平肝潜阳药物对甲状腺功能亢进症肝阳上亢证患者的临床疗效观察和血淋巴细胞蛋白质表达的影响

Herbs for calming liver and suppressing Yang in treatment of hyperthyroidism with hyperactive liver Yang:Herbal effects on lymphocyte protein expression

目的:观察平肝潜阳药物对甲状腺功能亢进症肝阳上亢证患者的临床疗效和血淋巴细胞蛋白质表达的影响,为深入研究平肝潜阳法治疗甲状腺功能亢进症肝阳上亢证分子机制奠定基础。方法:48例甲状腺功能亢进症肝阳上亢证患者随机分为治疗组和对照组,治疗组口服平肝潜阳法中药复方;对照组口服甲巯咪唑片剂。3个疗程后,比较2组治疗前后的中医症状和体征记分的变化,观察心电图(P波),甲状腺激素(TSH,FT3,FT4),B超和不良反应等变化;采用双向凝胶电泳-串联质谱法分离和鉴定甲状腺功能亢进症肝阳上亢证患者外周血淋巴细胞和正常人之间差异蛋白表达,并观察应用平肝潜阳法药物干预后差异蛋白质表达水平的变化。结果:治疗组具有减慢心率、降低P波振幅、调节甲状腺激素水平和缩小甲状腺肿块体积作用,与对照组比较,差异无统计学意义;但在改善中医症状和减少副反应方面,治疗组明显优于对照组,以改善口干、烦躁易怒、面部烘热症状更为明显(P<0.05)。2组在总疗效方面比较无差异。正常组、治疗组治疗前和治疗组治疗后淋巴细胞凝胶蛋白质点数依次为429±31,452±28和437±36。治疗组治疗前与正常组比较有8个蛋白质表达下调,11个蛋白质表达上调;治疗组治疗前后比较,表达下调8个蛋白质中有5个表达增强,而表达上调11个蛋白质中有8个表达降低。共得到10肽质量指纹图谱,2个无质谱结果,搜索到8个具有统计学意义的蛋白质,主要有通道蛋白、抗氧化蛋白、代谢相关蛋白、免疫相关蛋白和细胞信号转导蛋白等。结论:平肝潜阳药物中药复方能够调节甲状腺素水平、改善中医症状和体征、减少不良反应;其治疗甲状腺功能亢进症肝阳上亢证可能是通过调节部分血淋巴细胞蛋白质的表达而实现。

Objective： To observe the herbal effects on hyperthyroidism patients with syndrome of hyperactivity of liver-Yang by method for calming the liver and suppressing Yang and investigate its effects on the lymphocyte protein expression. This approach may lay a foundation for the further investigation of the curative mechanisms of calming the liver and suppressing Yang treatment. Method： A total of 48 hyperthyroidism patients with syndrome of hyperactivity of liver-Yang were randomly divided into treatment group and control group. The treatment group was treated by method for calming the liver and suppressing Yang in accordance with traditional Chinese medicine （TCM） and the control group with thiamazole tablets for three periods of treatment. The therapeutic effects, the score of TCM symptom, electrocardiogram （P wave）, thyroid hormones and ultrasound were observed in both groups before and after the treatment. The side effects in the treatment course were observed in both groups. The level of differential protein expression was analyzed by two-dimensional electrphoresis and matrix assisted laser desorption/ionizaton time-of-flight mass spectrometry. Result： The treatment group has the effect on stepping down the heart rate, cutting down the P wave amplitude changes, regulating the level of thyroid hormones and decreasing the volume of thyromegaly. There are not statistically significant between the treatment group and control group. However, the treatment group has obviously better effect on regulating TCM symptom and decreasing the side reaction than the control group（P〈0.05）. There are not statistically significant on the total effective between the treatment group and control group. The average spots in lymphocyte for normal people, before and after treating hyperthyroidism patients with syndrome of hyperactivity of liver-Yang were （429±31）, （452±28） and （437±36） spots respectively. Eight down-regulated protein expressions and 11 up-regulated protein expressions were obtained in the hyperthyroidism patients with syndrome of hyperactivity of liver-Yang and normal people. Five strengthened expressions of protein were also obtained in 8 down-regulated expressions of protein and 8 lower expressions of protein in 11 up-regulated expressions of protein before and after treating the migraine patients with syndrome of hyperactivity of liver-Yang. Ten of the total 8 differential protein spots were successfully identified by MALDI-TOF-MS. The functions of these proteins were involved in metabolism associated, transportation, antioxidation, sigal transduction and immume associated protein, etc. according to information provided by NCBI and MSDB database. Conclusion： In this study, the TCM complex prescription with herbs for calming the liver and suppressing Yang can regulate the thyroid hormones, improves TCM symptoms, and decrease the adverse reaction. It can possibly regulate lymphocyte protein expression.