耳穴疗法对肝气郁结型甲状腺结节合并焦虑抑郁的临床疗效观察

Clinical effects of auricular therapy in patients with thyroid nodules of liver qi stagnation type combined with anxiety and depression

目的探讨耳穴疗法对肝气郁结型甲状腺结节合并焦虑抑郁状态患者的临床疗效。方法选取2021年1月至2021年6月110例于北京中医药大学房山医院甲状腺门诊诊治的肝气郁结型TI-RADS 3级(TI-RADS)甲状腺结节合并焦虑抑郁状态患者作为研究对象,采用随机数字表法分为观察组(耳穴疗法)和对照组(随访观察),各55例。2组的患者均给予相同基础指导少食辛辣刺激食物、清淡饮食、适当运动和调控情绪等。对照组随访观察,不给予药物及相关的外治法。观察组在对照组基础上给予耳穴治疗,疗程为4周,观察周期12周。观察2组患者治疗前后的焦虑自评量表(SAS)分、抑郁自评量表(SDS)评分、匹茨堡睡眠质量指数表(PSQI)分、中医证候积分、甲状腺彩超、甲状腺功能指标的变化情况,评价2组患者的不良情绪改善情况和中医证候疗效。监测肝肾功能,观察不良反应的发生情况。结果观察组治疗后的4周和12周中医证候积分与对照组比较,差异均有统计学意义(P<0.05);观察组治疗后的4周和12周,中医证候有效率为85.45%和98.18%,明显高于对照组,差异均有统计学意义(P<0.05);SAS评分、SDA评分和PSQI评分,2组治疗后4周、12周较治疗前均有改善,治疗后的4周、12周观察组评分较对照组均明显下降,差异均有统计学意义(P<0.05);2组治疗前后甲状腺结节大小和甲状腺功能的变化情况,治疗后较治疗前指标有一定变化,但差异无统计学意义(P>0.05)。观察组有7例患者在治疗4周出现不同程度的耳穴压豆处的红肿疼痛,较对照组差异有统计学意义(P<0.05),予以对症处理后,无遗留相关并发症;2组治疗后的肝肾功能变化差异无统计学意义(P>0.05)。结论耳穴疗法能够明显降低肝气郁结型TI-RADS 3级甲状腺结节伴焦虑抑郁患者焦虑抑郁评分,改善其睡眠质量,缓解患者的焦虑抑郁状态,调整其不良情绪,提高中医证候疗效,且不良反应程度较低,具有较高的安全性。

Objective To evaluate the clinical efficacy of auricular therapy in patients with thyroid nodules of liver qi stagnation type combined with anxiety and depression.Methods One hundred and ten patients with TI-RADS 3 thyroid nodules of liver qi stagnation type combined with anxiety and depression were selected from January 2021 to June 2021,and they were divided into either an observation group(auricular therapy)or a control group(follow-up observation),with 55 cases in each groups.All the patients were given the same basic guidance to avoid less spicy or stimulating food,eat a light diet,and conduct appropriate exercise and emotional regulation.The control group was not give drugs or related external treatment,and was only followed up.The observation group received auricular therapy for 4 weeks with an observation period of 12 weeks.Self-rating anxiety scale(SAS)score,self-rating depression scale(SDS)score,Pittsburgh Sleep Quality Index(PSQI)score,TCM syndrome score,thyroid ultrasound,and the changes of thyroid function indexes were evaluated to observe the improvement of bad mood and TCM syndrome in the two groups.Liver and kidney function was monitored to observe the occurrence of adverse reactions.Results The TCM syndrome score at 4 and 12 weeks after treatment in the observation group was significantly different from that of the control group(P<0.05);the TCM syndrome improvement rate at 4 and 12 weeks after treatment was 85.45%and 98.18%,respectively,in the observation group,significantly higher than that of the control group(P<0.05).SAS,PDA,and PSQI scores at 4 weeks and 12 weeks after treatment were significantly lower in the observation group than in the control group(P<0.05).There were changes of thyroid nodule size and thyroid function after the treatment,but the difference was not statistically significant(P>0.05).Seven patients in the observation group developed redness and pain of different degrees at the site of therapy in 4 weeks of treatment,and no patients in the control group developed such complications(P<0.05).After symptomatic treatment,no sequelae related to the complications occurred.There was no difference in liver and kidney function in the two groups(P>0.05).Conclusion Auricular therapy can significantly reduce the anxiety and depression scores of patients with thyroid nodules of liver qi stagnation type combined with anxiety and depression,improve their sleep quality,adjust their bad mood,improve TCM syndrome,and have few adverse reactions.