通气散坚汤加减对甲状腺癌术后气滞血瘀证的改善效果  

Improvement Effect of Modified Tongqi Sanjian Decoction on Qi Stagnationand Blood Stasis Syndrome after Thyroid Cancer Surgery

作　　者：刘小庆[1] 耿中利[1] 张爽 任红艳 杨爽 王甲利 杨丽兵 LIU Xiaoqing;GENG Zhongli;ZHANG Shuang;REN Hongyan;YANG Shuang;WANG Jiali;YANG Libing(Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University,Urumqi 830000,China;Department of Critical Care Medicine,The Fourth People′s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830017,China)

机构地区：[1]新疆医科大学附属中医医院,乌鲁木齐830000 [2]新疆维吾尔自治区第四人民医院重症医学科,乌鲁木齐830017

出　　处：《世界中医药》2023年第18期2640-2644,共5页World Chinese Medicine

基　　金：新疆维吾尔自治区自然科学基金资助项目(2022D01C175)。

摘　　要：目的:探究通气散坚汤加减改善甲状腺癌(TC)术后气滞血瘀症的疗效。方法:选取2021年4月至2022年7月新疆医科大学附属中医医院收治的TC术后症状(气滞血瘀证)患者108例作为研究对象,按照简单随机化法分为对照组与观察组,每组54例,对照组给予促甲状腺激素(TSH)抑制治疗,观察组在对照组基础加以通气散坚汤治疗,比较2组中医证候积分、内分泌指标[血清游离三碘甲状腺原氨酸(FT_(3)),游离甲状腺素(FT_(4)),促甲状腺激素(TSH)]、骨代谢指标[钙、磷、碱性磷酸酶(ALP)]和骨密度、免疫功能、不良反应及预后。结果:治疗3个月后,2组中医证候积分均显著降低(P<0.05),血清FT_(3)、FT_(4)、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均显著升高(P<0.05),TSH、CD8^(+)水平均显著降低(P<0.05),组间比较差异有统计学意义(P<0.05);观察组Ward三角、股骨大转子骨密度显著高于对照组(P<0.05);观察组临床有效率显著高于对照组(P<0.05);术后6个月,观察组KPS评分显著高于对照组(P<0.05)。结论:通气散坚汤加减联合TSH抑制治疗气滞血瘀型甲状腺癌疗效突出,值得推荐。Objective:To explore the efficacy of modified Tongqi Sanjian Decoction in improving qi stagnation and blood stasis syndrome after thyroid cancer(TC)surgery.Methods:A total of 108 patients with qi stagnation and blood stasis syndrome after TC surgery in Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University from April 2021 to July 2022 were selected and divided into control group and observatioin group according to the simple randomization method,with 54 cases in each group.The control group was given thyroid stimulating hormone(TSH)suppressive therapy while the observation group was treated with Tongqi Sanjian Decoction on the basis of the control group.The traditional Chinese medicine(TCM)syndrome scores,endocrine indexes[serum free triiodothyronine(FT_(3)),free thyroxine(FT_(4)),TSH],bone metabolism indexes[calcium,phosphorus,alkaline phosphatase(ALP)],bone mineral density,immune function,adverse reactions and prognosis were compared between the two groups.Results:After 3 months of treatment,the TCM syndrome scores of the two groups were decreased(P<0.05),and serum FT_(3),FT_(4),CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)were enhanced(P<0.05)while TSH and CD8^(+)were reduced(P<0.05).The differences between the two groups after treatment were significant(P<0.05).The bone mineral densities of Ward′s triangle and greater trochanter in observation group were higher than those in control group(P<0.05).After 6 months of surgery,the Karnofsky Performance Status Scale(KPS)score in observation group at 6 months after surgery was higher than that in control group(P<0.05).Conclusion:Modified Tongqi Sanjian Decoction combined with TSH suppressive therapy presents a prominent efficacy in the treatment of thyroid cancer of qi stagnation and blood stasis type,which is worthy of promotion.

关 键 词：甲状腺癌 气滞血瘀证 促甲状腺激素 内分泌 骨密度 骨代谢 免疫功能 疗效 

分 类 号：R289.5[医药卫生—方剂学] R736.1[医药卫生—中药学]