柴葛解肌汤加减联合西药治疗亚急性甲状腺炎的疗效研究

Efficacy of Modified Chaige Jieji Decoction Combined with Western Medicine in the Treatment of Acute Phase of Subacute Thyroiditis

目的观察柴葛解肌汤加减联合西药治疗亚急性甲状腺炎(SAT)的疗效及对复发的预防效果。方法将82例急性期SAT患者按随机数字表法分为对照组与观察组各41例。对照组给予西药治疗,观察组在此基础上口服柴葛解肌汤加减方治疗,疗程均为2周。比较两组临床症状改善时间、临床疗效及不良反应,治疗前后检测甲状腺功能指标[促甲状腺激素(TSH)、游离三碘甲状原氨酸(FT3)、游离甲状腺素(FT4)]、氧化应激指标[超氧化物歧化酶(SOD)、总抗氧化能力(TAOC)和丙二醛(MDA)]、炎症指标[超敏C反应蛋白(hs-CRP)、白介细胞素-6(IL-6)和肿瘤坏死因子-α(TNF-α)]和血沉(ESR)水平变化。结果观察组与对照组总有效率相当(P>0.05),但观察组的临床控制率46.34%,高于对照组的21.95%(P<0.05);观察组中医证候疗效总有效率100.00%,高于对照组的90.24%(P<0.05)。两组治疗1周与2周后临床证候评分均显著下降,且观察组的评分下降程度均明显低于对照组(P<0.05),且观察组的退热时间、疼痛消失时间、肿胀消失时间及ESR复常时间均明显缩短(P<0.05)。治疗2周后,观察组的TSH、SOD和TAOC水平升高优于对照组,而FT3、FT4、ESR、MDA、hs-CRP、IL-6和TNF-α的降低较对照组更显著(P<0.05)。两组的药物不良反应差异无统计学意义(P>0.05),观察组6个月复发率2.44%,显著低于对照组的17.07%(P<0.05)。结论柴葛解肌汤加减联合西药治疗SAT疗效确切,可促进症状缓解,改善甲状腺功能状态,抑制炎症和氧化应激反应,并降低复发率。

Objective:To observe the curative effect of modified Chaige Jieji Decoction combined with western medicine in the treatment of subacute thyroiditis(SAT)in the acute phase and its preventive effect on recurrence.Methods:A total of 82 patients with acute phase SAT were randomly divided into the control group(n=41)and observation group(n=41).Western medicine was used in the control group,while modified Chaige Jieji Decoction was used in the observation group on the basis of western medicine treatment;the course of treatment was 2weeks.The clinical symptoms improvement time,clinical efficacy and adverse reactions were compared between the two groups.Thyroid function indexes[thyroid stimulating hormone(TSH),free triiodothyronine(FT3),free thyroxine(FT4)],oxidative stress indicators[superoxide dismutase(SOD),total antioxidant capacity(TAOC)and malondialdehyde(MDA)],inflammation indicators[hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6)and tumor necrosis factor alpha(TNF-α)]and erythrocyte sedimentation rate(ESR)levels were measured before and after treatment.Results:There was no significant difference in the total effective rate of disease between the observation group and the control group(P>0.05),but the clinical control rate of disease in the observation group was significantly higher than that of the control group(P<0.05).The total effective rate of traditional Chinese medical syndrome curative effect in the observation group was significantly higher than that in the control group(P<0.05).The clinical syndrome scores of the two groups were significantly decreased after 1 week and 2 weeks of treatment,and the decline in the observation group was significantly better than that in the control group(P<0.05).Compared with the control group,the antipyretic time,pain disappearance time,swelling disappearancetime and ESR return to normal time in observation group were significantly shortened(P<0.05).After 2 weeks oftreatment,the levels of TSH,SOD and TAOC in the observation group increased better than those in the controlgroup,while the decreases in FT3,FT4,ESR,MDA,hs-CRP,IL-6 and TNF-αwere more significant than those inthe control group(P<0.05).There was no significant difference in adverse drug reactions between the two groups(P>0.05).The recurrence rate of the observation group was 2.44%during the 6-month follow-up period,whichwas significantly lower than 17.07%in the control group(P<0.05).Conclusion:Modified Chaige Jieji Decoction combined with western medicine has a definite effect in the treatment of acute phase of SAT,which can promotethe alleviation of symptoms,improve the state of thyroid function,inhibit inflammation and oxidative stress,and re-duce the recurrence rate.