【作者】 吕秀群；

【导师】 廖世煌；

【作者基本信息】 广州中医药大学 ， 中医临床基础， 2005， 硕士

【摘要】 Graves病(简称GD),是一种伴甲状腺激素(TH)分泌增多的器官特异自身免疫病。临床表现为多系统的综合征,以高代谢征、弥漫性甲状腺肿、突眼征为特征。现代医学认为Graves病是由于自身免疫功能缺陷所致,与细胞间粘附分子-1(ICAM-1)密切相关。治疗方法包括药物治疗、手术治疗和放射疗法等,取效快但副作用多。中医认为GD发病是情志内伤、饮食劳倦等导致脏腑功能失调,产生气滞、肝火、痰凝、血瘀而导致本病。运用中医辨证论治法在改善GD症状、调节免疫功能方面具有优势,且副作用少,但作用机理未明确。中西医结合治疗,可以发挥二者长处,减少各自的缺点,治疗前景好。瘿气灵正是针对Graves病的病理特点,结合现代药理,制成的复方制剂。每片含生药1g,他巴唑1mg。具有益气养阴,化痰散结,兼清热活血的作用。 本研究目的:观察瘿气灵治疗Graves病的临床疗效并初步探讨其作用机理。方法:将83例Graves患者随机分为治疗组42例(瘿气灵5片Tid)和对照组41例(他巴唑10mg Tid),观察其治疗前后的全身症状和眼部症状(所有症状按轻中重程度计分0-3),体征(突眼度、心率、体重等),实验室检查(T3、T4、FT3、FT4、TSH,甲状腺B超,肝肾功能,血常规等)以及血清中sICAM-1的含量变化,观察时间为3个月。结果表明:1)瘿气灵能明显改善全身症状,尤其在烦躁易怒,眠差多梦,疲倦乏力及大便次数改善上疗效优于对照组(P<0.05);2)瘿气灵能缩小甲状腺肿,甲状腺体积从58.86±24.17cm~3缩小为治疗后44.16±17.94cm~3(P<0.05),而对照组治疗前后相比无统计学意义,治疗后两组间无明显差异;3)瘿气灵能明显改善患者的眼部症状及突眼度(P<0.01),而他巴唑组对突眼度无明显改善,治疗后两组差异有显著性意义(P<0.05);4)治疗后两组甲状腺功能均有明显下降(P<0.05),但两组间无显著性差异;5)治疗组GD患者血清中sICAM-1含量显著下降,从治疗前920.48±82.04ng/ml降为治疗后的517.45±89.82ng/ml,疗效优于对照组(P<0.05),治疗后两组的sICAM-1含量与正常人相比仍有显著差异(P<0.01):6)患者血清sICAM-1含量与甲状腺激素、突眼度及甲状腺肿大小呈正相关:7)治疗组临床控制21.4%,显效50%,有效28.6%,无效0%,而对照组临床控制14.6%,显效34.1%,有效48.8%,无效2.4%,疗效优于对照组(P<0.05);8)治疗组不良反应发生率(0%)低于对照组(14.6%)(P<0.05)。 结论:瘿气灵治疗Graves病疗效优于对照组,能明显改善全身症状,缩小甲状腺肿,减轻眼征及突眼度,降低甲状腺功能,下调血清中sICAM-1水平,具有整体调节作用,且瘿气灵不良反应发生率低。瘿气灵能缩小甲状腺肿和减轻眼征不是通过抑制甲状腺功能引起的,而是通过对机体的整体调节,降低血清中更多还原

【Abstract】 Graves Disease (GD), is an antoimmune disease which is due to excessive thyroid. There are clinic manifestations in main such as hypermetabolism .goiter and esophthalmas. Modern medicine thinks that Graves disease is caused by immunodeficiency and relates with ICAM-1. Traditional Chinese medicine considers emotional upset, irregular food in-taking as the nosogeny of GD. The diserse origins from the insufficiency of viscera’s qi and blood, energy-stagnation, accumulation of phlegm and blood stasis. As to treatment, mostly do diagnosis and treatment based on overall analysis of symptoms and signs. Chinese-west medical treatment may develop their specialty and avoid their defect. It is well prospective.Ying-Qi-Ling(YQL) is a Chinese-west medical. One weights lg including lmg tapazole and traditional Chinese medicine. It have the funtion of tonifying the Qi and producing the Yin, removing heat- phlegm, resolving blood stasis.In this paper, in order to study the therapeutic effect of YQL on Graves, eighty three patients were divided randomly into two groups ,the 42 patients in the treated group were treated with YQL , and 41 patients in the control group were treated with tapazole. The therapeutic course of both groups was 3 months. The symptoms, eye signs, volume of thyroid, thyroxin level, sICAM-1 level and other routine laboratory parameters as well as the adverse effect of the therapy were observed and compared between two groups. The results show that :1)All the symptoms in the treated group improve better than those in the control group, especially of dysphoria, fatigue, insomnia and dreamful sleep (p<0. 05);2)Goiter reduced in the treated group, the volume of thyroid更多还原