养阴清肝散结方联合西药治疗阴虚火旺型Graves病患者的临床疗效观察及其机制研究

Clinical effects and mechanism of Yangyin Qinggan Sanjie decoction combined western medicines against Graves disease in patients with fire excess from yin deficiency

目的:探讨养阴清肝散结方对阴虚火旺型Graves病的临床疗效及其作用机制。方法:将72例初诊为阴虚火旺型Graves病患者分为治疗组和对照组,每组各36例。2组均给予西药基础治疗(甲巯咪唑+普萘洛尔)控制甲亢。治疗组加用养阴清肝散结方。治疗1个月后观察2组临床疗效和甲状腺功能改善情况,放射免疫测定外周血IL-1β、TNF-α及VEGF水平,流式细胞仪检测PBMC表面抗原CD80、CD54及HLA-DR水平的变化。结果:治疗组临床总有效率显著高于对照组(P<0.05)。经治疗后,2组患者FT3、FT4较治疗前显著降低,TSH显著升高(P<0.05);且治疗组治疗后FT3、FT4和TSH与对照组治疗后相比差异具有统计学意义(P<0.05)。治疗组治疗前后TGAb和TPOAb两项抗体均显著降低(P<0.05),但对照组无明显变化(P>0.05)。2组治疗后外周血IL-1β、TNF-α、VEGF及CD80、HLA-DR水平均较治疗前有所改善(P<0.05),且治疗组治疗后各项指标水平与对照组治疗后相比差异具有统计学意义(P<0.05)。结论:养阴清肝散结方可协同西药改善Graves病的甲状腺功能,其机制可能通过调节T、B淋巴细胞的活化,降低机体炎性细胞水平,抑制机体的免疫炎症反应,有效降低VEGF水平表达,抑制甲状腺组织增殖来实现的。

OBJECTIVE To investigate the clinical effects and mechanism of Yangyin Qinggan Sanjie decoction combined western medicines against Graves disease in patients with fire excess from yin deficiency. METHODS Seventy two Graves disease patients with fire excess from yin deficiency were divided into treatment group and control group, each group included 36 patients. Patients in both groups were given western medicines （methimazole and propranolol） to control hyperthyroidism. Yangyin Qinggan Sanjie decoction was combined in treatment group. After I month of treatment, clinical efficacy and thyroid function were observed. Peripheral blood ILl 13, TNF-α and VEGF levels were measured by adioimmunoassay, CD80, CD54 and HI.A-DR of PBMC surface antigens were observed by flow cytometry. RESULTS The total effective rate of treatment group was significantly higher than that of control group （P〈0. 05）. The degree of improvement of thyroid function in treat ment group was superior to that in the control group （P〈0. 05）. The levels of TGAb and TPOAb after treatment were significantly lower than those before treatment （P〈0. 05） in treatment group rather than in control group （P〈0. 05）. After treat- ment, peripheral blood IL-1β, TNF-α, VEGF and CD80, HLA-DR levels in two group improved than those before treatment （P〈0. 05）. After treatment, above indicators in the treatment groups were statistically significant compared with those in the control group （P〈0. 05）. CONCLUSION Yangyin Qinggan Sanjie decoction combined western medicines can improve thyroid functions in patients with Graves disease, which may be achieved by immunomodulatory effects to promote the GD ＂immune re mission＂ and suppress the immune damage of the thyroid gland.