基于“靥本相应论”探讨丁治国教授内外合治桥本甲状腺炎的临床研究  

The clinical study of internal and external combined treatment of HT by Professor Ding Zhiguo based on"dimple corresponding theory"

作　　者：李心爱 祁烁[1,2,3] 陈晓珩 李哲[1] 丁治国[2,3,4] Li Xin'ai;Qi Shuo;Chen Xiaoheng;Li Zhe;Ding Zhiguo(Department of Thyroid Diseases,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Department of Thyroid Diseases,Sun Simiao Hospital,Beijing University of Chinese Medicine,Tongchuan 727100,China;Institute of Thyroid Disease,Sun Simiao Hospital,Beijing University of Chinese Medicine,Tongchuan 7271003,China;Sun Simiao Research Institute,Beijing University of Chinese Medicine,Tongchuan 727100,China)

机构地区：[1]北京中医药大学东直门医院甲状腺病科,北京100700 [2]北京中医药大学孙思邈医院甲状腺病科,铜川727100 [3]北京中药大学孙思邈医院甲状腺病研究所,铜川727100 [4]北京中医药大学孙思邈研究所,铜川727100

出　　处：《国际中医中药杂志》2024年第5期580-587,共8页International Journal of Traditional Chinese Medicine

基　　金：陕西省科技厅科研项目(S2023-YF-ZDCXL-ZDLSF-0111);陕西省中医药管理局科研项目(SZY-NLTL-2022-006);陕西省中医药管理局项目(2023-ZQNY-014);铜川市甲状腺病防治中心科研项目(TJF-2022-25)。

摘　　要：目的评价丁治国教授内外合治桥本甲状腺炎(HT)的临床疗效,探讨其作用机制。方法前瞻性队列研究。将2022年8月-2023年3月北京中医药大学孙思邈医院与北京中医药大学东直门医院丁治国教授门诊85例符合纳排标准的患者,根据患者意愿按照1∶1比例分为对照组43例、药物组42例,另招募20名健康志愿者进行健康对照观察。对照组予限碘饮食,药物组予清肝散结消瘿方随证加减并联合理气散结消瘿膏外敷治疗。2组均连续观察4周。健康对照组未予任何干预措施。分别于治疗前后进行中医证候评分,采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评估焦虑抑郁程度,匹兹堡睡眠质量指数(PSQI)评估睡眠质量,疲劳严重程度量表(FSS)评估疲劳程度,下肢淋巴水肿自感症状评估问卷评估下肢淋巴水肿症状;采用全自动电化学发光免疫分析仪检测血清甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)水平,计算下降率;采用ELISA法检测血清Akt、ERK、蛋白质激酶C(PKC)水平;行甲状腺超声检查,计算甲状腺体积,记录甲状腺峡部前后径;评价临床疗效及安全性。结果药物组总有效率为71.43%(30/42)、对照组为27.91%(12/43),2组比较差异有统计学意义(χ^(2)=16.10,P<0.01)。药物组治疗后血清TPOAb[137.95(141.44)IU/ml比153.40(154.93)IU/ml,Z=-4.37]、TGAb[182.00(238.52)IU/ml比190.50(257.55)IU/ml,Z=-2.13]水平较同组治疗前降低(P<0.01或P<0.05),血清TPOAb[15.62(21.90)%比-6.42(32.89)%,Z=-4.12]、TGAb[5.25(20.49)%比-0.72(17.67)%,Z=-2.67]水平下降率高于对照组(P<0.01)。药物组治疗后甲状腺体积[11.37(6.48)cm3比12.89(6.63)cm3,Z=-2.95]及峡部厚度[0.27(0.14)cm比0.28(0.15)cm,Z=-2.18]较同组治疗前缩小(P<0.05)。药物组治疗后中医证候积分[(6.10±1.38)分比(14.42±7.35)分,t=-7.29]及HAMA[(5.21±1.32)分比(9.28±2.25)分,Z=-7.02]、HAMD[(8.28±3.17)分比(10.42±5.28)分,t=-2.26]、PSQI[(6.00±2Objective To evaluate the clinical efficacy of Professor Ding Zhiguo's internal and external combined treatment of Hashimoto's disease,and to explore its mechanism.Methods Prospective cohort study.A total of 85 patients of professor Ding Zhiguo from Sun Simmiao Hospital of Beijing University of Chinese Medicine and Dongzhimen Hospital of Beijing University of Chinese Medicine from August 2022 to March 2023 were selected and divided into control group(43 cases)and drug group(42 cases)by random number table method.Another 20 healthy volunteers were recruited for health control observation.The control group was given iodine restricted diet,the drug group was treated with Qinggan Sanjie Xiaoying Prescription combined with Liqi Sanjie Xiaoying Ointment,and the healthy control group was not treated with any intervention.Both drug group and control group were observed continuously for 4 weeks.TCM syndrome scores were performed before and after treatment.Hamilton Anxiety Scale(HAMA)and Hamilton Depression Scale(HAMD)were used to assess the degree of anxiety and depression,Pittsburgh Sleep Quality Index(PSQI)was used to assess sleep quality,and fatigue severity Scale(FSS)was used to assess the degree of fatigue.Lower limb lymphedema self-sensory symptoms assessment questionnaire was used to evaluate the symptoms of lower limb lymphedema.The serum levels of thyroid peroxidase antibody(TPOAb)and thyroglobulin antibody(TGAb)were measured by automatic electrochemiluminescence immunoassay,and the reduction rate was calculated.The levels of serum Akt,ERK and protein kinase C(PKC)were detected by ELISA.The thyroid volume was calculated and the anterior and posterior diameter of the isthmus was recorded.The clinical efficacy and safety were evaluated.Results The total effective rate was 71.43%(30/42)in the drug group and 27.91%(12/43)in the control group,with statistical significance(χ^(2)=16.10,P<0.01).The serum TPOAb[137.95(141.44)IU/ml vs.153.40(154.93)IU/ml,Z=-4.37]and TGAb[182.00(238.52)IU/ml vs.190.50(257.55)IU/ml,Z=-2.13]

关 键 词：甲状腺炎 桥本氏病 清肝散结消瘿方 理气散结消瘿膏 甲状腺抗体 

分 类 号：R249[医药卫生—中医临床基础] R259[医药卫生—中医学]