疏肝散结消瘿汤联合穴位埋线治疗肝郁脾虚型桥本甲状腺炎甲减伴甲状腺肿疗效观察

Efficacy of Shugan Sanjie Xiaoying Decoction combined with acupoint catgut embedding on Hashimoto’s hypothyroidism with goiter of type of liver stangation and spleen deficiency

目的探讨疏肝散结消瘿汤联合穴位埋线治疗肝郁脾虚型桥本甲状腺炎(HT)甲状腺功能减退(甲减)伴甲状腺肿的疗效。方法选择2018年1月—2019年12月在上海市嘉定区中医医院就诊的HT甲减伴甲状腺肿患者140例,随机分为4组,每组35例。4组均予左甲状腺素钠治疗,在此基础上治疗组给予疏肝散结消瘿汤联合穴位埋线治疗,对照1组给予疏肝散结消瘿汤治疗,对照2组给予穴位埋线治疗,对照3组给予西维尔治疗。观察4组治疗12周后中医综合疗效;对比4组治疗前及治疗12周后的甲状腺激素水平、抗体滴度水平、T淋巴细胞亚群水平、甲状腺大小和治疗12周后的左甲状腺素钠用量。结果治疗后,治疗组中医症状改善总有效率显著高于其他3组(P均<0.05),对照1组显著高于对照2组、对照3组(P均<0.05);治疗后,4组甲状腺球蛋白抗体(TG-Ab)、甲状腺过氧化物酶抗体(TPO-Ab)水平均较治疗前显著下降(P均<0.05),治疗组显著低于其他3组(P均<0.05),对照1组、对照3组显著低于对照2组(P均<0.05)。治疗后,4组外周血CD3+T淋巴细胞计数显著升高(P均<0.05),CD4+T淋巴细胞计数和CD4+/CD8+比值显著降低(P均<0.05),治疗组以上指标变化幅度显著大于其他3组(P均<0.05),对照1组和对照2组变化幅度显著大于对照3组(P均<0.05);治疗后,4组甲状腺左叶、右叶及峡部厚度显著低于治疗前(P均<0.05),治疗组变化幅度显著大于其他3组(P均<0.05),对照1组、对照2组变化幅度显著大于对照3组(P均<0.05);治疗组的左甲状腺素钠用量显著少于其他3组(P均<0.05),对照1组显著少于其他2组(P均<0.05)。结论疏肝散结消瘿汤联合穴位埋线治疗肝郁脾虚型HT甲减患者的效果优于单纯中药组或西药组或穴位埋线,能有效改善甲状腺功能,降低抗体滴度水平,调节机体免疫功能,缩小甲状腺肿。

Objective It is to explore the curative effect of Shugan SanjieXiaoying Decoction combined with acupoint catgut embedding on Hashimoto’s hypothyroidism(HT)with goiter of type of liver stangation and spleen deficiency.Methods A total of 140 patients with HT with goiter of type of liver stangation and spleen deficiency treated in Jiading District Hospital of Traditional Chinese Medicine from January 2018 to December 2019 were selected and randomly divided into 4 groups,35 cases in each group.All the groups were given levothyroxine sodium to control thyroid function,additionally,the treatment group was treated with Shugan Sanjie Xiaoying Decoction combined with acupoint embedding therapy,the control groupⅠwas treated with Shugan Sanjie Xiaoying Decoction,the control groupⅡwas treated with acupoint embedding therapy,the control groupⅢwas treated with selenious yeast tablets.The total scores of TCM symptoms before treatment and after 12 weeks of treatment were observed in the 4 groups to evaluate the comprehensive curative effect;the levels of thyroid hormone,antibody titer,T lymphocyte subgroups,thyroid thickness and size before treatment and after 12 weeks of treatment,and levothyroxine sodium dosage after 12 weeks of treatment were compared among the 4 groups.Results After treatment,the total effective rate of the treatment group in improving TCM symptoms was significantly higher than that of the other 3 groups(P<0.05),that of the control groupⅠwas significantly higher than those of the control groupⅡand control groupⅢ(P<0.05).After treatment,the levels of thyroglobulin antibody(TG-Ab)and thyroid peroxidase antibody(TPO-Ab)of the 4 groups were significantly lower than those before treatment(P<0.05),and the levels in the treatment group was more significant than those of the other 3 groups(P<0.05),those of control groupⅠand control groupⅢwas more significant than that of control groupⅡ(P<0.05).After treatment,the peripheral blood CD3+T lymphocyte counts of the 4 groups was significantly increased(P<0.05),and CD4+T lymphocyte counts and CD4+/CD8+T lymphocyte ratio were significantly lower than before treatment,the increase of the treatment group was more significant than those of the other 3 groups(P<0.05),that of the control groupⅠand control groupⅡwere more significant than those of control groupⅢ(P<0.05).After treatment,the thickness of the right and left lobe and the isthmus of thyroid of the 4 groups was significantly decreased(P<0.05),the decrease in the treatment group was more significant than those of the other 3 groups(P<0.05),the decrease of the control group I and control groupⅡwas more significant than that of the control groupⅢ(P<0.05).The dosage of levothyroxine sodium used in the treatment group was significantly lower than that of the other 3 groups(P<0.05),and the control groupⅠwas significantly lower than the other two groups(P<0.05).Conclusion Shugan Sanjie Xiaoying Decoction combined with acupoint embedding therapy could shrink the goiter,effectively improve thyroid function,reduce levels of antibody titer,and regulate the body's immune function in the treatment of HT with goiter of type of liver stangation and spleen deficiency,its curative effect is better than simple Chinese medicine or western medicine and acupoint embedding.