滋阴降火散结中药辅助治疗Graves病的疗效及对血清干扰素诱导蛋白-10的影响

Effect of Nourishing-Yin Removing-Fire and Dissipating-Stagnation Decoction in Combination with Western Medicine Treatment on Thyroid Volumes and Interferon Induced Protein-10(IP-10)Levels in Patients with Graves Disease

目的：探讨滋阴降火散结方辅助治疗Graves病（以下简称GD）的疗效及作用机制。方法：将100例初诊GD患者随机分为联合中药治疗组（A组）与常规治疗组（B组）各50例,两组均口服他巴唑15-30 mg/d,联合治疗组在此基础上加服滋阴降火散结方50 mL,3次/d。两组均连续用药12周。观察两组治疗前后甲状腺体积、甲状腺上动脉血流速度、甲状腺血管指数及血清IP-10的水平变化,同时与正常人群做比较,并行相关分析。结果：治疗后联合中药治疗组较常规治疗组更明显的降低甲状腺体积（P〈0.05）、甲状腺上动脉血流速度（P〈0.05）、甲状腺血管指数（P〈0.05）。新发GD患者血清IP-10的水平有意义增加同时伴有甲状腺血流增加,血清IP-10的水平与甲状腺上动脉最大收缩速度（STA-PSV）、甲状腺内血管生成指数（TVI）和甲状腺容量相关（r=0.67,0.73,0.70,P〈0.05）。联合中药治疗组较常规治疗组更明显的降低血清IP-10的水平（P〈0.05）。结论：滋阴降火散结方对活动期的GD伴甲状腺肿大疗效确切,能有效抑制甲状腺内血管形成,其机制可能为降低血清中IP-10水平。

Objective ： To study the effect of the Nourishing-Yin Removing-Fire and Dissipating- Stagnation Decoction in combination with medicine treatment on thyroid volumes and serum interferon induced protein-10 （ IP-10 ） levels in patients with Graves disease （ GD ）. Methods ： 100 patients were divided into two groups ： Group A was treated with methimazole （ MT ） combined with Nourishing-Yin Removing-Fire and Dissipating-Stagnation Decoction and Group B was treated with MT alone. Thyroid volumes, superior thyroid artery peak systolic velocity （ STA-PSV ）, thyroid vascularity index （ TVI ） and serum IP-10 levels in patients were also observed in Group A and B before and after treatment. The correlation between thyroid volumes, STA-PSV, TVI and serum IP-10 levels in patients was analyzed. Results ： The levels of serum IP-10 was increased significantly with increased intrathyroidal blood flow in newly diagnosed GD patients. There was a positive correlation between thyroid volumes, STA-PSV, TVI and serum IP-10 levels in patients （ r=0.67,0.73,0.70, P〈0.05 ）. Thyroid volumes, superior thyroid artery peak systolic velocity （ STA-PSV ）, thyroid vascularity index （ TVI ） and serum VEGF levels were decreased more in Group A than in Group B after treatment （ 23.88 ± 9.46 vs 31.70 ± 18.90; 67.37 ± 38.85 vs 85.60 ± 43.80; 0.203 ± 0.108 vs 0.250± 0.075; 80.1± 33.9 vs 107.6 ±44.8, P〈0.05 ）. Conclusions ： Nourishing- Yin Removing-Fire and Dissipating-Stagnation Decoction in combination with western medicine treatment can improve goiters more effectively than only traditional western medicine by decreasing serum IP-10 levels Of patients with GD.