自拟“消瘿汤”肝、脾、肾三脏同调辨治桥本甲状腺炎的临床研究

doi:10.3760/cma.j.issn.1007-1245.2023.24.012

摘要/Abstract

摘要：

目的　探讨自拟“消瘿汤”肝、脾、肾三脏同调辨治桥本甲状腺炎（HT）的临床效果。方法　本研究为前瞻性研究。选取2020年9月至2022年6月泰安市中医医院收治的90例HT患者，按随机数字表法将其分为对照组和观察组，每组45例。对照组男4例，女41例，年龄（46.98±2.23）岁。观察组男5例，女40例，年龄（47.62±2.35）岁。两组均予以常规西药治疗（口服左甲状腺素钠片），观察组在对照组的基础上给予自拟“消瘿汤”治疗，两组均连续治疗12周。比较两组治疗后临床疗效，治疗前后甲状腺功能指标［游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、血清促甲状腺素（TSH）］、甲状腺抗体［甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TgAb）］及血清炎性因子［肿瘤坏死因子-α（TNF-α）、白介素细胞（IL）-6与IL-10］水平，治疗期间不良反应情况。采用χ²或Fisher确切概率法、t检验进行统计比较。结果　治疗后观察组临床总有效率为88.89%（40/45），高于对照组的71.11%（32/45），差异有统计学意义（χ²=4.444，P=0.035）。治疗后观察组的血清TSH、TG-Ab、TPO-Ab水平分别为（1.76±0.22）mIU/L、（237.62±48.47）IU/ml、（218.28±36.09）IU/ml，均低于对照组［（2.39±0.33）mIU/L、（326.97±46.23）IU/ml、（302.54±40.20）IU/ml］，差异均有统计学意义（t=10.865、8.949、10.463，均P<0.001）。治疗后观察组的血清IL-10水平为（94.36±10.36）ng/L，高于对照组（84.86±10.37）ng/L，血清IL-6、TNF-α水平分别为（8.14±1.26）ng/L、（84.20±11.95）ng/L，均低于对照组［（10.21±1.26）ng/L、（104.37±11.13）ng/L］，差异均有统计学意义（t=4.348、7.802、8.280，均P<0.001）。两组治疗期间不良反应总发生率差异无统计学意义（P=0.677）。结论　自拟“消瘿汤”肝、脾、肾三脏同调辨治HT，能有效改善患者甲状腺功能，减少甲状腺抗体，抑制炎症反应，且治疗期间安全性良好。

关键词:

桥本甲状腺炎, “消瘿汤”, 肝、脾、肾三脏同调辨治, 甲状腺功能

Abstract:

Objective　To explore the clinical effect of liver-spleen-kidney co-regulation with self-made Xiaoying Decoction in the differential treatment of patients with Hashimoto's thyroiditis (HT). Methods　This is a prospective study. Ninety patients with HT admitted to Tai'an Hospital of Traditional Chinese Medicine between September 2020 and June 2022 were selected. They were divided into a control group and an observation group the random number table method, with 45 cases in each group. In the control group, there were 4 males and 41 females; they were (46.98±2.23) years old. In the observation group, there were 5 males and 40 females; they were (47.62±2.35) years old. Both groups took routine western medicine (orally too levothyroxine sodium tablets); in addition, the observation group took self-made Xiaoying Decoction. Both groups were treated for 12 weeks continuously. The clinical curative effects after the treatment, the levels of thyroid function indicators [free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH)], thyroid antibodies [thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb)], and serum inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10)] before and after the treatment, and adverse reactions during the treatment were compared between the two groups. χ² test, Fisher exact probability test, and t test were used for the statistical comparisons. Results　After the treatment, the total clinical response rate of the observation group was higher than that of the control group [88.89% (40/45) vs. 71.11% (32/45)], with a statistical difference (χ²=4.444, P=0.035). After the treatment, the levels of serum TSH, TgAb, and TPOAb in the observation group were lower than those in the control group, and, [(1.76±0.22) mIU/L vs. (2.39±0.33) mIU/L, (237.62±48.47) IU/ml vs. (326.97±46.23) IU/ml, and (218.28±36.09) IU/ml vs. (302.54±40.20) IU/ml], with statistical differences (t=10.865, 8.949, and 10.463; all P<0.05). After the treatment, the level of serum IL-10 in the observation group was higher than that in the control group [(94.36±10.36) ng/L vs. (84.86±10.37) ng/L], while the levels of serum IL-6 and TNF-α were lower than those in the control group [(8.14±1.26) ng/L vs. (10.21±1.26) ng/L and (84.20±11.95) ng/L vs. (104.37±11.13) ng/L], with statistical differences (t=4.348, 7.802, and 8.280; all P<0.05). There was no statistical difference in the total incidence of adverse reactions during the treatment between the two groups (P=0.677). Conclusion　The liver-spleen-kidney co-regulation with self-made Xiaoying Decoction for patients with HT can effectively improve their thyroid function, reduce the levels of thyroid antibodies, and inhibit their inflammation response, with good safety during treatment.

Key words:

Hashimoto's thyroiditis, Xiaoying Decoction, Differential treatment of liver-spleen-kidney co-regulation, Thyroid function

周良军.

自拟“消瘿汤”肝、脾、肾三脏同调辨治桥本甲状腺炎的临床研究 [J]. 国际医药卫生导报, 2023, 29(24): 3580-3584.

Zhou Liangjun.

Liver-spleen-kidney co-regulation with self-made Xiaoying Decoction in differential treatment of patients with Hashimoto's thyroiditis [J]. International Medicine and Health Guidance News, 2023, 29(24): 3580-3584.

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