目的 觀察夏枯草顆粒聯(lián)合甲巰咪唑片治療彌漫性甲狀腺腫伴甲狀腺功能亢進(jìn)的臨床療效。方法 選取河北省胸科醫(yī)院2014年2月—2015年2月收治的彌漫性甲狀腺腫伴甲狀腺功能亢進(jìn)患者98例,隨機(jī)分為對照組和治療組,每組各49例。對照組口服甲巰咪唑片,初始劑量10 mg/次,3次/d,根據(jù)患者病情可適當(dāng)調(diào)節(jié)劑量(15～40 mg/d),最大量不超過60 mg/d。治療組在對照組的基礎(chǔ)上口服夏枯草顆粒,1袋/次,2次/d。兩組患者均連續(xù)治療3個(gè)月。觀察兩組的臨床療效,同時(shí)比較治療前后兩組的中醫(yī)癥狀積分,甲狀腺功能亢進(jìn)病情程度,甲狀腺功能指標(biāo)游離三碘甲狀腺原氨酸(FT₃)、游離甲狀腺素(FT₄)、促甲狀腺素(TSH)、肝功能損傷及損傷發(fā)生時(shí)間以及不良反應(yīng)的情況。結(jié)果 治療后,兩組患者治療后對照組總有效率為75.51%,治療組為91.84%,兩組總有效率比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。兩組的中醫(yī)癥候積分均較治療前顯著改善(P<0.01),且治療組較對照組改善更為明顯,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。兩組的甲狀腺功能亢進(jìn)病情程度均較治療前顯著改善(P<0.05),且治療組的重度患者例數(shù)降低更為明顯,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。兩組的FT₃、FT₄值均較治療前明顯下降(P<0.01),TSH明顯上升(P<0.01),且治療組較對照組改善更為明顯(P<0.05)。治療組輕度肝損傷發(fā)生例數(shù)顯著低于對照組(P<0.05);治療組肝損傷發(fā)生時(shí)間明顯短于對照組(P<0.01)。治療組和對照組不良反應(yīng)率分別為14.29%、32.65%,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論 夏枯草顆粒聯(lián)合甲巰咪唑片治療甲狀腺功能亢進(jìn)療效顯著、穩(wěn)定,且不良反應(yīng)少,具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To observe the clinical curative effect of Xiakucao Granules combined with Thiamazole Tablets in treatment of diffuse goiter with hyperthyroidism. Methods Patients (98 cases) with diffuse goiter with hyperthyroidism in Hebei Chest Hospital from February 2014 to February 2015 were randomly divided into control and treatment groups. Each group had 49 cases. Patients in control group were po administrated with Thiamazole Tablets, and the initial dosage was 10 mg/time, three times daily. The dosage was adjusted according to patient's condition, 15 — 40 mg/d, and the maximum dosage was 60 mg/d. On the basis of control group, patients in treatment group were po administrated with Xiakucao Granules, 1 bag/time, twice daily. Two groups were treated for 3 months. After treatment, the efficacy was evaluated, TCM syndromes, degree of hyperthyroidism, thyroid function indicators triiodothyronine (FT₃), free thyroxine (FT₄), thyroid stimulation hormone (TSH), liver function injury and injury time, and adverse reaction between two groups were compared. Results After treatment, the efficacies in the control and treatment groups were 75.51% and 91.84%, respectively, and there were significant difference between two groups (P < 0.05). TCM syndromes of two groups were better than those before treatment with significant difference (P < 0.01), and TCM syndromes in treatment group were better than those in control group, and the difference was significant (P < 0.05). The degree of hyperthyroidism in two groups were improved more than those before treatment (P < 0.05), and the cases of severe patients in treatment group decreased more with significant difference (P < 0.05). FT₃ and FT₄ of two groups were diminished more than those before treatment, TSH of two groups were increased more than those before treatment with significant difference (P < 0.01). And these indicators in treatment group improved better than those in the control group, with significant difference between two groups (P < 0.05). The cases of mild liver function injury in treatment group were lower than those in control group (P < 0.05). The time of liver injury in treatment group was less than that in control group with significant difference (P < 0.01). The adverse reaction rates in the treatment and control groups were 14.29% and 32.65%, respectively, and there were significant difference between two groups (P < 0.05). Conclusion Xiakucao Granules combined with Thiamazole Tablets has good and stable efficacy in treatment of hyperfunction with little adverse reaction, which has a certain clinical application value.