摘要
目的 观察针刺手足阳明经穴治疗桥本甲状腺炎的临床疗效。方法 纳入桥本甲状腺炎患者30例,取主穴:合谷(双侧)、曲池(双侧)、臂臑(双侧)、肩髃(双侧)、中脘、足三里(双侧)、人迎(双侧)、水突(双侧);阴虚火旺证加神门(双侧)、照海(双侧),肝郁脾虚证加太冲(双侧)、太白(双侧),脾肾阳虚证加关元、太溪(双侧),针刺得气后予平补平泻手法30 s,留针30 min,每周针刺3次,连续12周。伴甲状腺功能减退症或亚甲状腺功能减退症患者可口服左甲状腺素钠片(L-T4,优甲乐)以维持正常的血清促甲状腺激素(TSH)及游离甲状腺素(FT4)水平。观察治疗前后颈部不适感视觉模拟量表(VAS)评分、中医症状积分、甲状腺功能相关指标[TSH、游离三碘甲状腺原氨酸(FT3)、FT4]及甲状腺自身抗体[甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)]的变化。结果 治疗第8、12周后,患者颈部不适感VAS评分较治疗前下降(P<0.05);治疗第4、8、12周后,中医症状积分较治疗前下降(P<0.05)。30例患者中,治疗前后TSH、FT3、FT4正常的患者例数无明显变化(P>0.05);15例自愿检测抗体的患者中,TPOAb水平较治疗前下降(P<0.05),TgAb水平无明显变化(P>0.05)。15例伴甲状腺功能减退症或亚甲状腺功能减退症的患者治疗后TSH水平较治疗前降低(P<0.05)。结论 针刺手足阳明经穴可缓解桥本甲状腺炎患者的颈部压迫感或疼痛,改善全身症状,降低TPOAb水平,并可降低伴有甲状腺功能减退症或亚甲状腺功能减退症患者的TSH水平。
Objective To observe the clinical effect of needling at the acupoints of hand and foot Yangming(阳明)channels on Hashimoto's thyroiditis(HT).Methods Thirty participants with HT were included.Principal acu⁃points selected were Hegu(LI4,bilateral),Quchi(LT11,bilateral),Binao(LT14,bilateral),Jianyu(LT15,bila-teral),Zhongwan(CV12),Zusanli(ST36,bilateral),Renying(ST9,bilateral)and Shuitu(ST10,bilateral).For yin deficiency resulting in vigorous fire syndrome,Shenmen(HT7,bilateral)and Zhaohai(KI6,bilateral)were added.In terms of liver constraint and spleen deficiency syndrome,it is suggested to add Taichong(LR3,bilateral)and Taibai(SP3,bilateral).Guanyuan(CV4)and Taixi(KI3,bilateral)are added for spleen-kidney yang deficiency syndrome.After qi arrival,even supplementation and drainage manipulation was performed for 30 s,retention for 30 min,three times of treatment per week for a total of 12 weeks.Patients with hypothyroidism or subclinical hypo⁃thyroidism could take levothyroxine sodium tablets(L-T4,Euthyroxine)orally to maintain normal serum thyroid-stimulating hormone(TSH)and free thyroxine(FT4)levels.The neck discomfort visua analog scale(VAS)score,traditional Chinese medicine(TCM)symptom score,thyroid function-related indicators including TSH,free triiodo⁃thyronine(FT3)and FT4,and levels of thyroid autoantibodies including thyroid peroxidase antibody(TPOAb)and thyroglobulin antibodies(TgAb)were measured before and after the treatment.Results The VAS score of neck dis⁃comfort decreased after 8 and 12 weeks of treatment(P<0.05).TCM symptom score decreased after 4,8 and 12 weeks of treatment(P<0.05).The number of patients with normal TSH,FT3 and FT4 levels showed no significant diffe-rence before and after treatment of the 30 patients(P>0.05).Among the 15 patients who voluntarily tested anti⁃bodies,the TPOAb level decreased after treatment(P<0.05),while TgAb level showed no significant change(P>0.05).The TSH level of 15 patients with hypothyroidism or hypothyroidism decreased after treatment(P<0.05).Conclusion Needling at the acupoints of hand and foot yangming channel could significantly relieve neck pressure or pain,improve systematic symptoms,and reduce TPOAb level when treating HT,and for those with hypothyroidism or subclinical hypothyroidism,it could also reduce the TSH level of HT patients.
作者
曾炜美
王舢泽
王冠群
易莎莎
黄楚峰
赵吉平
CHEN Shu Bee;WANG Shanze;WANG Guanqun;YI Shasha;HUANG Chufeng;ZHAO Jiping(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing,100700)
出处
《中医杂志》
CSCD
北大核心
2023年第15期1550-1555,共6页
Journal of Traditional Chinese Medicine
基金
北京中医药大学东直门医院2020年度科技创新专项(DZMKJCX-2020-019)。
关键词
桥本甲状腺炎
针刺
阳明经
甲状腺功能减退症
Hashimoto's thyroiditis
acupuncture
yangming(阳明)channel
hypothyroidism
