穴位贴敷治疗肝气郁滞型桥本甲状腺炎的疗效:随机对照试验

Acupoint application for Hashimoto's thyroiditis with liver-qi stagnation:a randomized controlled trial

目的:观察穴位贴敷治疗肝气郁滞型桥本甲状腺炎(HT)的临床疗效及安全性。方法:将150例肝气郁滞型HT患者随机分为贴敷组(75例,剔除11例、脱落5例)和安慰组(75例,剔除12例、脱落3例)。在健康宣教联合西医常规治疗基础上,贴敷组给予穴位贴敷治疗,安慰组给予安慰剂穴位贴敷治疗。两组均选取神阙,双侧涌泉、腋十和阿是穴,其中腋十每周1次,余穴隔日1次,共治疗4周。比较两组患者治疗前后血清甲状腺球蛋白抗体(TgAb)、甲状腺过氧化物酶抗体(TPOAb)、游离三碘甲状原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平,甲状腺左叶、右叶、峡部厚度,中医症状评分、医院焦虑抑郁量表(HADS)评分、健康调查简表(SF-36)评分,观察两组不良反应发生情况。结果:治疗后,贴敷组患者血清TgAb、TPOAb水平低于治疗前(P<0.05),SF-36生理职能(RP)、躯体疼痛(BP)、精力(VT)、情感职能(RE)、精神健康(MH)维度评分均较治疗前升高(P<0.01,P<0.001);两组患者甲状腺峡部厚度均小于治疗前(P<0.05),中医症状评分、HADS焦虑(HADS-A)评分较治疗前降低(P<0.001,P<0.01);安慰组患者SF-36生理机能(PF)、RP、BP、VT、RE各维度评分均较治疗前升高(P<0.05,P<0.01,P<0.001);两组患者血清FT3、FT4、TSH水平组内比较差异无统计学意义(P>0.05)。以上各项指标组间比较差异无统计学意义(P>0.05)。贴敷组和安慰组的不良事件发生率分别为20.0%(15/75)和10.7%(8/75),不良反应主要为皮肤过敏。结论:穴位贴敷可降低肝气郁滞型HT患者血清TgAb、TPOAb水平,缓解甲状腺肿大程度,改善中医症状、焦虑情绪,提高生活质量,临床疗效安全可靠。

Objective To observe the clinical efficacy and safety of acupoint application for Hashimoto's thyroiditis(HT)with liver-qi stagnation.Methods One hundred and fifty patients of HT with liver-qi stagnation were randomly divided into an acupoint application group(75 cases,11 cases were excluded,5 cases dropped out)and a control group(75 cases,12 cases excluded,3 cases dropped out).Based on the health education combined with conventional western medicine treatment,the patients in the acupoint application group were treated with acupoint application,while the patients in the control group were treated with placebo acupoint application.Shenque(CV 8),bilateral Yongquan(KI 1),Yeshi,and ashi point were selected in both groups,with Yeshi treated once a week and the remaining acupoints treated every other day,for a total of 4 weeks.The serum levels of thyroglobulin antibody(TgAb),thyroid peroxidase antibody(TPOAb),free triiodothyronine(FT3),free thyroxine(FT4),and thyroid-stimulating hormone(TSH),as well as the thickness of thyroid left lobe,right lobe,and isthmus,TCM symptom score,hospital anxiety and depression scale(HADS)score,and MOS 36-item short form health survey(SF-36)score were compared between the two groups before and after treatment.Adverse reactions in both groups were observed.Results Compared with before treatment,in the acupoint application group,the serum levels of TgAb and TPOAb were reduced after treatment(P<0.05),and the scores of role physical(RP),body pain(BP),vitality(VT),role emotional(RE),and mental health(MH)in SF-36 were increased after treatment(P<0.01,P<0.001).The thickness of the thyroid isthmus after treatment was smaller than that before treatment(P<0.05),and the TCM symptom scores and HADS anxiety(HADS-A)scores after treatment were lower than those before treatment(P<0.001,P<0.01)in both groups.In the control group,the scores of physical function(PF),RP,BP,VT,and RE in SF-36 after treatment were higher than those before treatment(P<0.05,P<0.01,P<0.001).There was no statistically significant difference in serum FT3,FT4,and TSH levels within the groups(P>0.05).There was no statistically significant difference in the above indexes between the two groups(P>0.05).The incidence of adverse reactions in the acupoint application group and the control group was 20.0%(15/75)and 10.7%(8/75)respectively,with skin allergy being the main adverse reaction.Conclusion Acupoint application could reduce the serum levels of TgAb and TPOAb in patients of HT with liver-qi stagnation,alleviate thyroid enlargement,improve TCM symptoms and anxiety,and improve quality of life,with safe and reliable clinical efficacy.