泻火消瘿方联合甲巯咪唑片治疗毒性弥漫性甲状腺肿心肝火旺证30例临床观察

Clinical Observation on Xiehuo Xiaoying Decoction(泻火消瘿方) Combined with Thiamazole Tablets in Treating 30 Cases of Toxic Diffuse Goiter with Hyperactivity Heart-liver Fire Syndrome

目的观察泻火消瘿方治疗毒性弥漫性甲状腺肿(又称Graves病)心肝火旺证的临床疗效。方法将80例Graves病心肝火旺证患者随机分为治疗组和对照组各40例,对照组给予甲巯咪唑片治疗,治疗组在对照组基础上加用泻火消瘿方,每日1剂。两组均以4周为1个疗程,连续治疗3个疗程。比较两组患者治疗前后心率、体重、中医证候积分;检测治疗前及治疗1、2、3个疗程甲状腺功能[包括促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)],计算各指标恢复率及恢复至正常水平所需平均时间;检测治疗前后促甲状腺激素受体抗体(TRAb)水平;记录各疗程甲巯咪唑片用量。结果最终有61例患者完成研究,治疗组30例,对照组31例。治疗组在降低心率及中医证候积分方面优于对照组(P<0.05或P<0.01);与对照组比较,治疗组在1、2疗程时FT3、FT4水平更低,FT3、FT4恢复正常所需时间更少且治疗1个疗程时恢复率更高(P<0.05或P<0.01);治疗组在1、2、3疗程时甲巯咪唑片用量均低于同时间对照组(P<0.05或P<0.01)。两组患者治疗后均较治疗前体重增加,TSH水平升高,TRAb水平降低(P<0.01),治疗后两组各指标比较差异无统计学意义(P>0.05)。结论泻火消瘿方治疗Graves病心肝火旺证可迅速改善临床症状及甲状腺功能,并能减少西药用量。

Objective To observe the clinical effect of Xiehuo Xiaoying Decoction in treating Toxic diffuse goiter（ called Graves disease） with hyperactivity of heart-liver fire syndrome. Methods Eighty patients with Graves disease were randomized into a treatment group（ 40 cases） and a control group（ 40 cases）. Both groups were given thiamazole tablets. The treatment group was added with Xiehuo Xiaoying Decoction one dose every day. There were 4weeks as a course,and both groups were treated for 3 courses. Heart rate,body weight,and Chinese medicine syndrome score of patients in both groups were compared before and after treatment. Thyroid function [including thyroidstimulating hormone（ TSH）,free triiodothyronine（ FT3） and free thyroxine（ FT4） ]were tested before treatment and during the 1st,2nd and 3rd courses. Indexes recovery rates and average time of recovering to normal level were calculated. Level of thyrotrophin receptor antibody（ TRAb） was detected before and after treatment. Thiamazole tablets dosage was recorded in the 3 courses. Results Finally,61 patients,including 30 cases in the treatment group and31 cases in the control group,completed the study. As for slowing heart rate and reducing Chinese medicine syndrome score,the treatment group was superior to the control group（ P 〈0. 05 or P〈 0. 01）. Compared with those in the control group,the levels of FT3 and FT4 in the treatment group at the 1st and 2nd course were lower. The time for FT3 and FT4 recovering to normal,as well as the recovery rate at the 1st course in the treatment group was superior to those in the control group（ P〈 0. 05 or P 〈0. 01）. Thiamazole tablets dosage in the treatment group at the 1st,2nd and 3rd course were lower than those in the control group at the same time point（ P 〈0. 05 or P 〈0. 01）. After treatment,patients in both groups gained weight,and their level of TSH increased and the level of TRAb decreased（ P〈 0. 01）. There was no significant difference in indexes between the two groups after treatment（ P 〉0. 05）. Conclusion Xiehuo Xiaoying Decoction might reduce the dosage of Western medicine in treating Graves disease,and it might relieve the clinical symptoms and improve thyroid function quickly.