消瘿合剂加味方合消瘿散结膏内外兼治桥本甲状腺炎的临床观察

Clinical Efficacy of Supplemented Xiaoying Mixture Combined with Xiaoying Sanjie Ointment in Treating 37 cases of Hashimoto′s Thyroiditis

目的观察消瘿合剂加味方合消瘿散结膏内外兼治桥本甲状腺炎的临床疗效。方法选取2017年5月—2021年1月在上海中医药大学附属曙光医院中医外科、普外科就诊的桥本甲状腺炎患者150例,采用随机数字法将入组患者随机分为中药内外兼治组、中药内服组、西药内服组,每组各50例。治疗12周后,观察比较3组患者治疗后临床疗效及治疗前后甲状腺功能指标[血清游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、TPO-Ab、TgAb水平]、中医症状积分、B超下甲状腺峡部厚度、甲状腺上动脉收缩期峰值流速(Peak systolic velocity,PSV)、阻力指数(Resistance index,RI)。结果治疗后中药内外兼治组、中药内服组血清TPO-Ab、TgAb水平较治疗前明显降低,差异有统计学意义(P<0.05);且中药内外兼治组、中药内服组治疗后血清TPO-Ab、TgAb水平均明显低于西药内服组,差异有统计学意义(P<0.05);中药内外兼治组治疗后血清TPO-Ab、TgAb水平较中药内服组明显改善,差异有统计学意义(P<0.05)。治疗后中药内外兼治组、中药内服组患者中医症状积分较治疗前明显降低,差异有统计学意义(P<0.05);且中药内外兼治组、中药内服组较西药内服组明显改善,差异有统计学意义(P<0.01),中药内外兼治组中医症状积分改善较中药内服组明显改善,差异有统计学意义(P<0.05)。治疗后中药内外兼治组、中药内服组PSV、RI、甲状腺峡部厚度较治疗前明显降低,差异有统计学意义(P<0.05);且中药内外兼治组、中药内服组PSV、RI、甲状腺峡部厚度降低明显优于西药内服组,差异有统计学意义(P<0.05);中药内外兼治组PSV、RI降低明显优于中药内服组,差异有统计学意义(P<0.05)。治疗后中药内外兼治组总有效率为82.61%,中药内服组为77.08%、西药内服组为43.48%;中药内外兼治组、中药内服组明显优于西药内服组,差异有统计学意义(P<0.05);中药内外兼治组优于中药内服组,差异有统计学意义(P<0.05)。结论消瘿合剂加味方合消瘿散结膏内外兼治桥本甲状腺炎,能有效降低患者甲状腺抗体,改善中医临床症状并能改善患者甲状腺充血肿大。

Objective To observe the clinical efficacy of supplemented Xiaoying Mixture and Xiaoying Sanjie Ointment on Hashimoto′s thyroiditis.Methods A total of 150 patients with Hashimoto′s thyroiditis who were admitted to the Shuguang Hospital,Shanghai University of Traditional Chinese Medicine from May 2017 to January 2021 were randomly divided into the supplemented Xiaoying Mixture+Xiaoying Sanjie Ointment group,the oral Chinese medicine group,and oral western medicine group with the random number table method,50 in each group.After 12 weeks of treatment,the clinical efficacy,thyroid function indexes[serum free triiodothyronine(FT3),free thyroxine(FT4),thyroid-stimulating hormone(TSH),TPO-Ab,and TgAb],TCM symptom score,thyroid isthmus thickness,peak systolic velocity(PSV),and resistance index(RI)of the three groups were observed before and after treatment.Results The effective rates were 82.61%,77.08%,and 43.48%,respectively in the supplemented Xiaoying Mixture+Xiaoying Sanjie Ointment group,the oral Chinese medicine group,and the oral western medicine group,and the effect in the former two groups was better than that in the oral western medicine group(P<0.05).Moreover,the effect in the supplemented Xiaoying Mixture+Xiaoying Sanjie Ointment group was better than that in the oral Chinese medicine group.After treatment,the serum levels of TPO-Ab and TgAb in the supplemented Xiaoying Mixture+Xiaoying Sanjie Ointment group and the oral Chinese medicine group were lower than those before treatment(P<0.05)and in the oral western medicine group(P<0.05),and the levels of the two indexes were lower in the supplemented Xiaoying Mixture+Xiaoying Sanjie Ointment group than in the oral Chinese medicine group(P<0.05).After treatment,the TCM symptom scores in the supplemented Xiaoying Mixture+Xiaoying Sanjie Ointment group and oral Chinese medicine group were lower than those before treatment(P<0.05)and that in the western medicine group(P<0.01),and the score in the supplemented Xiaoying Mixture+Xiaoying Sanjie Ointment group was lower than that in the oral Chinese medicine group(P<0.05).After treatment,the PSV,RI,and thyroid isthmus thickness in the supplemented Xiaoying Mixture+Xiaoying Sanjie Ointment group and the oral Chinese medicine group were lower than those before treatment(P<0.05)and in the oral western medicine group(P<0.05),and PSV and RI were lower in the supplemented Xiaoying Mixture+Xiaoying Sanjie Ointment group than in the oral Chinese medicine group(P<0.05).Conclusion The combination of supplemented Xiaoying Mixture with Xiaoying Sanjie Ointment can effectively reduce the thyroid antibody and improve the TCM symptoms and thyroid hyperemia and swelling in the treatment of Hashimoto′s Thyroiditis.