解郁消瘿汤治疗肝郁脾虚型桥本甲状腺炎疗效及对Th17、Treg相关因子的影响

Effect of Using Jieyu Xiaoying Decoction in Treating Liver Depression and Spleen Deficiency Type Hashimoto’s Thyroiditis and Its Effect on Th17 and Treg Related Factors

目的:观察解郁消瘿汤组方治疗肝郁脾虚型桥本甲状腺炎(HT)疗效,并初步探讨其治疗机制。方法:选择94例HT患者作为研究对象,按照随机数字表法分为治疗组和对照组,每组47例。对照组予以硒酵母片口服,每次200mμg,每日2次,治疗组在此基础上予以中药解郁消瘿汤,疗程均为12周。比较两组治疗前后中医证候评分、甲状腺左叶、右叶和峡部厚度,并比较两组治疗前后游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)、促甲状腺激素(TSH)、抗甲状腺过氧化物酶抗体(TPOAb)、抗甲状腺球蛋白抗体(TGAb)和血清白细胞介素(IL)-17、IL-35、IL-10、γ-干扰素(IFN-γ)水平,比较两组治疗总有效率。结果:治疗后治疗组中医证候积分(颈部肿大、面部水肿、倦怠乏力、胸胁胀满、畏寒怕冷)均低于对照组(P<0.01);甲状腺左叶、右叶、峡部厚度均小于对照组(P<0.01);TSH、TPOAb、TGAb低于对照组(P<0.01);血清IL-10、IL-35水平高于对照组(P<0.01),IL-17、IFN-γ水平低于对照组(P<0.01),治疗总有效率高于对照组(P<0.05),差异均有统计学意义。结论:解郁消瘿汤可有效减少中医证候积分,降低甲状腺厚度,改善甲状腺功能,治疗肝郁脾虚型HT效果显著,其机制可能与调节Th17、Treg相关细胞因子有关.

Objective:To observe the therapeutic effect of Jieyu Xiaoying Decoction on Hashimoto’s thyroiditis(HT)of liver depression and spleen deficiency type,and to explore its therapeutic mechanism.Methods:94 patients with HT were randomly divided into a treatment group and a controlled group,with 47 cases in each group.The controlled group were given Selenium Yeast Tablets orally,200 mμg each time.The treatment group was treated with Jieyu Xiaoying Decoction twice a day for 12 weeks.The TCM syndrome score,the thickness of left lobe,right lobe and isthmus of thyroid were compared between the two groups before and after treatment,and the level of the free thyroxine(FT4),free triiodothyronine(FT3),thyroid stimulating hormone(TSH),anti thyroid peroxidase antibody(TPOAb),anti thyroglobulin antibody(TGAb),serum interleukin(IL)-17,IL-35 IL-10,γ-Interferon(IFN)-γ were compared between the two groups before and after treatment,and the total effective rates of the two groups were compared.Results:The scores of neck swelling,facial edema,fatigue,chest and flank fullness,fear of cold and fear of cold of the treatment group were lower than those of the controlled group after treatment(P<0.01).The thickness of left lobe,right lobe and isthmus of thyroid were lower than those of the controlled group(P<0.01).TSH,TPOAb and TGAb were lower than those of the controlled group(P<0.01).The levels of serum IL-10 and IL-35 of the controlled group were higher than those of the controlled group(P<0.01).The level of IL-17,IFN-γwere lower than those of the controlled group(P<0.01).The total effective rate of the treatment group was higher than that of the controlled group(P<0.05).Conclusion:Jieyu Xiaoying Decoction can effectively reduce TCM syndrome score,reduce thyroid thickness,improve thyroid function,and it has a significant effect on HT of liver depression and spleen deficiency type.Its mechanism may be related to the regulation of Th17 and Treg related cytokines.