柴银亚甲方治疗热毒壅盛型亚急性甲状腺炎患者的临床观察

Therapeutic Effect of Chaiyin Yajia Prescription on Subacute Thyroiditis in the Patients with Excessive Accumulation of Heat Toxin

目的探讨柴银亚甲方治疗热毒壅盛型亚急性甲状腺炎(Subacute thyroiditis,SAT)的临床价值。方法选取2021年1月—2021年12月期间唐山市中医医院收治的80例SAT患者开展研究,采用随机数字表法分为对照组和试验组,每组各40例。两组患者均给予一般治疗,在此基础上,对照组给予常规西医治疗,试验组给予常规西医联合柴银亚甲方治疗,两组患者均治疗4周。观察比较两组患者临床疗效、不良反应发生率、复发率,治疗前后中医主要症状积分、红细胞沉降率(Erythrocyte sedimentation rate,ESR)、血清甲状腺激素[游离三碘甲状腺原氨酸(Free triiodothyronine,FT3)、游离甲状腺素(Free thyroxine,FT4)、促甲状腺激素(Thyroid stimulating hormone,TSH)]、炎症因子[肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白细胞介素-2(Interleukin-2,IL-2)、白细胞介素-3(Interleukin-3,IL-3)]、补体C(C3、C4)、免疫球蛋白(IgA、IgM、IgG)水平。结果(1)临床疗效:治疗后试验组临床疗效总有效率95.00%(38/40)与对照组89.74%(35/39)比较,差异无统计学意义(P>0.05);但对照组愈显率85.00%(34/40)高于对照组66.67%(26/39),差异有统计学意义(P<0.05)。(2)中医主要症状积分:治疗后,两组患者中医主要症状颈前肿大、疼痛、发热、乏力、急躁易怒、多汗、心悸积分均较治疗前降低,差异有统计学意义(P<0.05);且试验组低于对照组,差异有统计学意义(P<0.05)。(3)ESR及甲状腺激素水平:治疗后,两组患者血清ESR、FT3、FT4水平较治疗前降低,TSH水平较治疗前升高,差异有统计学意义(P<0.05);且试验组血清ESR、FT3、FT4水平低于对照组,TSH水平高于对照组,差异有统计学意义(P<0.05)。(4)炎症因子:治疗后,两组患者血清TNF-α较治疗前降低,IL-2、IL-3水平较治疗前升高,差异有统计学意义(P<0.05);且试验组血清TNF-α低于对照组,IL-2、IL-3水平高于对照组,差异有统计学意义(P<0.05)。(5)补体C及Ig水平:治疗后,两组患者血清C3、C4及IgA、IgM、IgG水平均较治疗前降低,差异有统计学意义(P<0.05);且试验组低于对照组,差异有统计学意义(P<0.05)。(6)安全性:仅对照组发生1例轻度恶心反酸症状,未给予特殊干预自行缓解。(7)复发率:对照组复发率为10.26%,试验组无复发病例,差异有统计学意义(P<0.05)。结论柴银亚甲方治疗SAT效果显著、安全性高,有利于纠正ESR及血清甲状腺激素紊乱,且可降低疾病复发风险,可能与抑制炎症反应、调节免疫功能等机制有关。

Objective To investigate the clinical value of Chaiyin Yajia Prescription in the treatment of subacute thyroiditis(SAT)in the patients with excessive accumulation of heat toxin.Method Eighty patients with SAT treated in the Tangshan Hospital of Traditional Chinese Medicine from January to December in 2021 were assigned by the random number table method into a control group and a test group,with 40 patients in each group.Both groups received general treatment.On this basis,the control group received conventional Western medicine,and the test group received conventional Western medicine combined with Chaiyin Yajia Prescription.Both groups were treated for 4 weeks.The clinical efficacy,incidence of adverse reactions,and recurrence rate were compared between the two groups.The scores of main TCM symptoms,erythrocyte sedimentation rate(ESR),serum levels of thyroid hormones[free triiodothyronine(FT3),free thyroxine(FT4),and thyroid-stimulating hormone(TSH)],inflammatory cytokines[tumor necrosis factor-alpha(TNF-α),interleukin-2(IL-2),and interleukin-3(IL-3)],complement C(C3,C4),and immunoglobulins(IgA,IgM,and IgG)were determined before and after treatment.Results(1)Clinical efficacy:The total response rate in the test group was 95.0%(38/40),which had no significant difference compared with that(89.74%,35/39)in the control group(P>0.05).The cure rate in the test group was 85.0%(34/40),which was higher than that(66.67%,26/39)in the control group(P<0.05).(2)TCM symptom score:After treatment,the scores of anterior cervical swelling,pain,fever,fatigue,irritability,hyperhidrosis,and palpitation in the two groups declined compared with those before treatment,and the test group had lower scores than the control group(P<0.05).(3)ESR and thyroid hormone levels:The treatment in both groups decreased ESR,lowered the serum levels of FT3 and FT4,and elevated the serum level of TSH,and the test group had lower ESR,FT3,and FT4 and higher TSH than the control group after treatment(P<0.05).(4)Inflammatory cytokines:The treatment lowered the TNF-αlevel and elevated the IL-2 and IL-3 levels,and the test group was superior to the control group(P<0.05).(5)Complement C and Ig levels:After treatment,the levels of serum complement C3,C4,IgA,IgM,and IgG in the two groups were lower than those before treatment,and the levels in the test group were lower than those in the control group(P<0.05).(6)Safety:Only 1 case of mild nausea and acid reflux occurred in the control group,which subsided with no special intervention.(7)Recurrence rate:The recurrence rate in the control group was 10.26%,which was different from that(0)in the test group(P<0.05).Conclusion Chaiyin Yajia Prescription has definite effect and high safety in the treatment of SAT.It can recover ESR and serum levels of thyroid hormones and reduce the risk of disease recurrence,which may be related to the inhibition of inflammation and the regulation of immune functions.