【摘要】 目的：观察中医辨证治疗毒性弥漫性甲状腺肿（Graves）伴糖代谢异常患者的临床疗效。方法：选取120例Graves伴糖代谢异常患者作为研究对象，根据随机数字表法分为对照组和观察组各60例。对照组采用常规西医治疗，观察组采用常规西医联合中医辨证治疗。比较2组临床疗效，比较2组治疗前后中医证候积分、血糖相关指标、甲状腺激素指标，并分析糖化血红蛋白（HbA1c）与甲状腺激素的相关性。结果：观察组治疗总有效率95.00%，高于对照组81.67%(P<0.05)。治疗前，2组中医证候积分比较，差异无统计学意义（P>0.05）；治疗1个疗程、治疗2个疗程，2组中医证候积分均降低（P<0.05），且观察组低于同期对照组（P<0.05）。治疗前，2组HbA1c、空腹血糖（FBG）、餐后2 h血糖（P2hBG）水平比较，差异无统计学意义（P>0.05）；治疗后，2组HbA1c、FBG、P2hBG水平均下降（P<0.05），且观察组低于对照组（P<0.05）。治疗前，2组血清游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺素（TSH）水平比较，差异无统计学意义（P>0.05）；治疗后，2组FT3、FT4水平均降低（P<0.05），且观察组低于对照组（P<0.05）,2组TSH水平均升高（P<0.05），且观察组高于对照组（P<0.05）。治疗后对照组TSH与HbA1c呈正相关（r=0.263,P<0.001），观察组TSH与HbA1c呈正相关（r=0.035,P=0.006）。结论：中医辨证治疗Graves伴糖代谢异常，在提高临床总有效率、改善临床症状的基础上，能够更好地调节激素水平，降低血糖值，且TSH的升高会增加糖代谢异常风险。更多还原

【Abstract】 Objective: To observe the clinical effect of traditional Chinese medicine(TCM) syndrome differentiation and treatment for diffuse toxic goiter(Graves) complicated with abnormal glucose metabolism. Methods: A total of 120 cases of patients with Graves disease complicated with abnormal glucose metabolism were selected as the study subjects and divided into the control group and the observation group according to the random number table method,with 60 cases in each group. The control group was treated with routine western medicine, and the observation group was treated with routine western medicine and Chinese medicine syndrome differentiation and treatment. Clinical effects were compared between the two groups. TCM syndrome scores,blood glucose related indexes,and thyroid hormone indexes were compared before and after treatment between the two groups. The correlation between hemoglobin A1C(HbA1c) and thyroid hormone was analyzed. Results:The total effective rate of treatment was 95.00% in the observation group,higher than that of 81.67% in the control group(P<0.05).Before treatment, there was no significant difference being found in the comparison of TCM syndrome scores between the two groups(P>0.05);after one and two courses of treatment,TCM syndrome scores in the two groups were decreased(P<0.05), and the scores in the observation group were lower than those in the control group in the same period(P<0.05). Before treatment, there was no significant difference being found in the comparison of the levels of HbA1c, fasting blood glucose(FBG), and postprandial 2-hour blood glucose(P2hBG) between the two groups(P>0.05);after treatment,the levels of HbA1c, FBG, and P2hBG in the two groups were decreased(P<0.05), and the three levels in the observation group were lower than those in the control group(P<0.05). Before treatment,there was no significant difference being found in the comparison of the levels of free triiodothyronine(FT3), free thyroxine(FT4),and thyrotropin(TSH) in serum between the two groups(P>0.05);after treatment,the levels of FT3 and FT4 in the two groups were decreased(P<0.05),and the two levels in the observation group were lower than those in the control group(P<0.05);TSH levels in the two groups were increased(P<0.05),and the TSH level in the observation group was higher than that in the control group(P<0.05).After treatment,there was a positive correlation between TSH and HbA1c in the control group(r=0.263,P<0.001),and the correlation between TSH and HbA1c in the observation group was positive(r=0.035,P=0.006). Conclusion: TCM syndrone differentiation and treatment for Graves disease complicated with abnormal glucose metabolism can better regulate hormone levels and lower blood glucose values on the basis of improving the total clinical effective rates and clinical symptoms. The increase of TSH will increase the risk of abnormal glucose metabolism.更多还原