清热化痰散结方联合糖皮质激素对亚急性甲状腺炎患者的疗效研究

Therapeutic effect of Qingre Huatan Sanjie Formula combined with glucocorticoids for patients with subacute thyroiditis

目的观察清热化痰散结方联合糖皮质激素治疗亚急性甲状腺炎(SAT)患者的临床疗效及对相关炎症因子的影响。方法选取2021年6月1日至2023年5月31日广东省第二人民医院就诊的100例SAT患者为研究对象,按照不同治疗方法分为两组。对照组50例,男23例,女27例,年龄32~73(39.36±3.12)岁,单纯口服醋酸泼尼松片,首次治疗前2周药物用量为每次10 mg,每日3次,2周后根据病情好转情况,将用药量改为每次10 mg,每日2次,之后每周用药量减少5 mg至停药。观察组50例,男18例,女32例,年龄34~69(41.57±3.23)岁;口服醋酸泼尼松片的基础上加用清热化痰散结方内服外敷,清热化痰散结方每日1剂,水煎取汁200 ml,早晚分2次口服;清热化痰散结方打成粉末用蜂蜜调制成糊状,外敷于颈部疼痛处,用纱布覆盖,每日持续6 h,共治疗8周。观察两组治疗前、治疗8周后甲状腺功能[游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)、促甲状腺激素(TSH)、甲状腺过氧化物酶自身抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)、促甲状腺激素受体抗体(TRAb)]、炎症因子[红细胞沉降率(ESR)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-2(IL-2)、白细胞介素-6(IL-6)]、中医证候及临床疗效。统计学方法采用t检验、χ^(2)检验。结果治疗后,观察组甲状腺功能中FT3、FT4、TSH均优于对照组[(3.86±0.85)pmol/L比(4.53±0.87)pmol/L、(11.87±2.06)pmol/L比(13.74±2.12)pmol/L、(2.82±0.09)mIU/L比(1.57±0.15)mIU/L],TGAb、TPOAb、TRAb指标均低于对照组[(82.70±9.98)U/ml比(104.44±9.08)U/ml、(25.90±2.69)U/ml比(31.82±3.31)U/ml、(1.01±0.45)U/L比(1.80±0.91)U/L],差异均有统计学意义(t=-5.19、-4.46、50.13、-11.39、-9.81、-5.47,均P<0.05);两组治疗后各炎症因子均低于治疗前,且观察组均低于对照组(均P<0.05);观察组甲状腺肿胀消退时间、疼痛缓解及退热时间均短于对照组[(7.40±1.44)d比(9.02±1.67)d、(4.00±1.31)d比(6.94±1.38)d、(3.30±0.54)d比(5.12±0.82)d],差异均有统计学意义(t=-5.19、-10.94、-13.03,均P<0.05)。观察组总有效率高于对照组[98.00%(49/50)比88.00%(44/50)],差异有统计学意义(χ^(2)=8.21,P=0.042)。结论清热化痰散结方口服加外敷联合糖皮质激素治疗SAT患者较单纯使用糖皮质激素疗效更好,值得在临床中应用。

Objective To observe the clinical efficacy of Qingre Huatan Sanjie Formula combined with glucocorticoids in the treatment of patients with subacute thyroiditis(SAT),and to explore the effect of this formula on the related inflammatory factors.Methods One hundred patients with SAT treated at Guangdong Second Provincial General Hospital from June 1,2021 to May 31,2023 were selected as the study objects,and were divided into a control group and an observation group according to the treatment methods,with 50 cases in each group.There were 23 males and 27 females in the control group;they were 32-73(39.36±3.12)years old.There were 18 males and 32 females in the observation group;they were 34-69(41.57±3.23)years old.The control group orally took prednisone acetate tablets 10 mg per time,3 times/d in the first two weeks;after 2 weeks'treatment,when their conditions were better,they orally took prednisone acetate tablets 10 mg per time,twice a day,and the dosage was reduced 5 mg every week until they stopped using the drug.The observation group orally took prednisone acetate tablets as the control group,and orally took Qingre Huatan Sanjie Formula(the formula was cook to 200 ml,and was taken in the morning and at night,one dose per day)and externally used the formula(the formula was grinded to powder and coated it on the neck part with pain,and this part was wrapped with gauze for 6 h every day)for 8 weeks.The thyroid function[free triiodothyronine(FT3),free tetraiodothyronine(FT4),thyroid stimulating hormone(TSH),thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TGAb),and thyroid stimulating hormone receptor antibody(TRAb)]and inflammatory factors[erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-2(IL-2),and interleukin-6(IL-6)]before and 8 weeks after the treatment,traditional Chinese medicine syndromes,and clinical efficacies were compared between the two groups.t and χ^(2) tests were applied.Results After the treatment,the levels of FT3,FT4,TSH,TGAb,TPOAb,and TRAb in the observation group were better than those in the control group[(3.86±0.85)pmol/L vs.(4.53±0.87)pmol/L,(11.87±2.06)pmol/L vs.(13.74±2.12)pmol/L,(2.82±0.09)mIU/L vs.(1.57±0.15)mIU/L,(82.70±9.98)U/ml vs.(104.44±9.08)U/ml,(25.90±2.69)U/ml vs.(31.82±3.31)U/ml,and(1.01±0.45)U/L vs.(1.80±0.91)U/L],with statistical differences(t=-5.19,-4.46,50.13,-11.39,-9.81,and-5.47;all P<0.05).After the treatment,the levels of inflammatory factors were lower than those before the treatment in both groups,and the levels in the observation group were lower than those in the control group(all P<0.05).The time for disappearance of thyroid swelling,pain relieving time,and fever disappearing time in the observation group were shorter than those in the control group[(7.40±1.44)d vs.(9.02±1.67)d,(4.00±1.31)d vs.(6.94±1.38)d,and(3.30±0.54)d vs.(5.12±0.82)d],with statistical differences(t=-5.19,-10.94,and-13.03;all P<0.05).The total effective rate in the observation group was higher than that in the control group[98.00%(49/50)vs.88.00%(44/50)],with a statistical difference(χ^(2)=8.21,P=0.042).Conclusion The combination of oral and external application of Qingre Huatan Sanjie Formula with glucocorticoids for patients with SAT is more effective than simple glucocorticoids,so it is worth being clinically applied.