中西医结合治疗甲状腺功能亢进症近期疗效及远期复发率观察

摘要

目的：观察中西医结合治疗甲状腺功能亢进症的近期疗效和远期复发率。方法：将符合标准的74例患者随机分为两组，对照组40例采用甲巯咪唑治疗，治疗组34例在对照组基础上加用中药辨证论治，肝郁气滞化火者用柴胡疏肝散加减，阴虚火旺、痰瘀凝结者用知柏地黄丸合消瘰丸加减，气阴两虚兼痰瘀互结者予以生脉散、二至丸合消瘰丸加减。观察患者临床症状、体征和甲状腺功能变化情况、不良反应发生情况和复发率。结果：治疗组临床痊愈率和总有效率分别为44.12％、88.24％，对照组临床痊愈率和总有效率分别为25.00％、77.50％。两组比较，差异有统计学意义（ P＜0.05）。治疗1个月后，治疗组症状总积分低于对照组，但差异无统计学意义；自治疗3个月起，组间比较，差异均有统计学意义（ P＜0.05）。治疗后两组TT3、TT4、FT3、FT4和TRAb均降低，TSH升高，组间比较，差异均有统计学意义（P＜0.05）。治疗组和对照组不良反应率分别为5.88％、15.00％，差异有统计学意义（P＜0.05），以肝功能损害最为常见。临床痊愈患者中，治疗组复发6例，复发率40.00％，对照组复发6例，复发率60.00％。结论：甲巯咪唑联合中药辨证论治用于甲状腺功能亢进症，可有效改善患者临床症状和甲状腺功能，降低药物不良反应发生率，减少复发。%Objective:To observe therapeutic efficacy of combined treatment of traditional Chinese and western medicine on hyperthy -roidism and long-term recurrence.Methods:Seventy four patients were randomly divided into two groups , control group (40 cases) used Methyl mercaptoacetate imidazole , observation group (34 cases) used Methyl mercaptoacetate imidazole plus Chinese medicine treatment based on syndrome differentiation:liver stagnation resulting in exuberating fire used modified bupleurum Powder , Yin-deficiency , fire-ex-uberant phlegm-stagnation used modified Zhibai Dihang Pill and Xiaoluo Pill , qi-yin deficiency , phlegm stagnation used modified Shengmai Powder, Erzhi Pill and Xiaoluo Pill.After treatment, we compared changes of thyroid function , symptoms, physical signs, ad-verse reaction and recurrence .Results:Clinical cure rates and total effective rate of observation group were respectively , 44.12% and 88.24%, those of the control group were 25.00%and 77.50%(P<0.05).After 1-month treatment, the observer group’s total symp-tom score was lower than the control group (P>0.05), the difference showed statistic significance after 3-months treatment (P<0. 05).After treatment TT3、TT4、FT3、FT4and TRAb were reduced and TSH elevated in both groups with significant difference between the groups (P<0.05).AE occurrence rates of observation group and control group were respectively , 5.88% and 15.00% (P<0.05), liver damage was most noticeable .The observer group had 6 reoccurrences, recurrence rate =40%, the control group had 6 cases, re-currence rate =60%.Conclusion:Thiamazole combined with traditional Chinese medicine can effectively treat clinical symptoms and thyroid function of hyperthyroidism , control adverse reaction and recurrence .