中药诱导Graves'病甲状腺细胞凋亡的初步研究

Preliminary Study on Chinese Herb Induced Apoptosis of Thyrocytes in Graves′ Disease

目的：寻找快速缓解治疗弥漫性甲状腺肿大伴甲状腺功能亢进（Ｇｒａｖｅｓ′病）的途径。方法：对１３例Ｇｒａｖｅｓ′病患者，加用中药治疗前、后经皮穿刺针吸取甲状腺组织，采用核固红染色观察细胞形态，流式细胞仪检测细胞凋亡的比率，末端标记等方法观察抗甲状腺药物与中药联合应用对Ｇｒａｖｅｓ′病的影响。结果：与单纯抗甲状腺药物（Ａ组）治疗比较，患者经抗甲状腺药物与中药联合应用（Ｂ组）治疗２～１０周后，甲状腺组织明显缩小（Ｐ＜００１）；光镜下可见细胞发泡、核着边、核固缩、核小体、核分裂等凋亡细胞的典型形态；加中药治疗前后甲状腺细胞凋亡比率分别为（２１１±１７８）％和（１８６６±２００１）％（Ｐ＜００１）；末端标记呈阳性。结论：抗甲状腺药物与中药联合应用治疗Ｇｒａｖｅｓ′病时可诱导甲状腺细胞凋亡。

Objective: To investigate the cellular and molecular mechanisms of some Chinese herbs on apoptosis of thyrocytes in Graves′ disease. Methods: Thirteen patients of Graves′ disease were treated by anti thyroid drugs and Chinese herbs were added in the therapeutic period for 2～10 weeks. Thyroid tissue of patient was sucked by percutaneous aspiration before and after adding Chinese herbs for observing the cellular morphology by fast red tablet staining, monitoring the cell apoptotic ratio by flow cytometry and terminal uridine deoxynucleotidyl end labelling (TUNEL) method to observe the effect of anti thyroid drugs combined with Chinese herbs on Graves′ disease. Results: Compared with that treated with anti thyroid drugs alone, after the combined therapy, the size of thyroid decreased significantly, P<0 01. Typical apoptosis appearance, such as vacuolated cell, marginal nuclei, chromatin condensation and nuclear fragmentation, could be seen under light microscopy. The apoptotic rate before and after adding Chinese herbs was (2.11±1.78)% and (18.66±20.01)% respectively (P<0 01). TUNEL positive cells were detectable for up to 2～20 weeks after Chinese herbal treatment. Conclusion: Some Chiness herbs could induce cell apoptosis when used in combination with anti thyroid drugs in treating Graves′ disease.