世界中医药

目的:探究当归六黄汤治疗桥本甲状腺炎患者临床疗效,及对免疫功能的影响,为桥本甲状腺炎患者治疗方案选择提供参考。方法:选取2015年10月至2017年9月湖北省中医院收治的桥本甲状腺炎患者82例作为研究对象,按照就诊顺序编号,双号设为对照组,单号设为观察组,每组41例。对照组采用常规西药治疗,观察组在西药治疗基础上再予以当归六黄汤加减辨治,2组患者均连续治疗3个月为1个疗程。比较2组患者治疗前、后中医症状积分、免疫功能指标(IFN-γ、TNF-α、IL-6、IL-23、IL17A)、甲状腺病情进展情况(甲状腺重大、甲状腺结节、一过性甲状腺毒症、亚临床甲减等)。完成治疗后根据患者中医症状积分的变化,判断临床疗效并进行组间比较,收集治疗过程中2组患者药物不良反应情况并比较。结果:1)完成治疗后2组患者临床症状积分明显降低,且观察组明显低于对照组,观察组症状总有效率明显高于对照组(P<0.05)。2)1个疗程后,2组患者IFN-γ、TNF-α、IL-6、IL-23、IL-17A较治疗前降低,且观察组明显低于对照组(P<0.05)。3)治疗过程中对照组患者甲状腺重大、甲状腺结节、一过性甲状腺毒症、亚临床甲亢、亚临床甲减率于治疗前下降但治疗前后比较，差异无统计学意义(P>0.05);观察组患者上述并发疾病率均较治疗前明显下降,且均低于对照组(P<0.05)。4)2组患者治疗过程中药物不良反应率比较，差异无统计学意义(P>0.05)。结论:当归六黄汤加减辨治桥本甲状腺炎,可有效恢复患者Th1和Th2间维持的免疫平衡状态,减轻桥本甲状腺炎临床症状,缓解病情进一步进展,提升临床疗效,且安全性高,具有较高的临床价值。

English Summary:

To explore the clinical efficacy of Danggui six yellow soup in the treatment of Hashimoto's thyroiditis,and the influence on the immune function,and provide reference for the choice of treatment options for the patients with Hashimoto's thyroiditis.Methods:A total of 82 patients with Hashimoto's thyroiditis admitted in our hospital in October 2015 to September 2017 in were selected as the research subjects.According to the serial number,41 cases of the double number were set as the control group,and the single number was set up as 41 cases in the study group.The control group was treated with conventional western medicine,and the study group was treated with six yellow Decoction on the basis of Western medicine,and the two groups were treated for 3 months in a continuous period.The scores of TCM symptoms and immune function indexes(IFN-gamma,TNF-alpha,IL-2,IL-1,IL-6)before and after treatment were compared,and the progress of thyroid disease(thyroid gland,thyroid nodule,hyperthyroidism,subclinical hyperthyroidism,subclinical hypothyroidism)were compared.After completing the treatment,according to the change of the symptom score of the patients,the clinical effect was judged and the group was compared,and the adverse drug reaction of the two groups of patients was collected and compared.Results:1)After the treatment,the clinical symptom score of the two groups was obviously reduced,and the study group was obviously lower than the control group.The total effective rate of the study group was significantly higher than that of the control group(P<0.05).2)After a course of treatment,the two groups of patients with IFN-gamma,TNF-alpha and IL-2 were lower than before the treatment,and the study group was significantly lower than the control group(P<0.05),IL-1 and IL-6 were slightly lower than before the treatment,but there was no statistical difference before and after treatment(P>0.05).3)During the treatment,the thyroid gland,thyroid nodule,hyperthyroidism,subclinical hyperthyroidism,subclinical hypothyroidism and subclinical hypothyroidism decreased before and after treatment,but there was no significant difference before and after treatment(P>0.05),and the rate of concurrency disease in the study group was significantly lower than that before the treatment,and all were lower than that of the treatment group.Group(P<0.05).4)There was no significant difference in the rate of adverse drug reactions between the two groups(P>0.05).Conclusion:The treatment of Hashimoto's thyroiditis with Danggui six yellow soup can effectively restore the state of immune balance maintained between Th1 and Th2,alleviate the clinical symptoms of Hashimoto's thyroiditis,alleviate the further progress of the disease,improve the clinical efficacy,and have high safety and high clinical value.

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