清瘿散改善桥本甲状腺炎合并亚临床甲减患者抑郁焦虑状态及抗体紊乱的随机对照研究

A randomized controlled study:Qingying Powder in improving depression,anxiety and antibody disorder in patients with hashimoto thyroiditis complicated with subclinical hypothyroidism

关键词:  桥本甲状腺炎  亚临床甲减  清瘿散  抗甲状腺过氧化物酶抗体  抗甲状腺球蛋白体抗体  抑郁自评量表  焦虑自评量表  生活质量评分表

Key words:  hashimoto thyroiditis  subclinical hypothyroidism  Qingying Powder  anti-thyroid peroxidase antibody  anti-thyroglobulin body antibody  depression self-rating scale  anxiety self-rating scale  quality of life rating scale SF-36

摘要:

[目的]观察清瘿散对于肝郁脾虚型桥本甲状腺炎合并亚临床甲减患者的抑郁焦虑状态的改善作用,及其对血清抗甲状腺过氧化物酶抗体、抗甲状腺球蛋白抗体的影响。[方法]采用前瞻性设计,将2021年7月至2022年6月在上海市中医医院甲状腺病专科门诊明确诊断为肝郁脾虚型桥本甲状腺炎(HT)合并亚临床甲减(SCH)患者154例。根据不同治疗方案,用随机数字表法分为两组,试验组以清瘿散联用优甲乐治疗(77例),对照组以单药优甲乐治疗(77例),治疗周期12周。观察治疗前后两组患者抑郁及焦虑自评量表(SDS、SAS)计分、甲状腺疾病生活质量(SF-36)计分和血清抗甲状腺过氧化物酶抗体(TPOAb)、抗甲状腺球蛋白抗体浓度(TgAb)、促甲状腺素(TSH)浓度变化。[结果]治疗12周后,试验组SDS、SAS评分较治疗前下降显著多于对照组(P＜0.01)、试验组SF-36评分较治疗前提升,显著高于对照组(P＜0.05);试验组血清TPOAb、TgAb较治疗前显著下降(P＜0.01),对照组治疗前后均未见显著变化;两组治疗后血清TSH均较前显著下降(P＜0.01)。试验组总有效率为86.4%,显著高于对照组42.6%,两组间有显著差异(P＜0.01)。[结论]清瘿散加小剂量优甲乐治疗12周可显著改善肝郁脾虚型HT合并SCH患者抑郁及焦虑状态、提高患者生活质量,降低血清TSH、TPOAb、TgAb水平,临床疗效优于单药小剂量优甲乐治疗方案。

Abstract:

[Objective] To observe the effect of Qingying Powder on depression and anxiety in patients with hashimoto thyroiditis of liver depression and spleen deficiency complicated with subclinical hypothyroidism and its effect on serum anti-thyroid peroxidase antibody and anti-thyroglobulin antibody. [Methods] Using a prospective design,154 patients with hepatopathy and spleen deficiency type hashimoto thyroiditis(HT) combined with subclinical hypothyroidism(SCH) were specifically diagnosed between July 2021 and June 2022 at the thyroid specialty clinic of Shanghai Municipal Hospital of Traditional Chinese Medicine. They were divided into two groups according to different treatment regimens using a random number table,with experimental group treated with debridement gall dispersion combined with yumelen(77 cases) and control group treated with single agent yumelen(77 cases) for 12 weeks. The depression and anxiety self rating scale(SDS,SAS) scores,the quality of life in thyroid disease(SF-36) scores,and the serum concentrations of antithyroid peroxidase antibody (TPOAb),antithyroglobulin antibody(TGAb),and thyrotropin(TSH) in the two groups before and after treatment were observed. [Results] After 12 weeks of treatment,the SDS and SAS scores of the experimental group decreased significantly more than those of the control group than those of the control group(P＜0.01),and the SF-36 scores of the experimental group increased significantly than those of the control group,compared with those of the control group(P＜0.05). Serum TPOAb and TGAb in the experimental group decreased significantly compared to pretreatment values(P＜0.01),and no significant changes were observed in the control group before and after treatment;serum TSH decreased significantly after treatment in both groups compared to before(P＜0.01).The overall response rate of the experimental group was 86.4%,significantly higher than that of the control group by 42.6%,with a significant difference between the two groups(P＜0.01). [Conclusion] The treatment of 12 weeks with Qingying Powder plus low-dose Eugenol significantly improved depression and anxiety,quality of life,and reduced serum TSH,TPOAb,and TgAb levels in patients with HT combined with SCH with liver depression and spleen deficiency.