扶正祛瘀法联合左甲状腺素钠对甲状腺乳头状癌伴桥本甲状腺炎患者术后甲状腺功能和骨代谢的作用观察

Clincal observation on strengthening the body and removing blood stasis method combined with levothyroxine sodium on postoperative thyroid function and bone metabolism in patients with papillary thyroid cancer and Hashimoto’s thyroiditis

目的观察扶正祛瘀法联合左甲状腺素钠对甲状腺乳头状癌(PTC)伴桥本甲状腺炎(HT)患者术后甲状腺功能和骨代谢的作用。方法将我院104例PTC伴HT患者随机分为治疗组与对照组各52例。对照组口服左甲状腺素治疗,治疗组采用扶正祛瘀法、左甲状腺素联合治疗。比较两组总有效率,游离三碘甲状腺原氨酸(FT3)、游离甲状腺激素(FT4)、三碘促甲状腺激素(TSH)水平,L3~4、左侧股骨粗隆、Ward’s、股骨颈骨密度、CD3^(+)/CD4^(+)、CD3^(+)/CD8^(+)值。结果治疗后,治疗组总有效率显著高于对照组(P<0.05);两组FT3、FT4水平较治疗前升高,TSH水平较治疗前下降(P<0.05),治疗组L3~4、左侧股骨粗隆、Ward’s、股骨颈骨密度、CD3^(+)/CD4^(+)、CD3^(+)/CD8^(+)值较治疗前增加(P<0.05),对照组L3~4、左侧股骨粗隆、Ward’s、股骨颈骨密度较治疗前减少(P<0.05),CD3^(+)/CD4^(+)、CD3^(+)/CD8^(+)值较治疗前差异不显著(P>0.05);治疗组FT3、FT4水平、L3~4、左侧股骨粗隆、Ward’s、股骨颈骨密度、CD3^(+)/CD4^(+)、CD3^(+)/CD8^(+)值高于对照组,TSH水平低于对照组(P<0.05)。结论扶正祛瘀法联合左甲状腺素钠PTC伴HT患者术后治疗效果显著,调节甲状腺激素表达和骨代谢,提高免疫功能。

Objective To observe the effect of strengthening the body and removing blood stasis method combined with levothyroxine sodium on postoperative thyroid function and bone metabolism in patients with papillary thyroid carcinoma(PTC)and Hashimoto’s thyroiditis(HT).Methods A total of 104 patients with PTC and HT were randomly divided into treatment group and control group,with 52 cases in each group.Control group was treated with oral levothyroxine,and treatment group was treated with the combination therapy of strengthening the body and removing blood stasis and levothyroxine.The total effective rate,free triiodothyronine(FT3),free thyroid hormone(FT4),triiodothyronine(TSH)levels,L3~4,left femoral trochanter,Ward’s,femoral neck bone mineral density,CD3^(+)/CD4^(+),CD3^(+)/CD8^(+)values were compared between the two groups.Results After treatment,the total effective rate in treatment group was significantly higher than that in control group(<0.05);the FT3 and FT4 levels were increased compared with those before treatment in both groups,and the TSH level was decreased compared with those before treatment(P<0.05),the bone mineral density of the L3~4,lateral femoral trochanter,Ward’s,femoral neck,CD3^(+)/CD4^(+),CD3^(+)/CD8^(+)values were increased compared with those before treatment(P<0.05),while the CD3^(+)/CD4^(+)and CD3^(+)/CD8^(+)values in control group were not significantly different from those before treatment(P>0.05),the bone mineral density of the L3~4,lateral femoral trochanter,Ward’s,femoral neck decreased compared with those before treatment(P<0.05);the levels of FT3,FT4,the bone mineral density of the L3-4,lateral femoral trochanter,Ward’s,femoral neck,CD3^(+)/CD4^(+)and CD3^(+)/CD8^(+)values in treatment group were higher than those in control group,and the TSH level was lower than that in control group(P<0.05).Conclusion Strengthening the body and removing blood stasis method combined with levothyroxine has a significant effect on postoperative thyroid function and bone metabolism in patients with PTC and HT by regulating thyroid hormone expression and bone metabolism,and improving immune function.