目的 探讨中药煎剂联合糖皮质激素治疗亚急性甲状腺炎的疗效。方法 选取2018-01至2020-12武警第二机动总队医院内分泌科门诊收治的90例亚急性甲状腺炎患者,采用信封随机法分为西医组、中医组和中西医结合组,每组30例。西医组使用泼尼松 30 g/d,后逐渐减量治疗;中医组采用中药水煎服;中西医结合组采用泼尼松联合中药水煎服。分别在治疗前及治疗8 周后比较 3 组甲状腺功能、血清免疫学和炎性指标,比较三组临床症状消失时间及治疗期间不良反应发生情况。结果 治疗前,三组甲状腺功能、血清免疫学和炎性指标组间差异均无统计学意义。治疗8周后,三组患者血清游离三碘甲状腺原氨酸(FT₃)、游离四碘甲状腺原氨酸(FT₄)、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb) 、红细胞沉降率 (ESR)、C反应蛋白(CRP)和白细胞介素-6(IL-6)水平较治疗前显著下降,血清促甲状腺素 (TSH) 水平较治疗前升高,且中西医结合组比中医组及西医组治疗效果更好,差异均有统计学意义(P<0.05),而中医组和西医组上述指标差异无统计学意义。中西医结合组患者临床症状消失时间均比中医组和西医组短(P<0.05)。三组不良反应发生率比较差异无统计学意义。结论 中西医联合治疗亚急性甲状腺炎疗效更好,能够缓解患者临床症状和改善甲状腺功能,降低炎性指标水平。

Objective To investigate the therapeutic effect of Chinese medicine decoction combined with glucocorticoid in the treatment of subacute thyroiditis.Methods Ninety patients with subacute thyroiditis admitted to the outpatient department of endocrinology of the Second Mobile Corps Hospital of Chinese People's Armed Police Force from January 2018 to December 2020 were selected and randomly divided into western medicine group, traditional Chinese medicine group and integrated Chinese and western medicine group by envelope method, with 30 patients in each group. The western medicine group was treated with prednisone 30 g/d, the Chinese medicine group was treated with Chinese medicine decoction, and the third group used prednisone combined with Chinese medicine decoction. Thyroid function, serum immunological and inflammatory indexes of the three groups were compared before and 8 weeks after treatment, and the time of clinical symptoms disappearance and the incidence of adverse reactions during treatment were compared.Results Before treatment, there were no significant differences in thyroid function, serum immunology and inflammatory indexes among the three groups. After eight weeks of treatment, serum free triiodothyronine (FT₃), free tetraiodothyronine (FT₄), thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TGAb) and erythrocyte sedimentation rate in 3 groups (ESR), C-reactive protein (CRP) and interleukin-6 (IL-6) levels significantly decreased, and serum thyrotropin (TSH) levels increased, and the effect of integrated Chinese and western medicine group was better than that of traditional Chinese medicine and western medicine alone, the differences were statistically significant (P＜0.05), while there was no significant difference between the Chinese medicine group and the western medicine group. The time of clinical symptoms disappearance was shorter in integrated Chinese and western medicine group (P＜0.05). There was no significant difference in the incidence of adverse reactions among the three groups.Conclusion The combined treatment of traditional Chinese and western medicine has a better effect on subacute thyroiditis, which can relieve clinical symptoms, improve thyroid function and reduce the level of inflammatory indicators.