二仙消瘿汤对桥本甲状腺炎患者免疫性抗体、Th1/Th2相关细胞因子的影响

Effects of Erxian Xiaoying Decoction on Immune Antibodies and Th1/Th2-related Cytokines in Patients with Hashimoto′s Thyroiditis

目的:观察二仙消瘿汤治疗桥本甲状腺炎疗效及对甲状腺自身免疫性抗体、Th1/Th2相关细胞因子的影响。方法:90例桥本甲状腺炎患者作为本研究对象,按照随机数字表法将其分为观察组和对照组,每组各45例。对照组给予常规优甲乐治疗,观察组在此基础上给予二仙消瘿汤(方剂组成:仙茅、淫羊藿、熟地黄、山萸肉、淮山药、巴戟天、鹿角胶、当归、浙贝母、川芎、甘草等)。比较两组患者临床疗效、血清甲状腺激素水平、甲状腺自身相关抗体和Th1/Th2相关细胞因子。结果:观察组临床治疗有效率为93.33%,对照组为77.28%,两组比较,差异有统计学意义(P<0.05)。治疗后,两组患者中医证候积分均显著降低(P<0.05),且观察组治疗后低于对照组(P<0.05)。治疗前,两组患者血清抗甲状腺球蛋白抗体(antithyroglobulin antibody,TGAb)和抗甲状腺过氧化物酶抗体(anti-thyroid peroxidase antibody,TPOAb)比较,差异无统计学意义(P>0.05);治疗后两组血清TGAb、TPOAb均显著下降(P<0.05),且观察组显著低于对照组(P<0.05)。治疗前,两组患者血清γ-干扰素(interferon-γ,IFN-γ)、白细胞介素-10(interleukin-10,IL-10)比较,差异无统计学意义(P>0.05);治疗后,两组患者IFN-γ明显降低(P<0.05),IL-10明显升高(P<0.05);且观察组IFN-γ显著低于对照组(P<0.05),IL-10显著高于对照组(P<0.05)。治疗前两组患者促甲状腺激素(thyroid stimulating hormone,TSH)、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、血清游离甲状腺素(free thyroxine,FT4)水平比较,差异无统计学意义(P>0.05);治疗后两组患者TSH明显降低(P<0.05),FT3、FT4明显升高(P<0.05);且观察组TSH显著低于对照组(P<0.05),FT3、FT4显著高于对照组(P<0.05)。结论:二仙消瘿汤治疗桥本甲状腺炎疗效显著,能显著提高甲状腺功能,降低甲状腺自身免疫性抗体,其机制可能是降低IFN-γ表达,升高IL-10表达,调节Th1/Th2失衡。

Objective:To observe the efficacy of Erxian Xiaoying Decoction in the treatment of Hashimoto′s thyroiditis and its effect on thyroid autoimmune antibodies and Th1/Th2-related cytokines.Methods:Ninety patients with Hashimoto′s thyroiditis were taken as the object of this study.They were divided into observation group and control group according to the random number table method,with 45 cases in each group.The control group was given conventional Youjiale treatment,and the observation group was given Erxian Xiaoying Decoction(formula composition:Xianmao(Rhizoma curculiginis),Yinyanghuo(Epimedium),Shudihuang(Prepared rehmannia),Shanyurou Pulp of dogwood fruit),Huaishanyao(Huai yam),Bajitian(Morinda officinalis),Lujiaojiao(Antlers),Danggui(Angelica),Zhebeimu(Fritillaria cirrhosa),Chuanxiong(Ligusticum wallichii),Gancao(Licorice),etc.The clinical efficacy,serum thyroid hormone levels,thyroid autoantibodies,and Th1/Th2-related cytokines were compared between the two groups of patients.Results:The effective rate of clinical treatment was 93.33%in the observation group and 77.28%in the control group.There was a statistically significant difference between the two groups(P<0.05).After treatment,the TCM syndrome scores of both groups were significantly reduced(P<0.05),and the observation group was lower than that of the control group after treatment(P<0.05).Before treatment,there was no significant difference in serum antithyroglobulin antibody(TGAb)and anti-thyroid peroxidase antibody(TPOAb)between the two groups of patients(P>0.05).Serum TGAb and TPOAb in both groups decreased significantly(P<0.05),and the observation group was significantly lower than the control group(P<0.05).Before treatment,there was no significant difference in serumγ-interferon(IFN-γ)and interleukin-10(IL-10)between the two groups of patients(P>0.05).IFN-γwas significantly reduced in both groups(P<0.05),and IL-10 was significantly increased(P<0.05).In the observation group,IFN-γwas significantly lower than in the control group(P<0.05),and IL-10 was significantly higher than Control group(P<0.05).There was no significant difference in the levels of thyroid stimulating hormone(TSH),free triiodothyronine(FT3),and serum free thyroxine(FT4)in the two groups of patients before treatment(P>0.05);After treatment,TSH in the two groups was significantly reduced(P<0.05),and FT3 and FT4 were significantly increased(P<0.05);and TSH in the observation group was significantly lower than that in the control group(P<0.05),and FT3 and FT4 were significantly higher.In the control group(P<0.05).Conclusion:Erxian Xiaoying Decoction has a significant effect on Hashimoto′s thyroiditis,which can significantly improve thyroid function and reduce thyroid autoimmune antibodies.The mechanism may be to decrease Th1/Th2 imbalance by reducing IFN-γexpression and increasing IL-10 expression.