血清前白蛋白與甲亢合并肝損的相關(guān)性分析及中西醫(yī)結(jié)合治療近期療效觀察
發(fā)布時間：2018-07-20 12:18
【摘要】：目的：探討血清前白蛋白(PA)與甲狀腺功能亢進癥伴肝功能損傷患者甲狀腺免疫學指標、肝功能指標的相關(guān)性。同時,通過對單純西藥、單純中藥、中西醫(yī)結(jié)合治療方案的對比研究,客觀評價自擬清肝養(yǎng)陰方治療甲亢伴肝功能損傷肝火旺盛證的療效及安全性。 方法：1.采用病例對照研究方法,選取2011年1月1日至2013年12月31日期間,在江蘇省中醫(yī)院內(nèi)分泌科住院甲狀腺功能亢進癥伴肝功能損傷患者60例,正常對照組隨機選取同期甲狀腺功能亢進癥非肝功能損傷患者60例,對血清前白蛋白及甲狀腺免疫學指標、肝功能指標進行統(tǒng)計學分析。2.選取2012年12月1日-2013年12月31日在江蘇省中醫(yī)院內(nèi)分泌科住院甲狀腺功能亢進伴肝損傷患者共90例,根據(jù)治療方法,分為對照組30例,中西醫(yī)結(jié)合治療組(治療組1)30例,中醫(yī)治療組(治療組2)30例。觀測治療前后臨床癥狀、甲狀腺免疫學指標、肝功能、甲狀腺腫大程度等,以及不良反應(yīng)、依從性。全部數(shù)據(jù)使用SPSS17.0統(tǒng)計軟件進行統(tǒng)計學分析。 結(jié)果： (1)相關(guān)性分析： 經(jīng)過對照組、甲亢肝損組的統(tǒng)計學分析,提出推測：PA與ALT、FT3、FT4呈負向直線關(guān)系。 (2)癥狀改善： 組內(nèi)比較,治療后0.5月與治療前相比,對照組煩躁、胸脅脹痛、口干口苦、少寐多夢、消瘦、大便頻數(shù)癥狀較前好轉(zhuǎn)(P0.05),除治療組1、2甲狀腺腫、治療組2神疲乏力外余癥狀均較前好轉(zhuǎn)(P0.05)；治療后3月與治療前相比,三組中除對照組甲狀腺腫、心悸未見明顯好轉(zhuǎn),余癥狀較前均有明顯好轉(zhuǎn)(P0.05)；治療后3月與治療后0.5月相比,三組神疲乏力、胸脅脹痛、口干口苦、大便頻數(shù)、震顫癥狀均有明顯改善(P0.05)。 組間比較,治療后0.5月,治療組1與對照組相比,除煩躁、大便頻數(shù)、消瘦癥狀無顯著性統(tǒng)計學意義外,余癥狀均明顯改善(P0.05)；治療組2與對照組比,除煩躁、大便頻數(shù)、消瘦、多汗惡熱癥狀無顯著性統(tǒng)計學意義外,余癥狀均明顯改善(P0.05)；治療組1與治療組2比較,癥狀改善均無顯著性統(tǒng)計學意義(P0.05)。治療后3月,三組間癥狀比較均無顯著性統(tǒng)計學意義(P0.05)。 (3)中醫(yī)臨床證候積分： 經(jīng)治療后,3組患者癥狀較前均明顯改善(P0.01)。組間比較,3月后,治療組2較對照組癥狀改善(P0.05),治療組1較對照組改善有非常顯著性統(tǒng)計學意義(P0.01)。治療組1較治療組2改善效果更佳,但組間無顯著性統(tǒng)計學意義(P0.05)。 (4)實驗室指標： 治療后0.5月,三組PA均較治療前升高(P0.05)。ALT、AST、γ-GT、ALP均較治療前下降(P0.05),其中,對照組及治療組1PA、ALT、γ-GT;治療組2ALT、AST、γ-GT較治療前明顯改善(P0.01)。 治療后3月,對照組PA、ALT、AST、γ-GT、ALP較治療前及治療后0.5月改善(P0.05),其中ALT較治療前及治療后0.5月、AST較治療前、γ-GT較治療前及治療后0.5月明顯改善(P0.01)。治療組1PA、ALT、AST、ALP較治療前,治療組2PA、ALT、ALP較治療前及治療后0.5月、AST、γ-GT較治療前改善(P0.05),其中治療組1ALT較治療前及治療后0.5月、AST較治療前、ALP較治療后0.5月,治療組2ALT較治療前及治療后0.5月、AST、γ-GT較治療前有顯著統(tǒng)計學意義(P0.01)。 組間比較,治療后0.5月,治療組1PA、ALT、AST、γ-GT較對照組,均有顯著性統(tǒng)計學意義(P0.05)。治療組2與對照組比較,PA上升較對照組明顯,有顯著性統(tǒng)計學意義(P0.05)。治療組1與治療組2比較,治療組1PA較治療組2明顯上升,ALT、γ-GT明顯下降(P0.05)。 治療后3月,治療組1與對照組PA上升幅度相比,有顯著統(tǒng)計學意義(P0.01)；ALT、AST、γ-GT、ALP降低幅度均有統(tǒng)計學意義(P0.05)。治療組1與治療組2比較,治療組1PA、ALT、AST下降較治療組2明顯,有統(tǒng)計學意義(P0.05)。 (5)疾病療效比較： 治療組1療效顯著優(yōu)于對照組(P0.01)。 (6)治療前后肝功能指標恢復正常時間比較： 治療組1肝功能恢復時間與對照組及治療組2相比有統(tǒng)計學意義(P0.05)。 (7)安全性： 三組安全性比較無顯著性統(tǒng)計學意義(P0.05)。 結(jié)論： (1)甲狀腺功能亢進癥伴肝功能損傷患者血清前白蛋白水平明顯降低。 (2)血清前白蛋白水平可伴隨患者肝損恢復而恢復,有助于病情進展的判斷。 (3)清肝養(yǎng)陰方可明顯緩解甲亢伴肝損患者的癥狀、縮短肝功能恢復時間。中西醫(yī)結(jié)合治療可縮短病程,對降低復發(fā)率有一定意義。此方安全、有效、無嚴重不良反應(yīng)。
[Abstract]:Objective : To study the correlation between serum prealbumin ( PA ) and thyroid function injury in patients with liver function impairment .
