(P <0. 05),治疗组中医证候积分较对照组下降更明显(P <0. 05)。两组FT_3,FT4水平经3个月治疗后较本组治疗前显著上升(P <0. 01),治疗组上升趋势显著优于对照组(P <0. 01);两组TSH,Tg Ab,TPOAb经3个月治疗后较本组治疗前均明显下降(P <0. 05),且治疗组下降趋势更明显(P <0. 05);在治疗过程中未见任何不良反应发生。结论:加味参苓白术散联合甲状腺素片治疗HT,相较于单纯甲状腺素片临床效果显著,值得进一步临床和实验研究。
Objective: To observe the clinical efficacy of modified Shenling Baizhu San combined with thyroxine tablets in the treatment of Hashimoto’s thyroiditis( HT). Method: The 68 patients with HT were randomly divided into treatment group and control group,with 34 patients in each group. Control group was treated with thyroxine tablets alone,while treatment group was treated with modified Shenling Baizhu San in addition to the therapy of control group. Free triiodothyronine( FT_3),free Thyroxine( FT_4),thyroid stimulating hormone( TSH),serum thyroid peroxidase antibody( TPOAb) and thyroglobulin were observed before and after treatment in the two groups of HT patients. The changes of thyroglobulin antibody( TgAb) and traditional Chinese medicine( TCM) syndrome score,and the safety of TCM prescription were observed. Result: After 3 months of treatment,the effective rate of treatment group was 91. 2%,which was significantly higher than 70. 6% of control group,with statistically significant difference( P < 0. 05); after 3 months of treatment,the scores of TCM syndromes in two groups were significantly lower than those before treatment( P < 0. 05),and the scores of TCM syndromes in treatment group were significantly lower than those in control group( P < 0. 05). FT_3 and FT_4 in treatment group and control group increased significantly after 3 months of treatment( P < 0. 01),but treatment group increased more significantly than control group( P < 0. 01); TSH,Tg Ab and TPOAb in treatment group and control group decreased significantly after 3 months of treatment( P < 0. 05),and treatment group decreased more significantly than before treatment( P < 0. 05),with no adverse reaction during the treatment. Conclusion: Modified Shenling Baizhu San combined with thyroxine tablets in the treatment of HT is more effective than simple thyroxine tablets,which is worthy of further clinical and experimental study.
Objective: To observe the clinical efficacy of modified Shenling Baizhu San combined with thyroxine tablets in the treatment of Hashimoto’s thyroiditis( HT). Method: The 68 patients with HT were randomly divided into treatment group and control group,with 34 patients in each group. Control group was treated with thyroxine tablets alone,while treatment group was treated with modified Shenling Baizhu San in addition to the therapy of control group. Free triiodothyronine( FT_3),free Thyroxine( FT_4),thyroid stimulating hormone( TSH),serum thyroid peroxidase antibody( TPOAb) and thyroglobulin were observed before and after treatment in the two groups of HT patients. The changes of thyroglobulin antibody( TgAb) and traditional Chinese medicine( TCM) syndrome score,and the safety of TCM prescription were observed. Result: After 3 months of treatment,the effective rate of treatment group was 91. 2%,which was significantly higher than 70. 6% of control group,with statistically significant difference( P < 0. 05); after 3 months of treatment,the scores of TCM syndromes in two groups were significantly lower than those before treatment( P < 0. 05),and the scores of TCM syndromes in treatment group were significantly lower than those in control group( P < 0. 05). FT_3 and FT_4 in treatment group and control group increased significantly after 3 months of treatment( P < 0. 01),but treatment group increased more significantly than control group( P < 0. 01); TSH,Tg Ab and TPOAb in treatment group and control group decreased significantly after 3 months of treatment( P < 0. 05),and treatment group decreased more significantly than before treatment( P < 0. 05),with no adverse reaction during the treatment. Conclusion: Modified Shenling Baizhu San combined with thyroxine tablets in the treatment of HT is more effective than simple thyroxine tablets,which is worthy of further clinical and experimental study.
引文
[1]陈妙苑,罗雪莹,陈伟财,等.桥本氏甲状腺炎合并结节的临床诊断与治疗[J].深圳中西医结合杂志,2016,26(20):3-5.
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[6] Kallel S,Kallel R,Ayadi S,etal. Primary squamous cell carcinoma of the thyroid associated with papillary thyroid carcinoma and Hashimoto's thyroiditis[J]. Eur Ann Otorhinolaryngol Head Neck Dis,2018,19(6):458-461.
[7] Miranda M,Bustamante M L, Campero M, et al.Movement disorders in non-encephalopathic Hashimoto's thyroiditis[J]. Parkinsonism Relat Disord,2018,18(15):585-593.
[8]王平,王建凤,刘善新,等.桥本氏甲状腺炎发病机制及治疗方法研究进展[J].药学研究,2015,34(10):599-603.
[9]王静,徐佳.柴胡疏肝散加减联合左甲状腺素钠片治疗桥本氏甲状腺炎的分析[J].中国妇幼健康研究,2017,28(S4):451-452.
[10]俞烨晨,叶丽芳,李自尊.二仙消瘿汤联合左旋甲状腺素钠治疗桥本甲状腺炎继发甲状腺功能减退30例[J].上海中医药杂志,2018,52(9):44-46.
[11]尹冬,惠媛.金匮肾气丸联合左甲状腺素片治疗桥本甲状腺炎甲减的临床观察[J].中华中医药学刊,2018,36(3):756-758.
