Page 83 - 中国全科医学2022-18

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Medicine from April 2019 to June 2021，including 100 adult gynecological outpatients with HT，and 100 healthy，adult female
physical examinees. Both groups completed the Classification and Determination of Constitution in TCM（ZYYXH/T157-2009）
for assessing the constitution in TCM. Thyroid function test was performed to understand levels of thyroid function parameters
〔thyroglobulin antibody（TGAb），thyroid peroxidase antibody（TPOAb），thyroid-stimulating hormone（TSH），free
triiodothyronine（FT 3 ），free thyroxine（FT 4 ）〕. Full body thermography using infrared thermal imaging was implemented to
examine the calorific values of the left and right lobes of the thyroid gland，the uterus，the Shenque acupoint and the Governor
vessel. The aforementioned parameters were compared between HT patients and physical examinees to identify intergroup
differences. The calorific values of thyroid left and right lobes，the uterus，the Shenque acupoint and the Governor vessel were
compared across HT patients with 9 types of constitution in TCM，and the associations of them with thyroid function parameters
were explored，then their associations with infertility in HT were evaluated using binary logistic regression analysis. Results The
top 4 types of constitution in TCM in HT patients were yang-deficiency，qi-stagnation，damp-heat，and phlegm-dampness. The
calorific values of Shenque acupoint and the Governor vessel varied significantly across HT patients by types of constitution（n=9）
in TCM（P<0.05）. Compared with the control group, the levels of TGAb, TPOAb and TSH in HT group increased（P<0.05）.
There was no significant difference in FT 3 and FT 4 levels between the two groups（P>0.05）. HT patients had higher calorific
values of thyroid left and right lobes and lower calorific values of the uterus，Shenque acupoint and the Governor vessel than
physical examinees（P<0.05）. In the HT group，the calorific value of the left or right lobe of the thyroid gland was positively
correlated with TGAb（r s =0.260，0.198，P<0.05），and the calorific value of the uterus was negatively correlated with TSH
（r s =-0.313，P<0.05）. The calorific values of the uterus〔OR=0.413，95%CI（0.180，0.945）〕，the Governor vessel〔OR=0.270，
95%CI（0.075，0.971）〕，and the Shenque acupoint〔OR=0.264，95%CI（0.073，0.954）〕were associated with
infertility in HT（P<0.05）. Conclusion In adult female HT patients，the most common four types of constitution in TCM
were yang-deficiency，qi-stagnation，damp-heat，and phlegm-dampness. The metabolic calorific values measured by infrared
thermal imaging were featured by higher values of thyroid left and right lobes，and lower values of the uterus，Shenque acupoint
and the Governor vessel，which may be new theoretical evidence obtained from clinical practice explaining infertility in HT.
Furthermore，the calorific values of thyroid left and right lobes could be used as parameters for early screening or identifying HT.
So infrared thermal imaging could be used as an auxiliary diagnostic tool to improve the diagnostic efficiency of HT.
【Key words】 Hashimoto fisease；Infrared rays；Infrared thermal imaging；Thyroid hormones；Thyroid antibodies

桥本甲状腺炎（HT）又称慢性淋巴细胞性甲状腺炎，
本研究行业贡献：
是一种常见的自身免疫性疾病，其发病率逐年上升，全
（1）本研究应用红外热成像技术对女性桥本甲
球发病率为 5%~10%，女性发病率高于男性（8∶1），
状腺炎的整体热值特点进行探索，与既往相关研究比
其中以白种人女性发病率最高，其次为亚洲女性、黑种 较，打破了传统只针对甲状腺局部进行筛查的局限性，
人女性 ［1-3］ 。我国 HT 患病率为 16/1 000，发病率为 6.9 通过应用中医学理论中的整体观念及经络学说，发现
/1 000 ［4］ 。HT 的主要特征为血清中甲状腺过氧化物酶
了桥本氏甲状腺炎具有一定的热值规律，为桥本氏甲
抗体（TPOAb）阳性和甲状腺球蛋白抗体（TGAb）阳
状腺炎引起不孕提供了新的思路及方向。
性，且伴有甲状腺淋巴细胞的浸润，腺体逐渐被破坏，
（2）本研究 Spearman 秩相关系数法分析发现，
最终导致临床甲状腺功能减退和甲状腺组织纤维化，且 甲状腺左、右叶区位热值与甲状腺球蛋白抗体呈正相
是碘充足地区发生甲状腺功能减退的主要原因 ［2，5］ 。
关，可将其作为桥本甲状腺炎疾病早期诊断及筛查的
HT 目前也是引起女性排卵功能障碍、月经失调、不孕、
指标之一，以提高桥本氏甲状腺炎的早期诊断效能，
流产、早产等疾病的原因之一，HT 约占女性不孕症原 对于桥本氏甲状腺炎的及早诊治具有一定的临床意义。
因的 10.5% ［6-10］ 。本研究旨在探索女性 HT 红外热成像
人体代谢热值特点，为 HT 的辅助诊断提供帮助。 （2019KL-072）。
1 资料与方法 1.2 纳入标准
1.1 一般资料 选择 2019 年 4 月至 2021 年 6 月在成 1.2.1 HT 患者纳入标准 同时符合以下 4 项标准：（1）
都中医药大学附属医院妇科门诊就诊的 HT 女性患者 符合 HT 诊断标准 ［11］ ；（2）女性；（3）有独立行为能力；
100 例作为 HT 组，年龄 18~49 岁；选取同期体检无异 （4）签署知情同意书。
常的健康女性 100 例作为对照组，年龄 21~50 岁。本 1.2.2 对照组纳入标准 同时符合以下 4 项标准：（1）
研究通过成都中医药大学附属医院医学伦理委员会审批 女性；（2）甲状腺激素及甲状腺抗体检查均正常；（3）