Methods : 1 . A case - control study was used to select 60 patients with hyperthyroidism complicated with liver function during the period from January 1 , 2011 to December 31 , 2013 .
Results :
( 1 ) Correlation analysis :
Through the statistical analysis of the control group and the liver loss group of hyperthyroidism , it is suggested that PA is in negative linear relation with ALT , FT3 and FT4 .
( 2 ) Improvement of symptoms :
In the treatment group , the symptoms of fatigue and fatigue were better than those in the treatment group ( P0.05 ) .
Compared with the control group , there was no obvious improvement in the three groups except that in the control group before and after the treatment ( P0.05 ) .
Compared with 0 . 5 months after treatment , three groups of mental fatigue , chest pain , dry mouth , stool frequency and tremor were significantly improved ( P0.05 ) .
Compared with the control group , compared with the control group , there was no significant difference between treatment group 1 and the control group except for the symptoms of irritability , stool frequency and thin - thin symptom , and the residual symptoms were obviously improved ( P0.05 ) .
Compared with control group , there was no significant difference between treatment group 2 and control group than that in control group ( P0.05 ) .
No significant difference was found between treatment group 1 and treatment group 2 ( P0.05 ) .
( 3 ) Clinical syndrome integration of traditional Chinese medicine :
After treatment , the symptoms of the three groups were significantly improved ( P0.01 ) . After 3 months , the symptoms of the treatment group were improved compared with those in the control group ( P0.05 ) . The improvement of the treatment group 1 was better than that of the control group ( P0.01 ) .
( 4 ) Laboratory index :
ALT , AST , 緯 - GT and ALP decreased before treatment ( P0.05 ) .
ALT , AST , 緯 - GT and ALP were significantly improved before and after treatment ( P0.05 ) .
Compared with the control group , the level of PA in the treatment group was significantly higher than that in the control group ( P0.05 ) .
Compared with control group , there was significant difference between treatment group and control group ( P0.01 ) .
The levels of ALT , AST , 緯 - GT and ALP decreased significantly ( P0.05 ) . Compared with the treatment group , the decrease of 1PA , ALT and AST in the treatment group was significantly higher than that in the treatment group ( P0.05 ) .