[12]张栎婧,战丽彬.基于整合药理学平台探究参苓白术散治疗2型糖尿病的物质基础和作用机制[J].中国实验方剂学杂志,2018,24(21):157-162.
[13]余文燕,王桦影,王国娟,等.参苓白术散协同奥沙利铂对人结肠癌细胞增殖及凋亡的作用[J].中国实验方剂学杂志,2018,24(18):118-123.
[14]王庆兆,魏韬哲.现代甲状腺外科学[M].郑州:河南医科大学出版社,1997:202.
[15]葛均波,徐永健.内科学[M]. 8版.北京:人民卫生出版社,2013:693-695.
[16]朱文峰,何清湖.现代中医临床诊断学[M].北京:人民卫生出版社,2003:665-670.
[17]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:226-233.
[18]陈思兰,李桂芹,高冬梅.补肾健脾疏肝方治疗桥本氏甲状腺炎的临床研究[J].环球中医药,2013,6(4):245-249.
[19]熊山,丁晓晨.四君子汤化学成分和药理作用研究进展[J].山东医学高等专科学校学报,2017,39(5):371-374.
[20]辜沅,舒青龙.基于肠道微生态的参苓白术散药理研究进展[J].时珍国医国药,2018,29(3):674-676.
[21]姚梦杰,吕金朋,张乔,等.人参化学成分及药理作用研究[J].吉林中医药,2017,37(12):1261-1263.
[22]王涵,杨娜,谭静,等.白术化学成分、药理作用及临床应用的研究进展[J].甘肃医药,2018,37(1):23-26.
[23]朱广伟,张贵君,汪萌,等.中药芍药甘草汤基原及药效组分和药理作用研究概况[J].中华中医药杂志,2015,30(8):2865-2869.
[2]林果为,王吉耀,葛均波.实用内科学[M].北京:人民卫生出版社,2017:1234.
[3]肖硕,丁卓玲.常用中药在桥本氏甲状腺炎治疗中的应用研究[J].实用药物与临床,2012,15(3):174-175.
[4] Stanilova S A,Gerenova J B,Miteva L D,et al. The role of transforming growth factor-beta1 gene polymorphism and its serum levels in Hashimoto's thyroiditis[J]. Curr Pharm Biotechnol,2018,19(7):581-589.
[5] Krysiak R,Szkrobka W, Okopien B. The effect of gluten-free diet on thyroid autoimmunity in drug-naive women with Hashimoto's thyroiditis:a pilot study[J].Exp Clin Endocrinol Diabetes,2018,55(11):55-61.
[6] Kallel S,Kallel R,Ayadi S,etal. Primary squamous cell carcinoma of the thyroid associated with papillary thyroid carcinoma and Hashimoto's thyroiditis[J]. Eur Ann Otorhinolaryngol Head Neck Dis,2018,19(6):458-461.
[7] Miranda M,Bustamante M L, Campero M, et al.Movement disorders in non-encephalopathic Hashimoto's thyroiditis[J]. Parkinsonism Relat Disord,2018,18(15):585-593.
[8]王平,王建凤,刘善新,等.桥本氏甲状腺炎发病机制及治疗方法研究进展[J].药学研究,2015,34(10):599-603.
[9]王静,徐佳.柴胡疏肝散加减联合左甲状腺素钠片治疗桥本氏甲状腺炎的分析[J].中国妇幼健康研究,2017,28(S4):451-452.
[10]俞烨晨,叶丽芳,李自尊.二仙消瘿汤联合左旋甲状腺素钠治疗桥本甲状腺炎继发甲状腺功能减退30例[J].上海中医药杂志,2018,52(9):44-46.
[11]尹冬,惠媛.金匮肾气丸联合左甲状腺素片治疗桥本甲状腺炎甲减的临床观察[J].中华中医药学刊,2018,36(3):756-758.
[12]张栎婧,战丽彬.基于整合药理学平台探究参苓白术散治疗2型糖尿病的物质基础和作用机制[J].中国实验方剂学杂志,2018,24(21):157-162.
[13]余文燕,王桦影,王国娟,等.参苓白术散协同奥沙利铂对人结肠癌细胞增殖及凋亡的作用[J].中国实验方剂学杂志,2018,24(18):118-123.
[14]王庆兆,魏韬哲.现代甲状腺外科学[M].郑州:河南医科大学出版社,1997:202.
[15]葛均波,徐永健.内科学[M]. 8版.北京:人民卫生出版社,2013:693-695.
[16]朱文峰,何清湖.现代中医临床诊断学[M].北京:人民卫生出版社,2003:665-670.
[17]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:226-233.
[18]陈思兰,李桂芹,高冬梅.补肾健脾疏肝方治疗桥本氏甲状腺炎的临床研究[J].环球中医药,2013,6(4):245-249.
[19]熊山,丁晓晨.四君子汤化学成分和药理作用研究进展[J].山东医学高等专科学校学报,2017,39(5):371-374.
[20]辜沅,舒青龙.基于肠道微生态的参苓白术散药理研究进展[J].时珍国医国药,2018,29(3):674-676.
[21]姚梦杰,吕金朋,张乔,等.人参化学成分及药理作用研究[J].吉林中医药,2017,37(12):1261-1263.
[22]王涵,杨娜,谭静,等.白术化学成分、药理作用及临床应用的研究进展[J].甘肃医药,2018,37(1):23-26.
[23]朱广伟,张贵君,汪萌,等.中药芍药甘草汤基原及药效组分和药理作用研究概况[J].中华中医药杂志,2015,30(8):2865-2869.
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