参芪温元汤联合优甲乐对脾肾阳虚型甲减患者甲状腺激素及生活质量的影响

Shenqi Wenyuan Tang Combined with Youjiale Has Effect on Thyroid Hormone and the Quality of Life of Patients with Hypothyroidism of Spleen-kidney Yang Deficiency Type

目的:探讨参芪温元汤联合小剂量优甲乐对脾肾阳虚型甲减患者甲状腺激素及生活质量的影响。方法:选取脾肾阳虚型甲减患者96例,随机分为观察组与对照组,各48例。对照组予以优甲乐治疗,观察组予以参芪温元汤联合小剂量优甲乐治疗。比较治疗前后2组血清甲状腺激素水平、生活质量(QOL)维度评分、中医临床证候积分,比较临床疗效及不良反应情况。结果:观察组总有效率为95.56%,显著高于对照组7 9.55%,差异有统计学意义(P<0.0 5)。治疗前,2组促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)、总甲状腺素(TT_4)、甲状腺过氧化酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)水平,QOL的8个维度项目评分,中医临床证候积分比较,差异均无统计学意义(P>0.0 5)。治疗3个疗程后,2组TSH、TGAb、肌体疼痛(BP)值、中医临床证候积分均降低,FT_3、FT_4、TT_4水平均升高,QOL其余维度项目评分均不同程度的升高;观察组TPOAb水平降低;差异均有统计学意义(P<0.0 5,P<0.0 1)。治疗后,观察组TSH、TGAb、TPOAb、BP值、中医临床证候积分均低于对照组,FT_3、FT_4、TT_4水平均高于对照组,QOL其余各维度项目评分均高于对照组,差异均有统计学意义(P<0.0 5)。治疗后,对照组与观察组不良反应发生率分别为9.0 9%、11.11%,差异无统计学意义(χ~2=0.0 6,P>0.0 5)。结论:参芪温元汤联合小剂量优甲乐治疗脾肾阳虚型甲减具有较好的临床疗效,改善了患者的临床症状和血清甲状腺激素水平,提高了生活质量,且具有较高的安全性,优于单纯优甲乐治疗的临床效果。

Objective：To discuss the effect of Shenqi Wenyuan tang combined with low-dose Youjiale on thyroid hormone and the quality of life of patients with hypothyroidism of spleen-kidney yang deficiency type. Methods： Selected 96 cases of patients with hypothyroidism of spleen-kidney yang deficiency type,and divided them into the observation group and the control group randomly,48 cases in each group. The control group was given Youjiale,while the observation group was given Shenqi Wenyuan tang combined with low-dose Youjiale. Compared the levels of thyroid hormone in serum,dimensional scores of quality of life（QOF） and clinical syndrome scores in Chinese medicine of both groups before and after treatment, and compared the clinical effect and occurrence of adverse reactions. Results：The total effective rate was 95.56% in the observation group,significantly higher than 79.55% in the control group,difference being significant（P〈0.05）. Before treatment, comparing the levels of thyroid stimulating hormone（TSH）, free triiodothyronine（FT3）, free tetraiodothyronine（FT4）, total thyroxine（TT4）, thyroid peroxidase antibody（TPOAb） and thyroglobulin antibody（TGAb）, scores of QOL in 8 dimensions and clinical syndrome scores in Chinese medicine of both groups, there were no significant differences being found（P〈0.05）. After 3 courses of treatment,the levels of TSH and TGAb,values of bodily pain（BP）and clinical syndrome scores in Chinese medicine in both groups were all decreased,the levels of FT3,FT4 and TT4 were all increased,and scores of QOL in other dimensions were increased to different extent;the level of TPOAb in the observation group was decreased;there were significant differences being found（P〈0.05,P〈0.01）. After treatment,the levels of TSH,TGAb and TPOAb,values of BP and clinical syndrome scores in Chinese medicine of the observation group were all lower than those in the control group,the levels of FT3,FT4 and TT4 were all higher then those in the control group,and scores of QOL in other dimensions were all higher than those in the control group, differences being significant（P〈0.05）. After treatment, the incidence of adverse reactions was 9.09% in the control group and 11.11% in the observation group respectively, difference being insignificant（ χ^2 = 0.06, P〉0.05）. Conclusion：Shenqi Wenyuan tang combined with low-dose Youjiale for patients with hypothyroidism of spleen-kidney yang deficiency type has good clinical effect. With relatively high safety,it can improve the clinical symptoms and the level of thyroid hormone in serum of patients and promote the quality of life,which has better clinical effect than the simple application of Youjiale.