本文選題：橋本一過性甲狀腺毒癥 + 橋本甲亢��； 參考：《湖北中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:本研究采用回顧性分析方法,選取經臨床確診為橋本一過性甲狀腺毒癥病例、橋本甲亢病例各32例為研究對象,比較橋本一過性甲狀腺毒癥與橋本甲亢在發(fā)病特點、臨床癥狀、體征以及實驗室檢查等方面的異同,并分析使用復方消癭甲亢片、復方甲亢片治療橋本一過性甲狀腺毒癥的特點,對本病的臨床識別和處理進行初步探討,以期為橋本一過性甲狀腺毒癥的診治提供新的認識。方法:收集湖北省中醫(yī)院甲狀腺�？崎T診收治的經臨床確診為橋本一過性甲狀腺毒癥的患者32例(A組),確診為橋本甲亢的患者32例(B組)。分別統(tǒng)計A、B兩組患者在發(fā)病年齡、性別,臨床癥狀,甲狀腺腫大程度、質地,血清FT3、FT4、TSH、FT3/FT4、TGAb、TPOAb、TRAb測定結果及合并癥的異同。分析使用復方消癭甲亢片、復方甲亢片治療前后各時間點典型臨床癥狀及實驗室指標的差異,并進行統(tǒng)計學分析。結果:1.兩組發(fā)病年齡均集中在18-50歲之間,且均以女性占比更高,兩組年齡、性別比率無統(tǒng)計學差異(P0.05)。2.橋本一過性毒癥組在中醫(yī)證候積分、心率水平均較橋本甲亢組低(P0.05),說明橋本一過性毒癥發(fā)病時臨床癥狀較輕。3.兩組間甲狀腺腫大各分度所占比例有統(tǒng)計學差異(P0.05),橋本一過性毒癥組以Ⅰ°腫大及以內占比最多。4.兩組間甲狀腺不同質地所占比例差異無統(tǒng)計學意義(P0.05),均以質地中或質地韌占比為多。5.血清FT3升高各幅度所占比例在兩組間差異有顯著統(tǒng)計學意義(P0.01),FT4升高各幅度所占比例在兩組間差異有統(tǒng)計學意義(P0.05)。橋本一過性毒癥組以FT3、FT4輕度升高者最為多見。TSH水平比較差異無統(tǒng)計學意義(P0.05)。橋本一過性毒癥組FT3/FT4值低于橋本甲亢組,差異有統(tǒng)計學意義(P0.05)。6.兩組間TGAb、TPOAb陰性、陽性、強陽性率比較差異均有顯著統(tǒng)計學意義(P0.01),且橋本一過性毒癥組兩抗體陽性水平較橋本甲亢更低。單、雙抗體強陽性率比較差異無統(tǒng)計學意義(P0.05)。7.橋本一過性毒癥組TRAb陰性率顯著高于橋本甲亢組(96.9%),差異有顯著統(tǒng)計學意義(P0.01)。8.橋本一過性毒癥組無合并癥比例更大(75.0%),差異有顯著統(tǒng)計學意義(P0.01)。9.橋本一過性甲狀腺毒癥組的甲亢(亞甲亢)病程以1-3月占比最高(65.6%),在6月內恢復的比例均顯著高于橋本甲亢組,差異有顯著統(tǒng)計學意義(P0.01)。10.復方消癭甲亢片、復方甲亢片治療本病前后各時間點中醫(yī)證候積分、各實驗室指標整體差異均有統(tǒng)計學意義(P0.05),療效隨著治療時間而穩(wěn)步增加。11.橋本一過性甲狀腺毒癥組治療后甲功恢復更快,一般可在1個療程內恢復,2個療程內病情穩(wěn)定。經2個療程的鞏固治療后兩組治愈率均明顯高于1個療程者。結論:1.橋本一過性甲狀腺毒癥一般為青、中年發(fā)病,女性比例較男性大。2.橋本一過性甲狀腺毒癥患者的臨床典型甲亢癥狀、體征均較輕。甲狀腺腫大程度對本病鑒別診斷有意義,一般表現為甲腫Ⅰ°及以內。甲狀腺質地對本病與橋本甲亢鑒別無意義,甲狀腺質地中或質地韌僅作為識別的參考依據。3.橋本一過性甲狀腺毒癥的甲狀腺功能,以FT3、FT4輕度升高,FT3/FT4比值較低為特點,且存在FT3、FT4正常的亞臨床甲亢者,可作為本病診斷依據,TSH水平高低尚不能作為診斷依據。4.橋本一過性甲狀腺毒癥的TGAb、TPOAb陽性水平較橋本甲亢為低,單、雙抗體強陽性對本病鑒別意義不大。5.TRAb陰性可作為本病的診斷依據,但也存在個別(3.1%)可疑陽性結果。6.橋本一過性甲狀腺毒癥一般不出現甲亢常見合并癥,但若出現合并癥,需在控制甲亢的同時積極治療合并癥。7.本病甲狀腺毒癥表現為一過性,治療后甲亢期一般不超過3個月,臨床癥狀也在3個月內明顯緩解。8.使用復方消癭甲亢片治療橋本一過性甲狀腺毒癥甲功表現為亞甲亢者,使用復方甲亢片治療甲功表現為甲亢者,具體劑量遵循個體化原則,初治后需嚴密監(jiān)測甲狀腺功能,適時調整劑量,并以3個月為1個療程,甲功一般可在1個療程內恢復,2個療程內穩(wěn)定。9.本病診斷性治療后應重視隨訪,若甲功波動較大,必要時仍需行FNAC病理學檢查重新確診。
[Abstract]:Objective: in this study, 32 cases of Hashimoto hyperthyroidism were selected by retrospective analysis, and 32 cases of Hashimoto hyperthyroidism were selected to compare the similarities and differences of Hashimoto's hyperthyroidism and Hashimoto hyperthyroidism in the characteristics, clinical symptoms, physical signs and laboratory examination, and to analyze the use of compound elimination. Gall hyperthyroidism tablets, compound hyperthyroidism tablets in the treatment of Hashimoto hyperthyroidism, the clinical identification and treatment of this disease are preliminarily discussed in order to provide a new understanding of the diagnosis and treatment of Hashimoto hyperthyroidism. Methods: the clinical diagnosis of Hashimoto hyperthyroidism in the Hubei Provincial Traditional Chinese Medical Hospital of the thyroid specialist clinic was collected. 32 cases (group A) and 32 cases (group B) were diagnosed as hyperthyroidism (group B). The age of onset, sex, clinical symptoms, thyroid enlargement, texture, serum FT3, FT4, TSH, FT3/FT4, TGAb, TPOAb, TRAb determination and the similarities and differences between the A, B two groups were analyzed. The difference between the typical clinical symptoms and the laboratory indexes at the time point, and the statistical analysis. Results: 1. the age of the 1. two groups were all concentrated between 18-50 years, and both were higher in women, two groups of age, sex ratio was not statistically significant (P0.05).2. Hashimoto hypertoxic group in TCM syndrome score, heart rate level was lower than the Hashimoto hyperthyroidism group (P 0.05), it shows that there is a statistical difference in the proportion of the degrees of thyroid enlargement between the.3. two groups and the.3. two groups. There is no statistically significant difference in the proportion of the thyroid dissimilarity between the two groups of.4. and two groups, which are not statistically significant in texture or texture. The proportion of the increase in the proportion of.5. serum FT3 was significantly different between the two groups (P0.01), and the proportion of the FT4 increased in the two groups was statistically significant (P0.05). There was