桥本氏病伴发甲状腺结节临床特征和中医证候分布

Clinical Features and Traditional Chinese Medicine Syndrome Types of Hashimoto's Disease with Thyroid Nodules

目的分析桥本氏病伴发甲状腺结节的临床特征及相关影响因素和中医证候分布,为早期防治桥本氏病伴发甲状腺结节提供参考。方法将175例桥本氏病患者分为桥本氏病伴发甲状腺结节组(109例)与非结节组(66例),比较两组的一般情况、甲状腺功能、抗甲状腺抗体、甲状腺超声的差异,分析桥本氏病伴发甲状腺结节的中医证候特点,采用Logistic回归分析探索桥本氏病伴发甲状腺结节的相关影响因素。结果结节组病程长于非结节组,曾使用过中药治疗的比例少于非结节组,差异均有统计学意义(P<0.05)。与非结节组比较,伴发结节组的游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)水平更低,甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)水平更高,差异均有统计学意义(P<0.05)。桥本氏病伴发结节患者的中医证候类型为脾虚痰凝证、阴虚火炽证、气阴两虚证、肝郁痰凝证、痰瘀互结证、脾肾阳虚证,以脾虚痰凝证多见。FT3、TPOAb是桥本氏病伴发甲状腺结节的相关影响因素(P<0.05)。受试者工作特征曲线显示,FT3<3.735 pg/mL、TPOAb>147.1 IU/mL对于早期预警桥本氏病伴发甲状腺结节可能具有一定的参考价值。结论FT3、TPOAb可作为桥本氏病伴发甲状腺结节的早期预警因素;在中医辨证论治的基础上予扶正化痰消瘿散结法治疗可作为当前的治疗策略之一。

Objective To investigate the clinical features,related influencing factors,and traditional Chinese medicine(TCM)syndrome types of Hashimoto's disease with thyroid nodules,and to provide a reference for early prevention and treatment of Hashimoto's disease with thyroid nodules.Methods A total of 175 patients with Hashimoto's disease were divided into thyroid nodule group with 109 patients and non-thyroid nodule group with 66 patients,and the two groups were compared in terms of general status,thyroid function,antithyroid antibody,and thyroid ultrasound findings.The TCM syndrome features of Hashimoto's disease with thyroid nodules were analyzed,and a logistic regression analysis was used to investigate the influencing factors for Hashimoto's disease with thyroid nodules.Results Compared with the non-thyroid nodule group,the thyroid nodule group had a significantly longer course of disease and a significantly lower proportion of patients receiving TCM therapy(P<0.05).Compared with the non-thyroid nodule group,the thyroid nodule group had significantly lower levels of free triiodothyronine(FT3)and free thyroxine and a significantly higher level of thyroid peroxidase antibody(TPOAb)(P<0.05).The patients with Hashimoto's disease and thyroid nodules had the TCM syndrome types of spleen deficiency and phlegm coagulation,Yin deficiency and exuberance of fire,deficiency of both Qi and Yin,stagnation of liver Qi and phlegm coagulation,intermingled phlegm and blood stasis,and spleen-kidney Yang deficiency,among which spleen deficiency and phlegm coagulation was the most common syndrome type.FT3 and TPOAb were the influencing factors for Hashimoto's disease with thyroid nodules(P<0.05).The receiver operating characteristic curve analysis showed that FT3<3.735 pg/mL and TPOAb>147.1 IU/mL had a certain reference value in the early warning of Hashimoto's disease with thyroid nodules.Conclusion FT3 and TPOAb can be used as early warning factors for Hashimoto's disease with thyroid nodules,and on the basis of TCM syndrome differentiation-based treatment,the vital Qi-strengthening,phlegm-eliminating,goiter-dispersing,and static blood-resolving therapy may be one of the treatment strategies.