温肾健脾疏肝膏方治疗桥本甲状腺炎合并甲减疗效及对Th1/Th2相关细胞因子的影响

Efficacy of warming kidney,invigorating spleen and soothing liver paste recipe on Hashimoto’s thyroiditis combined with hypothyroidism and its influence on Th1/Th2 related cytokines

目的探讨温肾健脾疏肝膏方联合左甲状腺素钠片治疗桥本甲状腺炎合并甲状腺功能减退症(桥本甲减)的疗效及对Th1/Th2相关细胞因子的影响。方法选取河北中医学院第一附属医院2020年10月-2022年4月诊治的脾肾阳虚兼肝郁型桥本甲减患者61例,按照随机数字法分为治疗组31例和对照组30例。2组均采用左甲状腺素钠片治疗,治疗组在此基础上加用温肾健脾疏肝膏方治疗,2组均治疗12周。观察2组治疗前后血清甲状腺激素[促甲状腺激素(TSH)、血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)]、甲状腺自身抗体[甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)]、Th1/Th2相关细胞因子[血清干扰素-γ(IFN-γ)、白细胞介素-10(IL-10)]、甲状腺肿大程度及中医证候积分变化,评估2组临床疗效及不良反应发生情况。结果与治疗前比较,治疗后2组血清FT3、FT4、IL-10水平均明显升高,血清TSH、TPOAb、TGAb、IFN-γ水平及甲状腺肿大程度评分、中医证候积分均明显降低,且治疗组各指标改善情况显著优于对照组,差异均有统计学意义(P均<0.05);治疗12周后,治疗组总有效率为87.10%(27/31),显著高于对照组的66.67%(20/30)(P<0.05);2组不良反应发生率比较差异无统计学意义(P>0.05)。结论温肾健脾疏肝膏方联合左甲状腺素钠片可有效改善脾肾阳虚兼肝郁型桥本甲减患者甲状腺功能及临床症状,降低抗体滴度,改善Th1/Th2失衡状态,缩小甲状腺肿大,临床疗效优于单纯西药治疗,且不增加不良反应。

Objective It is to investigate the therapeutic efficacy of warming kidney,invigorating spleen and soothing liver paste recipe combined with levothyroxine sodium tablets in the treatment of Hashimoto’s thyroiditis combined with hypothyroidism and its influence on Th1/Th2 related cytokines.Methods Sixty-one patients with Hashimoto's thyroiditis with hypothyroidism of syndrome of spleen and kidney yang deficiency with liver depression who were diagnosed and treated at the First Affiliated Hospital of Hebei College of Traditional Chinese Medicine from October 2020 to April 2022 were divided into 31 cases in the treatment group and 30 cases in the control group according to the randomized numerical method,both groups were treated with levothyroxine sodium tablets,and the treatment group was additionally treated with warming kidney,invigorating spleen and soothing liver paste recipe,and the treatment courses of both groups were 12 weeks.The levels of serum thyroid hormones[thyroid-stimulating hormone(TSH),serum free triiodothyronine(FT3),free thyroxine(FT4)],thyroid autoantibodies[thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TGAb)],Th1/Th2-related cytokines[serum interferon-gamma(IFN-γ),interleukin-10(IL-10)],the degree of goiter,and the Chinese medicine symptom scores of the two groups were observed before and after treatment,the clinical efficacy and the occurrence of adverse reactions in the two groups were assessed.Results Compared with before treatment,the levels of serum FT3,FT4 and IL-10 of the two groups were increased significantly,and the the levels of serum TSH,TPOAb,TGAb,IFN-γand the scores of goiter degree and Chinese medicine symptom were decreased significantly after treatment,and the improvement of each index of the treatment group was significantly better than that of the control group,and the differences were all statistically significant(all P<0.05);after 12 weeks of treatment,the total effective rate of the treatment group was 87.10%(27/31),which was significantly higher than that 66.67%(20/30)of the control group(P<0.05);the difference in the incidence rate of adverse reactions between the two groups was not statistically significant(P“>0.05).Conclusion warming kidney,invigorating spleen and soothing liver paste recipe combined with levothyroxine sodium tablets can effectively improve the thyroid function and clinical symptoms,reduce the antibody titer,improve the Th1/Th2 imbalance,and reduce the size of thyroid enlargement in patients with Hashimoto's thyroiditis with hypothyroidism of syndrome of spleen and kidney yang deficiency with liver depression,its clinical curative effect is better than that of western drug treatment alone.