参芪扶正汤治疗桥本氏甲状腺炎合并甲状腺功能减退临床疗效及相关机制研究

Effect and study on related mechanisms of Shenqi Fuzheng Decoction in treatment of hashimoto’s thyroiditis combined with hypothyroidism

[目的]探讨参芪扶正汤治疗桥本氏甲状腺炎(HT)合并甲状腺功能减退的临床疗效,初步分析其治疗机制。[方法]选择秦皇岛市中医医院2020年1月—2023年1月收治的HT患者110例,按照随机数字表法分为观察组和对照组,每组55例,两组均口服左甲状腺素钠片,在此基础上,对照组口服亚硒酸钠片,观察组口服中药参芪扶正汤,疗程12周。比较两组治疗前后中医证候评分、甲状腺体积和峡部厚度、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)、甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb),长链非编码RNA人母系表达基因3(lncRNA MEG3)、微小RNA-17(miR-17)、辅助性T淋巴细胞亚群17(Th17)、调节性T细胞(Treg)含量、Th17/Treg值,并比较两组治疗总有效率。[结果]治疗后观察组中医证候评分低于对照组(P<0.05),甲状腺体积和峡部厚度均低于对照组(P<0.05);血清FT3、FT4水平高于对照组(P<0.05),TSH、TGAb、TPOAb水平低于对照组(P<0.05);观察组Th17、Th17/Treg、miR-17低于对照组(P<0.05),Treg、lncRNA MEG3高于对照组(P<0.05);治疗总有效率高于对照组(P<0.05)。[结论]参芪扶正汤可以改善中医证候和甲状腺功能,调节甲状腺自身抗体,减小甲状腺体积,治疗HT合并甲状腺功能减退效果显著,其机制可能与调节血清lncRNA MEG3、miR-17有关。

[Objective]To explore the clinical efficacy of Shenqi Fuzheng Decoction in the treatment of hashimoto’s thyroiditis(HT)with hypothyroidism,and to analyze its therapeutic mechanism preliminarily.[Methods]The 110 HT patients admitted to our hospital from January,2020 to January,2023 were randomly divided into an observation group and a control group,with 55 cases in each group.Both groups were orally treated with levothyroxine sodium tablets.The control group were orally treated with sodium selenite tablets,while the observation group were treated with traditional Chinese medicine(TCM)Shenqi Fuzheng Decoction orally for 12 weeks.The TCM syndrome scores,thyroid volume and isthmus thickness,free triiodothyronine(FT3),free thyroxine(FT4),thyrotropin(TSH),thyroid globulin antibody(TGAb),thyroid peroxidase antibody(TPOAb),lncRNA MEG3,miR-17,Th17,Treg content,Th17/Treg value before and after treatment were compared between the two groups,and the total effective rate was compared between the two groups.[Results]The TCM syndrome score of the observation group was lower than that of the control group(P<0.05),and the thyroid volume and isthmus thickness were lower than those of the control group(P<0.05).The serum levels of FT3,FT4 were higher than those of the control group(P<0.05).TSH,TGAb,and TPOAb were lower than those in the control group(P<0.05).The Th17,Th17/Treg,and miR-17 levels of the observation group were lower than those of the control group(P<0.05),while Treg and lncRNA MEG3 levels were higher than those of the control group(P<0.05).The total effective rate of treatment was higher than that of the control group(P<0.05).[Conclusion]Shenqi Fuzheng Decoction can effectively improve traditional Chinese medicine syndromes and thyroid function,regulate thyroid autoantibodies,reduce thyroid volume,and it has a significant therapeutic effect on HT combined with hypothyroidism.Its mechanism may be related to the regulation of serum lncRNA MEG3 and miR-17.