温肾健脾汤辅治甲状腺功能减退不孕的价值

Value of Wenshen Jianpi Decoction(温肾健脾汤)in Adjuvant Treatment of Hypothyroidism with Infertility

目的 观察温肾健脾汤加减联合左甲状腺素钠片治疗甲状腺功能减退不孕的临床疗效。方法 选取该院2020年6月—2021年6月因甲状腺功能减退致不孕患者60例,以抛硬币法随机分为干预组与对照组各30例,对照组患者口服左甲状腺素钠片联合枸橼酸氯米芬片治疗,干预组给予温肾健脾汤加减联合左甲状腺素钠片治疗,比较两组患者的疗效、甲状腺功能指标、白细胞介素-2(IL-2)、白细胞介素-17(IL-17)、肿瘤坏死因子-α(TNF-α)水平及不良反应情况。结果 干预组与对照组的治疗总有效率分别为90.00%(27/30)、70.00%(21/30),干预组高于对照组,但差异无统计学意义(P>0.05),干预组疗效等级优于对照组(P<0.05);治疗2周后,两组患者游离三碘甲状腺原氨酸(FT3)、游离甲状腺激素(FT4)、促甲状腺激素(TSH)等甲状腺功能指标均较前改善,且干预组改善幅度优于对照组(P<0.05);两组患者治疗后IL-2水平升高、IL-17与TNF-α水平降低(P<0.05),且干预组患者IL-2水平高于对照组,IL-17与TNF-α水平低于对照组(P<0.05)。结论 温肾健脾汤加减联合左甲状腺素钠片治疗甲状腺功能减退不孕症安全有效,可显著改善患者甲状腺功能,调节细胞免疫状态。

Objective To observe the clinical efficacy of Modified Wenshen Jianpi Decoction(温肾健脾汤)combined with levothyroxine tablets in the treatment of hypothyroidism with infertility.Methods Sixty patients with infertility caused by hypothyroidism in the hospital were selected between June 2020 and June 2021,and were randomly divided into intervention group and control group by coin tossing,with 30 cases in each group.The control group was treated with levothyroxine tablets combined with clomifene citrate capsules,and the intervention group was given Modified Wenshen Jianpi Decoction combined with levothyroxine tablets.The efficacy,thyroid function indicators,interleukin-2(IL-2),interleukin-17(IL-17),tumor necrosis factor-α(TNF-α)and adverse reactions were compared between the two groups.Results The total effective rate of treatment of 90.00%(27/30)in the intervention group was higher than 70.00%(21/30)in the control group(P>0.05),and the efficacy grading was better in the intervention group than that in the control group(P<0.05).After 2 weeks of treatment,the levels of thyroid function indicators such as free triodothyronine(FT3),free thyroid hormone(FT4)and thyroid stimulating hormone(TSH)were improved in the two groups compared with those before treatment,and the improvement degrees were better in the intervention group compared with those in the control group(P<0.05).After treatment,the IL-2 level was increased while the levels of IL-17 and TNF-αwere decreased(P<0.05),and the IL-2 level of the intervention group was higher than that of the control group while the levels of IL-17 and TNF-αwere lower than those of the control group(P<0.05).Conclusion Modified Wenshen Jianpi Decoction combined with levothyroxine tablets is safe and effective in the treatment of hypothyroidism with infertility.It can significantly improve the thyroid function and regulate the cellular immune status.