目的 观察夏枯草颗粒联合甲巯咪唑片治疗弥漫性甲状腺肿伴甲状腺功能亢进的临床疗效。方法 选取河北省胸科医院2014年2月—2015年2月收治的弥漫性甲状腺肿伴甲状腺功能亢进患者98例,随机分为对照组和治疗组,每组各49例。对照组口服甲巯咪唑片,初始剂量10 mg/次,3次/d,根据患者病情可适当调节剂量(15～40 mg/d),最大量不超过60 mg/d。治疗组在对照组的基础上口服夏枯草颗粒,1袋/次,2次/d。两组患者均连续治疗3个月。观察两组的临床疗效,同时比较治疗前后两组的中医症状积分,甲状腺功能亢进病情程度,甲状腺功能指标游离三碘甲状腺原氨酸(FT₃)、游离甲状腺素(FT₄)、促甲状腺素(TSH)、肝功能损伤及损伤发生时间以及不良反应的情况。结果 治疗后,两组患者治疗后对照组总有效率为75.51%,治疗组为91.84%,两组总有效率比较差异具有统计学意义(P<0.05)。两组的中医症候积分均较治疗前显著改善(P<0.01),且治疗组较对照组改善更为明显,两组比较差异具有统计学意义(P<0.05)。两组的甲状腺功能亢进病情程度均较治疗前显著改善(P<0.05),且治疗组的重度患者例数降低更为明显,两组比较差异具有统计学意义(P<0.05)。两组的FT₃、FT₄值均较治疗前明显下降(P<0.01),TSH明显上升(P<0.01),且治疗组较对照组改善更为明显(P<0.05)。治疗组轻度肝损伤发生例数显著低于对照组(P<0.05);治疗组肝损伤发生时间明显短于对照组(P<0.01)。治疗组和对照组不良反应率分别为14.29%、32.65%,两组比较差异具有统计学意义(P<0.05)。结论 夏枯草颗粒联合甲巯咪唑片治疗甲状腺功能亢进疗效显著、稳定,且不良反应少,具有一定的临床推广应用价值。

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.