桥本甲状腺炎中医辨证分型标准的建立及证型分布规律

Establishment of TCM Syndrome Differentiation Standard and Syndrome Distribution Rule of Hashimoto Thyroiditis

目的探讨桥本氏甲状腺炎(Hashimoto′s thyroiditis,HT)中医辨证标准的建立及证型分布规律。方法以文献研究为基础,结合专家意见,初步确定30项证候要素,选取2020年6月—2021年3月期间上海中医药大学附属龙华医院中医外科门诊就诊的桥本甲状腺炎患者,通过收集患者四诊信息,运用SPSS统计学软件进行统计分析和聚类分析,咨询该领域经验丰富、副主任医师及以上职称的8位专家,最终确定桥本甲状腺炎中医辨证分型标准的建立及证型分布规律。结果通过证候要素频数分析、聚类分析和主成分分析,经该领域专家咨询,得出桥本甲状腺炎辨证分型标准四型:肝郁脾虚证(32.50%)、痰瘀互结证(25.63%)、脾肾阳虚证(30.63%)、阴虚火旺证(11.25%)。结论通过研究分析桥本甲状腺炎辨证分型的四个证型:肝郁脾虚证、痰瘀互结证、脾肾阳虚证、阴虚火旺证,确立了桥本甲状腺炎中医临床分型标准,为桥本甲状腺炎的临床辨证论治提供了依据。

Objective To explore the establishment of traditional Chinese medicine(TCM)syndrome differentiation standard and the syndrome distribution rule of Hashimoto thyroiditis(HT).Methods Based on literature research and expert opinions,30 syndrome factors were initially identified,and patients with HT attending the outpatient clinic of the Department of TCM Surgery of Longhua Hospital,Shanghai University of Traditional Chinese Medicine from June 202 to March 2021 were selected.The information of the patients was collected by the four methods of diagnosis,and statistical analysis and cluster analysis were carried out by SPSS statistical software.Eight experts including associate chief physicians and more experienced physicians with rich experience in the field were consulted.Finally,the TCM syndrome differentiation standard and the syndrome distribution rule of Hashimoto thyroiditis were determined.Results Through frequency analysis,cluster analysis,and principal component analysis of syndrome factors,four types of syndrome differentiation standards of Hashimoto thyroiditis were obtained after consultation with experts in this field,including liver-depression and spleen-deficiency syndrome(32.50%),phlegm-stasis interconnection syndrome(25.63%),spleen-kidney Yang-deficiency syndrome(30.63%),and Yin-deficiency and fire-exuberance syndrome(11.25%).Conclusion The four types of syndrome differentiation standards of Hashimoto thyroiditis were analyzed:liver-depression and spleen-deficiency syndrome,phlegm-stasis interconnection syndrome,spleen-kidney Yang-deficiency syndrome,and Yin-deficiency and fire-exuberance syndrome,and the clinical TCM syndrome differentiation standard of Hashimoto thyroiditis was determined,providing a basis for the clinical diagnosis and treatment of Hashimoto thyroiditis.