温阳疏肝化痰法治疗桥本甲减合并抑郁状态的临床研究

Clinical Study on Treatment of Hashimoto’s Thyroiditis Induced Hypothyroidism Complicated with Depressive Disorder by Therapy of Warming Yang,Soothing Liver and Resolving Phlegm

【目的】观察温阳疏肝化痰法中药联合左甲状腺素钠片治疗桥本甲状腺炎伴甲状腺功能减退(简称桥本甲减)合并抑郁状态的临床疗效。【方法】将60例阳虚肝郁痰浊型桥本甲减合并抑郁状态患者随机分为治疗组和对照组,每组各30例。对照组给予常规左甲状腺素钠片治疗,治疗组在常规左甲状腺素钠片治疗的基础上,给予加服温阳疏肝化痰法中药治疗,4周为1个疗程,连续治疗3个疗程。观察2组患者治疗前后血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、甲状腺球蛋白抗体(TGAb)和甲状腺过氧化物酶抗体(TPOAb)水平及汉密尔顿抑郁量表(HAMD)评分的变化情况,并评价2组患者的中医证候疗效和安全性。【结果】(1)治疗12周后,治疗组的总有效率为93.3%(28/30),对照组为46.7%(14/30),治疗组的中医证候疗效明显优于对照组,差异有统计学意义(P<0.05)。(2)治疗后,2组患者血清FT3、FT4、TSH及TGAb、TPOAb水平均较治疗前明显改善(P<0.05),且治疗组对血清FT3、FT4、TSH及TGAb、TPOAb水平的改善作用均明显优于对照组(P<0.05)。(3)治疗后,2组患者的HAMD评分较治疗前明显降低(P<0.05),且治疗组对HAMD评分的降低作用明显优于对照组(P<0.05)。(4)试验过程中,2组患者均未出现与治疗药物有关的过敏现象及其他严重不适症状,并且2组患者的血、尿、大便常规和肝、肾功能等安全性指标均无异常改变。【结论】温阳疏肝化痰法中药联合左甲状腺素钠片治疗阳虚肝郁痰浊型桥本甲减合并抑郁状态患者具有较好的疗效,其疗效优于单用左甲状腺素钠片治疗。

Objective To observe the clinical effect of the therapy of warming yang,soothing liver and resolving phlegm combined with Levothyroxine Sodium Tablets in the treatment of Hashimoto’s thyroiditis induced hypothyroidism(abbreviated as Hashimoto hypothyroidism)complicated with depressive disorder.Methods Sixty cases of Hashimoto hypothyroidism complicated with depressive disorder differentiated as the syndrome of yang deficiency with liver depression and phlegm turbidity were randomly divided into treatment group and control group,30 cases in each group.The control group was treated with Levothyroxine Sodium Tablets,while the treatment group was treated with Levothyroxine Sodium Tablets plus Chinese medicine decoction with the actions of warming yang,soothing liver and resolving phlegm.Four weeks constituted one course of treatment,and the treatment for the two groups lasted for 3 courses.Before and after treatment,the changes of serum levels of thyroid stimulating hormone(TSH),free triiodothyronine(FT3),free thyroxine(FT4),thyroglobulin antibody(TGAb),and thyroid peroxidase antibody(TPOAb)as well as the scores of Hamilton Depression Scale(HAMD)were observed in the two groups.After treatment,the efficacy for traditional Chinese medicine(TCM)syndrome and the clinical safety in the two groups were also evaluated.Results(1)After treatment for 12 weeks,the tota effective rate of the treatment group was 93.3%(28/30),and that of the control group was 46.7%(14/30).The efficacy for TCM syndrome in the treatment group was superior to than that in the control group(P<0.05).(2)After treatment,serum FT3,FT4 and TSH levels,and TGAb and TPOAb titers in the two groups were significantly improved(P<0.05 in comparison with those before treatment),and the improvement effect on serum FT3,FT4and TSH levels as well as TGAb and TPOAb titers in the treatment group was superior to than that in the control group(P<0.05).(3)After treatment,the HAMD scores in the two groups were significantly decreased(P<0.05 in comparison with those before treatment),and the decrease of HAMD scores in the treatment group was superior to than that in the control group(P<0.05).(4)During the trial,no allergic reaction or severe discomfort associated with the medicine was found in the two groups,no abnormal changes were found in the safety indicators of the routine test for blood,urine,stool or hepatic and renal function indexes of the two groups either.Conclusion Chinese medicine of warming yang,soothing liver and resolving phlegm combined with Levothyroxine Sodium Tablets exerts certain effect for the treatment of Hashimoto’s thyroiditis induced hypothyroidism(abbreviated as Hashimoto hypothyroidism)complicated with depressive disorder,and the combined therapy is more effective than Levothyroxine Sodium Tablets alone.