海藻-甘草反药组合在海藻玉壶汤抗丙硫氧嘧啶致甲状腺肿大中的作用研究

目的:探讨海藻-甘草剂量为《中华人民共和国药典》2015年版规定高限剂量2倍的条件下,海藻-甘草反药组合在海藻玉壶汤抗丙硫氧嘧啶(PTU)致大鼠甲状腺肿大中的作用。方法:Wistar雄性大鼠84只,按体质量随机分为对照组、模型组、阳性药组(优甲乐)、海藻玉壶汤全方组(简称“全方组”)、海藻玉壶汤去海藻组(简称“去海藻组”)、海藻玉壶汤去甘草组(简称“去甘草组”)、海藻玉壶汤去海藻及甘草组(简称“去藻草组”),每组12只。造模期间,除对照组外,其余各组大鼠灌胃给予PTU(10 mg·kg^(-1)),每日1次,共14 d。模型制备成功后,对照组与模型组大鼠灌胃给予去离子水,阳性药组大鼠给予优甲乐(20μg·kg^(-1)),其余各给药组给予相应中药煎液(给药剂量为全方组12.06 g·kg^(-1)、去海藻组9.9 g·kg^(-1)、去甘草组10.26 g·kg^(-1)、去藻草组8.1 g·kg^(-1)),每日给药1次,持续28 d。治疗期间,每隔1 d,除对照组外,其余各组大鼠均灌胃给予PTU以维持模型稳定,剂量依前。给药结束后计算各组大鼠的甲状腺系数;光镜下观察甲状腺组织形态;放射免疫法检测血清中三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平。结果:与对照组比较,各组大鼠甲状腺系数显著升高(P<0.01);与模型组比较,各中药煎液给药组大鼠甲状腺系数显著降低(P<0.01)。光镜下观察大鼠甲状腺组织形态,结果显示,与对照组比较,模型组与阳性药组变化最为显著,甲状腺组织小叶排列紊乱,结构不清,细胞核数目增多(P<0.05),上皮细胞增生肥大,细胞直径增加(P<0.05),滤泡腔大小不一,形状各异,面积显著减小(P<0.05),其余各给药组大鼠甲状腺组织的病变均有一定减轻,其中全方组大鼠甲状腺组织形态与对照组最为接近。与对照组比较,模型组大鼠血清中T3、T4水平显著降低(P<0.05),TSH水平显著升高(P<0.05)。与模型组比较,阳性药组、全方组大鼠血清T3、T4水平显著升高(P<0.05),TSH水平有降低趋势,但差异无统计学意义。结论:海藻玉壶汤全方及去掉1味或2味反药组合能回调甲状腺肿大大鼠甲状腺系数,改善甲状腺组织病理形态及恢复血清中激素水平,且全方组优于全方去掉1味或2味反药组,由此说明,海藻-甘草反药组合是海藻玉壶汤中关键的药对,对于甲状腺肿大的治疗缺一不可。

Extrathyroidal Implantation of Thyroid Hyperplastic/neoplastic Cells after Endoscopic Thyroid Surgery

Objective To report a case of the implantation of thyroid hyperplastic or neoplastic tissue after endoscopic thyroidectomy and discuss this complication in aspects of prevalence, pathogenesis, protection, and therapies. Methods A systematic search of literature from the PubMed database was conducted for identifying eligible studies on implantation of thyroid hyperplastic or neoplastic cells after endoscopic thyroid surgery. Results Overall, 5 reported cases on patients suffering from endoscopic thyroid surgery with implantation of thyroid hyperplastic or neoplastic cells were included in the systematic review. Conclusions Unskilled surgeons, rough intraoperative surgical treatment, scarification or rupture of tumor, contamination of instruments, chimney effect, aerosolization of tumor cells may be associated with the implantation after endoscopic thyroidectomy. To minimize the risk of such complication, we should be more meticulous and strict the endoscopic surgery indications.