辨体治疗格雷夫斯病伴肝损害25例临床观察

Clinical Study on Graves′ Disease with Liver Damage Treated by TCM Constitution Identification and Immune Regulation

目的:研究按中医体质辨识理论拟定的龟芍方对格雷夫斯病(Graves病)伴肝损害甲状腺功能及肝功能的改善作用与机制。方法:选取Graves病伴肝损害患者50例,随机分成两组,治疗组25例给予龟芍方加甲巯咪唑片治疗,对照组25例采用复合磷酸酯酶肠溶片加甲巯咪唑片治疗,疗程均为12周。观察两组治疗前后游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素受体抗体(TRAb)、谷丙转氨酶(glutamic-pyruvic transaminase,ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、白细胞介素-17A(IL-17A)、白细胞介素-17F(IL-17F)、白细胞介素-23(IL-23)的变化。结果:经12周治疗,两组患者各异常指标较前均有改善。其中治疗组显效7例,有效15例,无效3例,总有效率为88.0%;对照组中显效3例,有效13例,无效9例,总有效率64.0%;两组有效率比较,差异有统计学意义(P<0.05)。治疗组经12周治疗后各项指标均显著低于对照组,差异有统计学意义(P<0.05)。结论:龟芍方对Graves病伴肝损害患者的甲状腺功能及肝功能有改善作用,其机制与调节细胞免疫有关。

Objective:To study the effect and mechanism of Decoction of GuiShao according to the TCM constitution for improving thyroid function and liver function on Graves'disease with liver damage.Methods:50 patients were randomly divided into two groups.25 cases in the treatment group were treated with GuiShao Decoction and methimazole,others in the control group were treated with Phosphoesterase Complex Enteric-coated Tablets and methimazole,and the course for all was 12 weeks.Changes of free triiodothyronine(FT3),free thyroxine(FT4),thyrotropin receptor antibody(TRAb),glutamic-pyruvic transaminase(ALT),glutamic-oxalacetic transaminase(AST),total bilirubin(TBIL),interleukin-17 A(IL-17A),interleukin-17F(IL-17F),interleukin-23(IL-23)were observed before and after treatment.Results:All the above-mentioned indexes were improved after 12 weeks'treatment in both groups.In treatment group 7 cases were excellent,15 ones effective,and 3 ones ineffective.The total effective rate was 88.0%.In control group 3 cases were excellent,13 ones effective,and 9 ones ineffective.The total effective rate was 64.0%.There was significant differe nee between the two groups(P<0.05).After 12 weeks'treatment,all the above-mentioned indexes were significantly lower in treatment group than those in control group(P<0.05).Conclusion:Decoction of GuiShao has therapeutic effect on thyroid function and liver function,who suffers from Graves'disease with liver damage.Its possible mechanism is related with the regulation on cell immunity.