莲蓣消瘿汤联合中药透药治疗肝郁脾虚型桥本甲状腺炎临床研究

Clinical Study on Treatment of Hashimoto Thyroiditiswith Liver Depression and Spleen Deficiency by Lianyu Xiaoying Decoction Combined with Chinese Medicine Penetration

目的:观察莲蓣消瘿汤中药内服联合中药透药对肝郁脾虚型甲状腺功能正常HT患者的疗效。方法:选取2017年1月-2019年7月在上海市嘉定区中医医院内分泌科就诊甲状腺功能正常的桥本甲状腺炎患者132例,随机分成莲蓣消瘿汤药组、中药透药组、莲蓣消瘿汤联合透药组3组,治疗12周;治疗前后通过化学发光免疫分析法检测FT3、FT4、TSH、TPO-Ab、TG-Ab浓度,ELISA检测外周血血浆IL-2、IL4水平,彩超检测甲状腺肿并评估中医证候积分。结果:(1)甲状腺自身抗体比较:三组TPO-Ab、TG-Ab治疗后明显低于治疗前(P<0.01);联合组TPO-Ab、TG-Ab明显低于莲蓣消瘿汤组、透药组(P<0.01),莲蓣消瘿汤组TPO-Ab、TG-Ab低于透药组(P<0.05);(2)甲状腺肿大比较:三组甲状腺大小左叶、右叶、峡部均较治疗前减小(P<0.05);联合组左叶、右叶、峡部均小于莲蓣消瘿汤组、透药组(P<0.05),透药组左叶、右叶、峡部小于莲蓣消瘿汤组(P<0.05);(3)中医证候积分:治疗后三组症状总积分较治疗前明显降低(P<0.05),联合组、莲蓣消瘿汤组总积分明显低于透药组(P<0.05),莲蓣消瘿汤组低于透药组(P<0.05),联合组与莲蓣消瘿汤组无明显差异(P>0.05);(4)IL-2、IL-4水平比较:治疗后三组患者IL-2水平显著低于治疗前(P<0.05),联合组、汤药组下降程度优于透药组(P<0.05);IL-4水平显著高于治疗前(P<0.05),联合组、汤药组上升程度优于透药组(P<0.05)。结论:莲蓣消瘿汤联合中药透药可有效缩小甲状腺肿大,降低甲状腺抗体滴度,调节Th1/Th2细胞表达因子,改善临床症状,并且不会引起甲状腺功能波动,可安全应用于临床治疗桥本甲状腺炎。

Objective:To investigate the clinical effect of Lianyu Xiaoying(LYXY)Decoction combined with traditional Chinese medicine(TCM)penetration in treatment of Hashimoto thyroiditis with normal thyroid function due to liver depression and spleen deficiency.Methods:Patients(132 cases)with Hashimoto thyroiditis in Department of endocrinology,traditional Chinese medicine Hospital of Jiading District of Shanghai from January 2017 to July 2019,were randomly divided into LYXY decoction,TCM penetration and combine groups.Treatment after 12 weeks,the TCM clinical symptoms,FT3,FT4,TSH,TPO-Ab and TG-Ab titer change and improvement of thyroid enlargement were evaluated,the expression level of IL-2、IL-4 were determined by enzyme-linked immunosorbent assay(ELISA).Results:(1)Comparison of thyroid autoantibodies:the three groups of TPO-Ab and TG-Ab were significantly lower than before treatment(P<0.01);the combined group of TPO-Ab and TG-Ab were significantly lower than the LYXY decoction group and the TCM penetration group(P<0.01),TPO-Ab and TG-Ab in the LYXY Decoction group were lower than those in the TCM penetration group(P<0.05);(2)Comparison of goiter:the left,right lobes and isthmus of the three groups were more treated Anterior reduction(P<0.05);the left,right,and isthmus of the combined group were smaller than the LYXY decoction group and the TCM penetration group(P<0.05),and the left,right,and isthmus of the TCM penetration group were smaller than the LYXY decoction group(P<0.05);(3)TCM syndrome score:After treatment,the total score of the three groups was significantly lower than before treatment(P<0.05).The total score of the combined group and the LYXY decoction group was significantly lower than that of the TCM penetration group(P<0.05),the LYXY decoction group was lower than the TCM penetration group(P<0.05),and there was no significant difference between the combined group and the LYXY decoction group(P>0.05);(4)Comparison of IL-2 and IL-4 levels:treatment the level of IL-2 in the latter three groups was significantly lower than that before treatment(P<0.05),and the decrease in the combination group and the LYXY decoction group was better than that in the TCM penetration group(P<0.05);the level of IL-4 was significantly higher than that before treatment(P<0.05);and the increase in the combination group and the LYXY decoction group was better than that in the TCM penetration group(P<0.05).Conclusion:LYXY decoction combined with TCM penetration has obviously decreased TPO-Ab and TG-Ab titer of Hashimoto thyroiditis with normal thyroid function,can control the balance of Th1/Th2 cell,regulate the immune system and reduce goiter,improve clinical symptoms,signs and clinical efficacy.