丹栀逍遥散对活动期甲状腺相关眼病患者的疗效及泪液Th1/Th2细胞因子的干预调节作用

Effect of Danzhi-xiaoyao San on tear Th1/Th2 cytokines levels in patients with active thyroid-associated ophthalmopathy

目的基于Th1/Th2细胞因子平衡探讨中药丹栀逍遥散对活动期甲状腺相关眼病(TAO患者的治疗效果及泪液Th1/Th2细胞因子的干预机制。方法36例活动期TAO患者,随机分为对照组(完成15例,失访1例,退出2例)及治疗组(完成16例,失访1例,退出1例),各18例。对照组给予基础治疗及强的松口服,治疗组在对照组基础上加用中药丹栀逍遥散口服。比较两组患者治疗前后的中医证候积分、突眼度、临床活动性评分(CAS),游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)、促甲状腺素受体抗体(TRAb),泪液中的白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)、干扰素诱导蛋白-10(IP-10)、肿瘤坏死因子-α(TNF-α)水平。结果治疗后,两组患者的中医证候积分、突眼度、CAS评分均较本组治疗前降低,且治疗组患者的中医证候积分、突眼度、CAS评分分别为(1.64±0.71)分、(14.16±0.94)mm、(1.71±0.51)分,均低于对照组的(2.37±1.22)分、(15.82±2.15)mm、(2.32±0.84)分,差异均具有统计学意义(P<0.05)。两组患者治疗前后组内、组间的FT3、FT4、TSH、TGAb、TPOAb、TRAb水平比较,差异均无统计学意义(P>0.05)。治疗后,两组患者泪液细胞因子IL-6、IL-8、IL-10、IP-10、TNF-α水平均较本组治疗前降低,差异均具有统计学意义(P<0.05);且治疗组患者的IL-6、TNF-α水平低于对照组,差异均具有统计学意义(P<0.05)。结论中药丹栀逍遥散可有效改善活动期TAO患者的临床症状及体征,其机制可能是通过下调泪腺IL-6、TNF-α等细胞因子表达,调整局部Th1/Th2细胞因子平衡实现的。

Objective To discuss the therapeutic effect of traditional Chinese medicine Danzhi-xiaoyao San on patients with active thyroid-associated ophthalmopathy(TAO)and the intervention mechanism of Th1/Th2 cytokines in tears based on the balance of Th1/Th2 cytokines.Methods A total of 36 cases of active TAO patients were randomly divided into control group(15 completed cases,1 lost case,2 quit cases)and treatment group(16 completed cases,1 lost case,1 quit case),with 18 cases in each group.The control group received basic therapy and oral administration of prednisone,and the treatment group received oral administration of traditional Chinese medicine of Danzhi-xiaoyao San.The traditional Chinese medicine syndrome score,exophthalmos,clinical activity score(CAS),free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH),thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TGAb),thyrotropin receptor antibody(TRAb),interleukin-6(IL-6),interleukin-8(IL-8),interleukin-10(IL-10)interferon-inducible protein-10(IP-10),tumor necrosis factor-α(TNF-α)levels before and after treatment were compared between the two groups.Results After treatment,the traditional Chinese medicine syndrome score,exophthalmos and CAS score of the two groups were lower than those before treatment of the same group,and the traditional Chinese medicine syndrome score,exophthalmos and CAS score of the treatment group were(1.64±0.71)points,(14.16±0.94)mm and(1.71±0.51)points,which were all lower than those of the control group(2.37±1.22)points,(15.82±2.15)mm and(2.32±0.84)points.The difference was statistically significant(P<0.05).Before and after treatment,there was no satistically significant difference in levels of FT3,FT4,TSH,TGAb,TPOAb and TRAb within and between the two groups(P>0.05).After treatment,the levels of tear cytokines IL-6,IL-8,IL-10,IP-10,and TNF-αin the two groups were lower than those before treatment of the same group,and the difference was statistically significant(P<0.05).After treatment,the levels of IL-6 and TNF-αof the treatment group were lower than those of the control group,and the difference was statistically significant(P<0.05).Conclusion Traditional Chinese medicine Danzhi-xiaoyao San can effectively improve the clinical symptoms and signs of patients with active TAO.The mechanism may be achieved by down-regulating the expression of cytokines such as lacrimal gland IL-6 and TNF-αand adjusting the balance of local Th1/Th2 cytokines.