疏肝解郁、软坚散结法治疗甲状腺良性结节患者临床研究

The efficacy of soothing liver and resolving stagnation and softening firmness and dispersing stagnation method on benign thyroid nodules

目的观察彩色多普勒超声评价疏肝解郁、软坚散结法对甲状腺良性结节(肝郁痰凝血瘀型)患者临床疗效。方法将我院111例甲状腺良性结节(肝郁痰凝血瘀型)患者随机分为对照组56例与实验组55例。对照组予贴敷药剂治疗,实验组予疏肝消瘿方、贴敷药剂联合治疗。比较两组患者临床疗效、各项中医症候评分、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、胰岛素样生长因子β-1(IGF-1)、转化生长因子β-1(TGF-β1)水平,甲状腺结节最大直径、峡部厚度。结果治疗后,实验组总有效率显著高于对照组(P<0.05);两组各项中医症候评分较治疗前均减少,实验组各项中医症候评分均少于对照组(P<0.05);两组FT3、FT4、TSH水平较治疗前差异无统计学意义(P>0.05),IGF-1水平较治疗前减少,TGF-β1水平较治疗前增加,实验组IGF-1水平低于对照组,TGF-β1水平高于对照组(P<0.05);两组最大直径、峡部厚度较治疗前均减少,实验组最大直径、峡部厚度均低于对照组(P<0.05)。结论疏肝解郁、软坚散结法可提高对甲状腺良性结节(肝郁痰凝血瘀型)患者的疗效,显著改善中医症候,下调IGF-1及TGF-β1水平,缩小结节,且不影响甲状腺功能。彩色多普勒超声对疏肝解郁、软坚散结法治疗甲状腺良性结节(肝郁痰凝血瘀型)疗效评价具有重要价值。

Objective To observe the clinical efficacy of soothing liver and resolving stagnation and softening firmness and dispersing stagnation method by color Doppler ultrasound in patients with benign thyroid nodules(liver stagnation and phlegm coagulation and blood stasis type).Methods A total of 111 patients with benign thyroid nodules(liver stagnation and phlegm blood stasis type)were randomly divided into control group of 56 cases and experimental group of 55 cases.Control group was treated with sticking drugs,while experimental group was treated with Shugan Xiaoying Decoctionm and sticking drugs.The clinical efficacy,TCM symptom scores,free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH)and insulin-like growth factor-1(IGF-β1)Transforming growth factor-1(TGF-β1)levels,maximum diameter of thyroid nodules,thickness of isthmus were compared between the two groups.Results After treatment,the total effective rate of experimental group was significantly higher than that of control group(P<0.05);the scores of various TCM symptoms were decreased in both groups compared with those before treatment,and the scores of various TCM symptoms in experimental group were lower than those in control group(P<0.05);there was no significant difference in the levels of FT3,FT4 and TSH between the two groups compared with those before treatment(>0.05),the level of IGF-β1 was decreased,and were lower in observation group than control group(P<0.05),the level of TGF-β1 was increased,and was higher in observation group than control group(P<0.05);the maximum diameter and isthmus thickness were decreased in both groups,and were lower in experimental group than control group(P<0.05).Conclusion Soothing liver and resolving stagnation and softening firmness and dispersing stagnation method can improve the curative effect of patients with benign thyroid nodules(liver stagnation and phlegm coagulation and blood stasis type),significantly improve TCM symptoms,down-regulate the levels of IGF-β1 and TGF-β1,reduce the nodules,reduce the incidence of thyroid nodules,and dosen’t affect thyroid function.Color Doppler ultrasonography is of great value in evaluating the efficacy of soothing liver and resolving stagnation and softening firmness and dispersing stagnation method in treatment of benign thyroid nodules(liver stagnation and phlegm coagulation and blood stasis type).