加味小柴胡汤对甲状腺癌术后气郁痰阻证患者的临床效果观察

Observation on the clinical effect of supplemented Xiaochaihu Decoction on patients with Qi-stagnation phlegm-obstruction syndrome after thyroid cancer operation

目的探讨加味小柴胡汤对甲状腺癌术后气郁痰阻证患者的临床效果。方法以我院2021年1月至2023年5月收治的70例甲状腺癌术后气郁痰阻证患者为研究对象,按照不同治疗方案分为常规组、实验组,两组各35例。常规组采用常规药物左甲状腺素钠片治疗,实验组在常规组基础上增加加味小柴胡汤治疗。比较两组治疗后临床疗效、治疗前后中医证候积分变化、相关评分[焦虑自评量表(SAS)、卡氏功能状态评分(KPS)、抑郁自评量表(SDS)]水平、甲状腺功能指标[促甲状腺激素(TSH)、三碘甲状腺原氨酸(FT3)、抗甲状腺球蛋白抗体(TgAb)、甲状腺球蛋白(Tg)、四碘甲状腺原氨酸(FT4)]水平、免疫功能指标[T淋巴细胞(CD4^(+)、CD3^(+)、CD8^(+))、CD4^(+)/CD8^(+)]水平。结果治疗后实验组临床总有效率为97.14%,高于常规组的82.86%,差异有统计学意义(P<0.05);治疗后两组颈部不适、失眠多梦、口干苦、情绪不稳、胸胁胀痛等中医证候积分均明显下降,其中实验组下降幅度更为显著,差异有统计学意义(P<0.05);治疗后实验组KPS评分高于常规组,SAS及SDS评分低于常规组,差异有统计学意义(P<0.05);治疗后实验组TgAb水平高于常规组,TSH、Tg、FT3及FT4水平低于常规组,差异有统计学意义(P<0.05);与常规组相比,治疗后实验组CD4^(+)/CD8^(+)、CD4^(+)、CD3^(+)较高,CD8^(+)较低,差异有统计学意义(P<0.05)。结论加味小柴胡汤对甲状腺癌术后气郁痰阻证患者疗效显著,可改善患者术后临床症状,缓解不良情绪,增强甲状腺功能及免疫功能,促进病情恢复。

Objective To investigate the clinical effect of supplemented Xiaochaihu decoction on patients with Qi-stagnation and phlegm-obstruction syndrome after thyroid cancer surgery.Methods 70 patients with Qi-stagnation syndrome of thyroid cancer treated in our hospital from January 2021 to May 2023 were selected as the study objects,and were divided into conventional group and experimental group according to different treatment plans,with 35 cases in each group.The conventional group was treated with levothyroxine sodium tablets,and the experimental group was treated with supplemented Xiaochaihu decoction on the basis of the conventional group.The clinical efficacy,changes of TCM syndrome scores before and after treatment,levels of relevant scores(SAS,KPS,SDS),thyroid function indicators(TSH,FT3,TgAb),thyroglobulin(Tg),tetraiodothyronine(FT4)levels,immune function indicators[T lymphocytes(CD4^(+),CD3^(+),CD8^(+)),CD4^(+)/CD8^(+)]levels were compared between the two groups after treatment.Results After treatment,the total effective rate of the experimental group was 97.14%,higher than that of the conventional group(82.86%),the difference was statistically significant(P<0.05).After treatment,the scores of TCM syndrome such as neck discomfort,insomnia and dreaminess,dry mouth,emotional instability,chest and hypochondriac pain all decreased significantly in the two groups,and the decrease was more significant in the experimental group,with statistical significance(P<0.05).After treatment,the KPS score of the experimental group was higher than that of the conventional group,and the SAS and SDS scores were lower than that of the conventional group,with statistical significance(P<0.05).After treatment,the TgAb level of the experimental group was higher than that of the conventional group,while the TSH,Tg,FT3 and FT4 levels of the experimental group were lower than that of the conventional group,with statistical significance(P<0.05).Compared with the conventional group,CD4^(+)/CD8^(+),CD4^(+),CD3^(+)were higher in the experimental group after treatment,and CD8^(+)was lower,with statistical significance(P<0.05).Conclusion Supplemented Xiaochaihu Decoction has significant effect on patients with Qi-stagnation phlegm obstruction after thyroid cancer surgery,which can improve the clinical symptoms,relieve the adverse mood,enhance the thyroid function and immune function,and promote the recovery of the disease.