优甲乐结合疏肝健脾温肾方改善桥本甲状腺炎患者免疫功能的研究

Effect of L-T4 Combined with Shugan Jianpi Wenshen Formula on Immune Function of Patients with Hashimoto Thyroiditis

目的:探讨优甲乐结合疏肝健脾温肾方对桥本甲状腺炎患者免疫功能的影响。方法:选取符合纳入标准的桥本甲状腺炎患者120例随机分为西药组与联合组,每组60例。西药组患者口服优甲乐(左甲状腺素钠片)1~2μg/(kg·d)进行治疗,联合组在西药组的基础上给予疏肝健脾温肾方治疗,3个月后比较两组患者血清Th17/CD_4^+T的比例以及甲状腺自身抗体水平的变化,同时对两组患者的甲状腺形态及其相关的功能指标进行对比分析。结果:两组患者TPOAb,TGAb水平在治疗前后均存在显著性差异(P<0.05),且治疗后联合组患者抗体水平显著低于西药组(P<0.05)。在Th17/CD_4^+方面,西药组治疗后并不具有显著性差异(P>0.05),但是联合组治疗前后具有显著性差异,且与治疗后的西药组相比,差异具有统计学意义(P<0.05);同时西药组治疗前后患者的甲状腺形态并无显著性变化(P>0.05),但联合组治疗前后差异具有统计学意义(P<0.05),而且对治疗后的两组甲状腺形态比较,可以发现联合组甲状腺肿大减少显著低于西药组(P<0.05)。两组患者治疗前后血脂指标值均具有明显差异,且治疗后的联合组显著低于西药组,经统计学分析,组间差异具有显著性(P<0.05)。联合组的临床疗效显著高于西药组(P<0.05),不良反应较少,但两组间比较,无显著性差异。结论:优甲乐结合疏肝健脾温肾方可以改善桥本甲状腺炎患者的免疫功能,用药安全,临床疗效显著。

Objective： To explore the effect of L-T4 combined with Shugan Jianpi Wenshen Formula on improving the immune function of the patients with Hashimoto thyroiditis. Methods： 120 patients with Hashimoto thyroiditis were randomly divided into the western medicine group（ n = 60） and the combined group（ n = 60）.The patients in the western medicine group were treated with L-T4[1 ~ 2 μg/（ kg·d） ]; on which basis,the combined group was also treated with Shugan Jianpi Wenshen Formula. After three months of treatment,the ratio of serum levels of Th17/CD_4~＋ T and thyroid autoantibody were compared between the two groups,and the thyroid morphology and its related functional indexes were compared as well. Results： There were significant difference in the levels of TPOAb and TGAb before and after the treatment in the two groups（ P〈0. 05）,and the antibody level of the combined group was significantly lower than that of the western medicine group. In terms of the level of Th17/CD_4~＋ T,there was no significant difference before and after the treatment in the western medicine group（ P〉0. 05）,but there was significant difference before and after the treatment in the combined group; and the difference was statistically significant between the two groups after the treatment（ P〈0. 05）. In terms of thyroid morphology,there was no significant difference between before and after the treatment in the western medicine group（ P〉0. 05）,but there was significant difference in the combined group（ P〈0. 05）; the reduction of goiter in the combined group was more significant than that in the western medicine group（ P〈0. 05）. In terms of index value of blood lipid,there was significant difference in the two groups before and after treatment,and the combined group was significantly better than the western medicine group（ P〈0. 05）. The clinical efficacy was higher in the combined group than that in the western medicine group（ P〈0. 05）,but there was no differences in adverse reactions between the two groups（ P〉0. 05）. Conclusion： The therapy of L-T4 combined with Shugan Jianpi Wenshen Formula can improve the immune function of patients with Hashimoto thyroiditis,and it is safe with remarkable clinical efficacy.