Abstract:

Objective　To explore the effect of methimazole combined with Yangyin Pingjia Decoction for patients with hyperthyroidism characterized by yin deficiency and exuberant fire. Methods　Ninety patients with hyperthyroidism characterized by yin deficiency and exuberant fire treated at Xi'an Traditional Chinese Medicine Hospital from February 2022 to February 2024 were selected for the randomized controlled trial, and were divided into a control group and an observation group by the random number table method, with 45 cases in each group. There were 18 males and 27 females in the control group; they were (54.69±5.38) years old. There were 19 males and 26 females in the observation group; they were (54.78±5.26) years old. The control group took methimazole, and the observation group methimazole and Yangyin Pingjia Decoction, for 2 months. The clinical efficacies, scores of traditional Chinese medicine (TCM) symptoms and thyroid function [free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH)] before and after the treatment, and incidence rates of adverse reactions were compared between the two groups. χ² and t tests were used for the statistical analysis. Results　The total effective rate in the observation group was higher than that in the control group [93.33% (42/45) vs. 77.78% (35/45)], with a statistical difference (χ²=4.406; P<0.05). After the treatment, the scores of heat sensation, irritability, fatigue, and palpitation and insomnia in the observation group were lower than those in the control group (1.36±0.14 vs. 2.45±0.21, 1.21±0.12 vs. 2.29±0.20, 1.12±0.11 vs. 2.94±0.27, and 1.34±0.15 vs. 3.01±0.32), with statistical differences (t=28.971, 31.062, 41.876, and 31.699; all P<0.05). After the treatment, the levels of FT3, FT4, and TSH in the observation group were better than those in the control group [(7.46±1.59) pmol/L vs. (11.02±2.23) pmol/L, (26.54±2.76) pmol/L vs. (33.57±3.85) pmol/L, and (0.86±0.19) mIU/L vs. (0.41±0.10) mIU/L], with statistical differences (t=8.720, 9.955, and 14.059; all P<0.05). The incidence rate of adverse reactions in the observation group was lower than that in the control grouip [4.44% (2/45) vs. 20.00% (9/45)], with a statistical difference (χ²=5.075; P<0.05). Conclusion　Methimazole combined with Yangyin Pingjia Decoction is more effective and safer than methimazole alone in treating patients with hyperthyroidism characterized by yin deficiency and exuberant fire, and can improve their clinical symptoms, and regulate their thyroid function indicators.

Key words:

Hyperthyroidism, Methimazole, Yangyin Pingjia , Decoction, Yin deficiency and exuberant fire, TCM symptom scores

摘要：

目的　探讨甲巯咪唑联合养阴平甲汤治疗阴虚火旺型甲状腺功能亢进症患者的效果。方法　选取2022年2月至2024年2月西安市中医医院收治的90例阴虚火旺型甲状腺功能亢进患者进行随机对照试验。采用随机数字表法将其分为对照组和观察组，各45例。对照组男18例，女27例，年龄（54.69±5.38）岁。观察组男19例，女26例，年龄（54.78±5.26）岁。对照组予以甲巯咪唑治疗，观察组予以甲巯咪唑联合养阴平甲汤治疗。两组均治疗2个月。比较两组临床疗效、治疗前后中医症候积分、甲状腺功能［游离三碘甲状腺原氨酸（free triiodothyronine，FT₃）、游离四碘甲状腺原氨酸（free thyroxine，FT₄）、促甲状腺激素（thyroid stimulating hormone，TSH）］和不良反应发生情况。采用χ²检验、t检验进行统计分析。结果　观察组治疗总有效率高于对照组［93.33%（42/45）比77.78%（35/45）］，差异有统计学意义（χ²=4.406，P<0.05）。治疗后，观察组烘热多汗、烦躁易怒、倦怠乏力、心悸失眠得分均低于对照组［（1.36±0.14）分比（2.45±0.21）分、（1.21±0.12）分比（2.29±0.20）分、（1.12±0.11）分比（2.94±0.27）分、（1.34±0.15）分比（3.01±0.32）分］，差异均有统计学意义（t=28.971、31.062、41.876、31.699，均P<0.05）。治疗后，观察组FT₃、FT₄水平均低于对照组［（7.46±1.59）pmol/L比（11.02±2.23）pmol/L、（26.54±2.76）pmol/L比（33.57±3.85）pmol/L］，TSH水平高于对照组［（0.86±0.19）mIU/L比（0.41±0.10）mIU/L］，差异均有统计学意义（t=8.720、9.955、14.059，均P<0.05）。观察组不良反应发生率低于对照组［4.44%（2/45）比20.00%（9/45）］，差异有统计学意义（χ²=5.075，P<0.05）。结论　甲巯咪唑联合养阴平甲汤治疗阴虚火旺型甲状腺功能亢进症患者的效果优于单独使用甲巯咪唑，能改善患者临床症状，调节甲状腺功能指标，且安全性更高。

关键词:

甲状腺功能亢进症, 甲巯咪唑, 养阴平甲汤, 阴虚火旺型, 中医症候积分