( 5 ) Comparison of curative effect :
The curative effect of the treatment group was significantly better than that of the control group ( P0.01 ) .
( 6 ) Before and after treatment , the liver function indexes were returned to normal time :
The recovery time of liver function in the treatment group was significantly higher than that of the control group and the treatment group ( P0.05 ) .
( 7 ) Safety :
There was no significant difference between the three groups ( P0.05 ) .
Conclusion :
( 1 ) The levels of serum prealbumin in patients with hyperthyroidism accompanied with liver function were significantly lower .
( 2 ) The level of serum prealbumin can be recovered with the recovery of liver loss of the patient , which can help to judge the progress of the disease .
( 3 ) Clearing the liver and nourishing yin can obviously relieve the symptoms of the patients with hyperthyroidism and liver loss , shorten the recovery time of the liver function , shorten the course of the treatment by combining the traditional Chinese medicine and western medicine , and have a certain meaning to reduce the recurrence rate .
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R581.1;R575
本文編號：2133491
[Abstract]:Objective : To study the correlation between serum prealbumin ( PA ) and thyroid function injury in patients with liver function impairment .
Methods : 1 . A case - control study was used to select 60 patients with hyperthyroidism complicated with liver function during the period from January 1 , 2011 to December 31 , 2013 .
Results :
( 1 ) Correlation analysis :
Through the statistical analysis of the control group and the liver loss group of hyperthyroidism , it is suggested that PA is in negative linear relation with ALT , FT3 and FT4 .
( 2 ) Improvement of symptoms :
In the treatment group , the symptoms of fatigue and fatigue were better than those in the treatment group ( P0.05 ) .
Compared with the control group , there was no obvious improvement in the three groups except that in the control group before and after the treatment ( P0.05 ) .
Compared with 0 . 5 months after treatment , three groups of mental fatigue , chest pain , dry mouth , stool frequency and tremor were significantly improved ( P0.05 ) .
Compared with the control group , compared with the control group , there was no significant difference between treatment group 1 and the control group except for the symptoms of irritability , stool frequency and thin - thin symptom , and the residual symptoms were obviously improved ( P0.05 ) .
Compared with control group , there was no significant difference between treatment group 2 and control group than that in control group ( P0.05 ) .
No significant difference was found between treatment group 1 and treatment group 2 ( P0.05 ) .
( 3 ) Clinical syndrome integration of traditional Chinese medicine :
After treatment , the symptoms of the three groups were significantly improved ( P0.01 ) . After 3 months , the symptoms of the treatment group were improved compared with those in the control group ( P0.05 ) . The improvement of the treatment group 1 was better than that of the control group ( P0.01 ) .
( 4 ) Laboratory index :
ALT , AST , 緯 - GT and ALP decreased before treatment ( P0.05 ) .
ALT , AST , 緯 - GT and ALP were significantly improved before and after treatment ( P0.05 ) .
Compared with the control group , the level of PA in the treatment group was significantly higher than that in the control group ( P0.05 ) .
Compared with control group , there was significant difference between treatment group and control group ( P0.01 ) .
The levels of ALT , AST , 緯 - GT and ALP decreased significantly ( P0.05 ) . Compared with the treatment group , the decrease of 1PA , ALT and AST in the treatment group was significantly higher than that in the treatment group ( P0.05 ) .
( 5 ) Comparison of curative effect :
The curative effect of the treatment group was significantly better than that of the control group ( P0.01 ) .
( 6 ) Before and after treatment , the liver function indexes were returned to normal time :
The recovery time of liver function in the treatment group was significantly higher than that of the control group and the treatment group ( P0.05 ) .
( 7 ) Safety :
There was no significant difference between the three groups ( P0.05 ) .
Conclusion :
( 1 ) The levels of serum prealbumin in patients with hyperthyroidism accompanied with liver function were significantly lower .
( 2 ) The level of serum prealbumin can be recovered with the recovery of liver loss of the patient , which can help to judge the progress of the disease .
( 3 ) Clearing the liver and nourishing yin can obviously relieve the symptoms of the patients with hyperthyroidism and liver loss , shorten the recovery time of the liver function , shorten the course of the treatment by combining the traditional Chinese medicine and western medicine , and have a certain meaning to reduce the recurrence rate .
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R581.1;R575
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