白芍总苷联合硒酵母对Graves病患者促甲状腺激素受体抗体水平及突眼度的影响

Effects of total glucosides of paeonia lactiflora combined with selenium yeast on thyrotropin receptor antibody level and exophthalmos in patients with Graves disease

目的观察白芍总苷联合硒酵母对Graves病患者促甲状腺激素受体抗体(TRAb)水平及突眼度的影响。方法选取本院内分泌科门诊2019年10月至2020年2月收治的90例Graves患者为研究对象,按随机数字表法将其分为对照组、治疗组1、治疗组2,各30例。三组均予以甲巯咪唑治疗,治疗组1在此基础上加用硒酵母治疗,治疗组2在治疗组1基础上加用白芍总苷治疗。比较三组治疗前及治疗3、6个月后的甲状腺功能指标,治疗前与治疗6个月后的左、右眼突眼度差值,治疗6个月后甲巯咪唑的使用总量及不良反应发生情况。结果治疗前,三组患者的FT_(3)、FT_(4)、TSH、T_(3)、T_(4)、TRAb水平比较,差异无统计学意义(P>0.05);治疗3、6个月后,三组患者的FT_(3)、FT_(4)、T_(3)、T_(4)、TRAb水平均低于治疗前,TSH水平均高于治疗前,差异具有统计学意义(P<0.01);治疗3、6个月后,治疗组1、治疗组2的FT_(3)、FT_(4)、T_(3)、T_(4)、TRAb水平均低于对照组,且治疗组2低于治疗组1,差异具有统计学意义(P<0.05);治疗3、6个月后,治疗组1、治疗组2的TSH水平均高于对照组,且治疗组2高于治疗组1,差异具有统计学意义(P<0.05)。治疗组2治疗前与治疗6个月后的左、右眼突眼度差值均低于对照组、治疗组1,治疗6个月后甲巯咪唑的使用总量少于对照组、治疗组1,差异具有统计学意义(P<0.05)。三组治疗期间的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论白芍总苷联合硒酵母治疗Graves病能降低患者的TRAb水平,延缓突眼的发展,减少甲巯咪唑的使用总量,提高抑制甲状腺激素的效果,改善症状,值得临床推广应用。

Objective To observe the effects of total glucosides of paeonia lactiflora combined with selenium yeast on thyrotropin receptor antibody(TRAb) level and exophthalmos in patients with Graves disease. Methods A total of 90 patients with Graves disease admitted in the clinic of endocrinology department of our hospital from October 2019 to February 2020 were selected as the research objects, and the patients were divided into control group, treatment group 1 and treatment group 2 according to random number table method, with 30 cases in each group. All three groups were treated with methimazole, the treatment group 1 was additionally treated with selenium yeast on this basis, and the treatment group 2 was additionally treated with total glucosides of paeonia lactiflora on the basis of the treatment group 1.The indexes of thyroid function before treatment and after 3 and 6 months of treatment, the difference of exophthalmos of left and right eye before and 6 months after treatment, the used total amount of methimazole after 6 months of treatment and the occurrence of adverse reactions were compared among the three groups. Results Before treatment, there were no statistically significant differences in the FT_(3), FT_(4), TSH, T_(4), T_(4) and TRAb levels among the three groups(P>0.05);after 3 and 6 months of treatment, the FT_(3), FT_(4), T_(3), T_(4) and TRAb levels in the three groups were lower than those before treatment, and the TSH level was higher than that before treatment, the differences were statistically significant(P<0.01);after 3 and 6 months of treatment, the FT_(3), FT_(4), T_(3), T_(4) and TRAb levels in the treatment group 1 and the treatment group2 were lower than those in the control group, and those in the treatment group 2 were lower than the treatment group 1,the differences were statistically significant(P<0.05);after 3 and 6 months of treatment, the TSH level in the treatment group 1 and the treatment group 2 was higher than that in the control group, and that in the treatment group 2 was higher than the treatment group 1, the differences were statistically significant(P<0.05). The difference of exophthalmos of left and right eye in the treatment group 2 before treatment and 6 months after treatment was lower than that in the control group and the treatment group 1, the used total amount of methimazole after 6 months of treatment was less than that in the control group and the treatment group 1, the differences were statistically significant(P<0.05). There was no significant difference in the total incidence of adverse reactions among the three groups during treatment(P >0.05).Conclusion The total glucosides of paeonia lactiflora combined with selenium yeast in the treatment of Graves disease can reduce the TRAb level, delay the development of exophthalmos, reduce the used total amount of methimazole,improve the effect of inhibiting thyroid hormone and symptoms of patients, which is worthy of clinical promotion and application.