杨聪 郑刚 齐婧 熊鹏 徐佳萌 王艳琴 钟伟

[摘要] 目的 觀察加味真武汤联合常规西药治疗心肾阳虚型甲状腺功能减退性心脏病的临床效果。 方法 选择2016年10月—2019年10月陕西中医药大学附属医院心内科收治的50例心肾阳虚型甲状腺功能减退性心脏病患者，按随机数字表法将其分为对照组与治疗组，各25例。对照组给予常规左甲状腺素钠片口服治疗，治疗组在对照组基础上服用加味真武汤，治疗12周。比较两组中医证候疗效以及治疗前后的中医症状评分、甲状腺功能、心功能及安全性情况。 结果 治疗组中医证候总有效率高于对照组，差异有统计学意义（P < 0.05）。治疗后，两组中医症状各项评分（心悸、胸闷、气短、水肿）均低于治疗前，且治疗组低于对照组（P < 0.05）。治疗后，两组游离甲状腺素、游离三碘甲状腺原氨酸、甲状腺素、三碘甲状腺原氨酸水平均高于治疗前，促甲状腺激素水平低于治疗前，且治疗组各项指标改善程度较对照组明显（P < 0.05）。治疗后，两组左心室射血分数高于治疗前，心输出量和每搏输出量均多于治疗前，心率快于治疗前，治疗组各项指标改善程度较对照组明显（P < 0.05）。两组治疗过程中不良反应发生率比较，差异无统计学意义（P > 0.05）。 结论 加味真武汤联合常规西药左甲状腺素钠片治疗甲状腺功能减退性心脏病效果显著，中西医结合治疗可明显改善患者心功能、甲状腺功能，减轻临床症状。

[关键词] 甲状腺功能减退性心脏病;真武汤;中西医结合;心肾阳虚型

[中图分类号] R255          [文献标识码] A          [文章编号] 1673-7210（2020）07（c）-0161-04

Clinical effect of Jiawei Zhenwu Decoction in the treatment of hypothyroid heart disease with syndrome of yang deficiency of heart and kidney

YANG Cong1   ZHENG Gang1，2▲   QI Jing2   XIONG Peng3   XU Jiameng1   WANG Yanqin1   ZHONG Wei2

1.Department of Clinical Medicine of Traditional Chinese and Western Medicine， the First Clinical Medical College， Shaanxi University of Chinese Medicine， Shaanxi Province， Xianyang   712046， China; 2.Institute of Cardiocerebrovascular Diseases， the Second Affiliated Hospital of Shaanxi University of Chinese Medicine， Shaanxi Province， Xianyang   712000， China; 3.Department of Geriatrics， Affiliated Hospital of Shaanxi University of Chinese Medicine， Shaanxi Province， Xianyang   712000， China

[Abstract] Objective To observe clinical efficacy of Jiawei Zhenwu Decoction combined with Levothyroxine Sodium Tablets in the treatment of hypothyroid heart disease with syndrome of yang deficiency of heart and kidney. Methods Fifty patients with hypothyroid heart disease with syndrome of yang deficiency of heart and kidney from October 2016 to October 2019 in Department of Cardiology， Affiliated Hospital of Shaanxi University of Chinese Medicine were selected and divided into control group and treatment group by random number table method， each with 25 cases. Control group was given conventional Levothyroxine Sodium Tablets， while treatment group was given Jiawei Zhenwu Decoction on the basis of control group. After 12 weeks of treatment， traditional Chinese medicine syndrome efficacy， thyroid function， cardiac function and safety of two groups were compared before and after treatment. Results Total effective rate of traditional Chinese medicine syndrome in treatment group was higher than that in control group （P < 0.05）. After treatment， the scores of traditional Chinese medicine symptoms in two groups were lower than those before treatment， and treatment group was lower than that in control group （P < 0.05）. After treatment， the levels of free thyroxine， free triiodothyronine， thyroxine and triiodothyronine in two groups were higher than those before treatment， and the level of thyroid stimulating hormone was lower than that before treatment， and the improvement of various indexes in treatment group was more obvious than that in control group （P < 0.05）. After treatment， the left ventricular ejection fraction of two groups were higher than that before treatment， the cardiac output and stroke volume were both higher than those before treatment， the heart rate was faster than that before treatment， and the improvement degree of each index in treatment group was more obvious than that in control group （P < 0.05）. There was no significant difference in the incidence of adverse reactions between two groups （P > 0.05）. Conclusion The effect of Jiawei Zhenwu Decoction combined with conventional Western medicine Levothyroxine Sodium Tablets in the treatment of hypothyroid heart disease is remarkable. The combination of traditional Chinese and Western medicine can significantly improve heart function， thyroid function and reduce clinical symptoms.

[Key words] Hypothyroid heart disease; Zhenwu Decoction; Integration of traditional Chinese and Western medicine; Syndrome of yang deficiency of heart and kidney

甲状腺功能减退性心脏病是一种内分泌紊乱性心脏病，由于甲状腺激素合成、分泌不足等导致心肌收缩功能减弱，临床症状复杂、进展较慢，有较高的误诊、漏诊率[1-2]。甲状腺功能减退性心脏病发病率约为甲状腺功能减退的10%，甲状腺功能减退若持续得不到控制，将导致心肌黏液性水肿，患者可出现活动能力下降、心悸气促、心脏扩大、心包积液、心电图异常（T波改变）等[3]。本研究在常规西药治疗基础上加服加味真武汤，辨证治疗心肾阳虚型甲状腺功能减退性心脏病，对中西医结合疗效及用药安全予以评价，目的在于为临床治疗方案的选择提供参考依据。……