泻火消瘿方联合甲巯咪唑治疗Graves甲亢初治期心肝火旺证的远期疗效

Long-term Effects of Fire-purging Goiter-removing Prescription and Methimazole in Treating Graves Hyperthyroidism of Heart and Liver Fire Flaming Pattern at Initial Treatment Stage

目的:观察泻火消瘿方联合甲巯咪唑(methimazole,MMI)治疗Graves甲亢初治期心肝火旺证的远期疗效及安全性。方法:将Graves病初治期心肝火旺证患者80例按照随机数字表法分为对照组及治疗组各40例。对照组予MMI(赛治)每日10~30 mg控制症状,后逐渐减量至部分停药或小剂量维持至12个月。治疗组在对照组基础上加用泻火消瘿方,每日1剂,分2次口服,4周为1个疗程,连续治疗3个疗程。观察两组患者0、3、6、12月时甲状腺功能情况[包括血清游离三碘甲腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)、促甲状腺素(thyroid stimulating hormone,TSH)及促甲状腺素受体抗体(thyrotrophin receptor antibody,TRAb)]、甲状腺体积、甲状腺上动脉流速(peak systolic velocity,PSV)以及MMI剂量变化情况。结果:治疗后3、6、12个月治疗组FT3、FT4水平低于对照组,差异具有统计学意义(P<0.05),TSH无明显差异(P>0.05);治疗后3、6个月TRAb水平两组比较无明显差异(P>0.05),但治疗后12个月TRAb水平两组比较差异具有统计学意义(P<0.05)。治疗后12个月,治疗组甲状腺体积小于对照组,PSV低于对照组(P<0.05)。治疗3个月后,治疗组MMI剂量低于对照组,差异具有统计学意义(P<0.05);12个月时,两组MMI用药剂量无明显差异(P>0.05)。治疗组FT3、FT4达标时间均较对照组缩短,差异具有统计学意义(P<0.05)。不良反应事件两组比较差异无统计学意义(P>0.05)。结论:泻火消瘿方联合MMI可有效降低Graves甲亢初治期心肝火旺证患者甲状腺激素水平,有助于降低TRAb水平,缩短FT3、FT4恢复时间,缩小甲状腺体积,减少甲状腺局部血流,减少MMI用量,效果优于单纯MMI治疗。

Objective:To investigate long-term effects and its safety of fire-purging goiter-removing prescription and methimazole(MMI)in the treatment of Graves hyperthyroidism of heart and liver fire flaming pattern at initial treatment stage.Methods:Eighty patients were divided into the control group and the treatment group according to random number table method with 40 cases in each group.The control group was given MMI,10-30mg/d,to control the symptoms,and then gradually reduced to partial withdrawal or low-dose maintenance to 12 months.The treatment group took fire-purging goiter-removing prescription on the foundation of Western medicine,one dose each day,oral administration and taking twice.Four weeks of TCM was one course,treating for three consecutive courses.To observe thyroid function(FT3,FT4,TSH,TRAb),thyroid volume,thyroid PSV and the dosage of MMI of the patients in both groups at zero,three,six and twelve months.Results:After three,six and twelve months of the treatment,the levels of FT3 and FT4 of the treatment group were lower than these of the control group,and the difference had statistical meaning(P<0.05),while no significant difference could be found in TSH(P>0.05);after three and six months of treatment,no significant difference could be found in the levels of TRAb between both groups(P>0.05),while the difference had statistical meaning in the levels of TRAb after twelve months of treatment between both groups(P<0.05).After twelve months of treatment,thyroid volume of the treatment group was smaller than that of the control group,PSV lower than that of the control group(P<0.05).After three months of treatment,the dose of MMI of the treatment group were lower than these of the control group,and the difference had statistical meaning(P<0.05);after twelve months of treatment,no significant difference could be seen in the dose of MMI between both groups(P>0.05).The time of FT3 and FT4 reaching the standard of the treatment group were lower than these of the control group,and the difference had statistical meaning(P<0.05).The difference had no statistical meaning in the incidence of adverse reactions between both groups(P>0.05).Conclusion:Fire-purging goiter-removing prescription combined with MMIT could effectively lower the levels of thyroid hormone in the patients suffering Graves hyperthyroidism of heart and liver fire flaming pattern at initial treatment stage,help reduce the levels of TRAb,shorten the recovery time of FT3 and FT4,reduce thyroid volume,local blood flow and the dose of MMI,and its effects are superior to these of only MMI.