no statistical significance (P0.05) for the most common.TSH water level in the patients with Hashimoto transient toxicity (FT3), and there was no statistical significance (P0.05). The FT3/FT4 value of the drug group was lower than the Hashimoto hyperthyroidism group, the difference was statistically significant (P0.05).6. two groups TGAb, TPOAb negative, positive, the difference of strong positive rate had significant statistical significance (P0.01), and the positive level of the pashimoto hypertoxic group was lower than that of the Hashimoto hyperthyroidism. The difference of the strong positive rate of double antibody was not statistically significant (P0.05). The negative rate of TRAb in.7. bridge hypertoxic group was significantly higher than that of Hashimoto hyperthyroidism group (96.9%), the difference was significant (P0.01), the proportion of.8. Hashimoto hypertoxic group was greater (75%), and the difference was statistically significant (P0.01).9. bridge hyperthyroidism group hyperthyroidism (Ya Jiakang) course of 1-3 months was the highest (65.6%). The proportion of recovery in June was significantly higher than that of Hashimoto hyperthyroidism group, the difference was statistically significant (P0.01).10. compound gall gall hyperthyroidism tablets, compound hyperthyroidism tablets were treated with TCM syndrome scores at each time point before and after the disease, and the overall difference in the laboratory indexes was statistically significant (P0.05). The curative effect increased steadily with the time of treatment of.11. Hashimoto. After treatment, the recovery of thyroid function was faster in the group of sexual thyroidism, generally within 1 courses of treatment and stable in 2 courses. After 2 courses of consolidation treatment, the cure rate of two groups was obviously higher than that of 1 courses. Conclusion: 1. Hashimoto hyperthyroidism is generally green, middle-aged and female, and the proportion of women is larger than male.2. Hashimoto and hyperthyroidism The typical symptoms and signs of hyperthyroidism in the patients with toxic disease are lighter. The degree of thyroid enlargement is significant to the differential diagnosis of this disease. The thyroid texture is not significant for the identification of the disease and the hyperthyroidism. The thyroid texture or texture is only a reference basis for the identification of.3. Hashimoto hyperthyroidism. Gland function, with FT3, FT4 mild elevation, low FT3/FT4 ratio, and FT3, FT4 normal subclinical hyperthyroidism, can be used as a diagnostic basis for this disease. The level of TSH can not be used as a diagnostic basis for.4. Hashimoto hyperthyroidism TGAb, TPOAb positive level is lower than Hashimoto hyperthyroidism, single, double antibody strongly positive for this disease identification meaning .5.TRAb negative can be used as the basis for diagnosis of this disease, but there are also individual (3.1%) suspected positive results of.6. bridge, hyperthyroidism usually do not appear hyperthyroidism common complication, but if there is a combination of hyperthyroidism, it is necessary to take active treatment of hyperthyroidism at the same time that the.7. is a hyperthyroidism, after treatment, hyperthyroidism is a period of one period. The clinical symptoms were not more than 3 months, and the clinical symptoms were obviously relieved within 3 months..8. used compound Xiaoying hyperthyroidism in the treatment of Hashimoto hyperthyroidism and hyperthyroidism. The use of compound hyperthyroidism to treat Jia Gong was hyperthyroidism. The specific dose followed the individualized principle. After the initial treatment, the thyroid function should be closely monitored and the dose was adjusted in time. And in 3 months as a course of 1, a general recovery work in the 1 treatment period, 2 treatment in stable.9. treatment should pay attention to the follow-up after the diagnosis of the disease, if a power fluctuations, when necessary, still need FNAC pathological examination were diagnosed again.
【學位授予單位】：湖北中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R581

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