摘要
目的探讨清肝散结消瘿方联合左甲状腺素钠片治疗慢性淋巴细胞性甲状腺炎(CLT)合并甲状腺功能减退症(甲减)的临床疗效、安全性及对血清炎症因子的影响。方法选择2022年5月—2023年5月就诊于北京中医药大学孙思邈医院和北京中医药大学东直门医院甲状腺病科门诊的CLT合并甲减患者89例,根据患者意愿分为观察组44例和对照组45例,并招募健康志愿者30例作为健康组。对照组和观察组患者均限碘饮食,对照组给予左甲状腺素钠片口服,治疗组给予左甲状腺素钠片联合清肝散结消瘿方口服,2组均干预8周。比较对照组与观察组患者治疗前后甲状腺相关自身抗体滴度水平、甲状腺功能[血清游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)、促甲状腺激素(TSH)水平]、中医证候积分、甲状腺病证候群评分、下肢局部水肿评分及中医证候疗效、安全性,检测健康组受试者和观察组中30例患者(随机选取)治疗前后血清白细胞介素-2(IL-2)、白细胞介素-12(IL-12)、单核细胞趋化蛋白1(MCP-1)水平。结果治疗后观察组血清甲状腺过氧化物酶抗体(TPOAb)滴度水平较治疗前明显降低(P<0.05),FT4水平较治疗前明显升高(P<0.05),但与对照组比较差异均无统计学意义(P均>0.05);治疗后观察组中医证候积分、甲状腺病证候群评分、下肢局部水肿评分均明显低于治疗前及对照组(P均<0.05);治疗前观察组30例患者血清IL-2、IL-12、MCP-1水平均明显高于健康组(P均<0.05),治疗后血清IL-2、IL-12、MCP-1水平均较治疗前明显降低(P均<0.05)。治疗后观察组中医证候总有效率明显高于对照组[86.36%(38/44)vs 35.56%(16/45),P<0.05],对照组与观察组患者治疗后均未出现不良事件。结论清肝散结消瘿方联合左甲状腺素钠片治疗CLT合并甲减能够明显降低甲状腺抗体滴度水平,可明显改善甲状腺功能和临床症状和减轻炎症反应。
Objective It is to investigate the clinical efficacy,safety of decoction for clearing liver,dissipating binds,dispersing goiter combined with levothyroxine on chronic lymphocytic thyroiditis(CLT)with hypothyroidism and its effect on serum inflammatory factors.Methods Eighty-nine patients with CLT with hypothyroidism were selected from Department of Thyroid Diseases of SUN Simiao Hospital and Dongzhimen Hospital of Beijing University of Chinese Medicine from May 2022 to May 2023,and divided into control group(n=45)and observation group(n=44)according to their treatment wishes,and 30 healthy volunteers were recruited as the healthy group.The patients of the control group and observation group were required to limit iodine diet,additionally,the control group was given levothyroxine tablets orally,and the observation group was given decoction for clearing liver,dissipating binds,dispersing goiter+levothyroxine tablets.Both groups were treated for 8 weeks.The levels of thyroid-related autoantibodies,thyroid function indexes[serum free triiodothyronine(FT3),free tetraiodothyronine(FT4),and thyroid-stimulating hormone(TSH)],traditional Chinese medicine syndrome scores,thyroid disease syndrome group scores,lower extremity localized edema scores before and after treatment,and the efficacy of Chinese medicine syndrome,and safety were compared between the control group and observation group,and the levels of serum interleukin-2(IL-2),interleukin-12(IL-12),and monocyte chemotaxis protein 1(MCP-1)in subjects of the healthy group and 30 patients(randomly selected)of the observation group before and after treatment were measured.Results The serum levels of thyroid peroxidase antibody(TPOAb)after treatment were significantly lower and the level of FT4 level was significantly higher than those before treatment in the observation group(all P<0.05),but the differences were not statistically significant compared with the control group(all P>0.05).The traditional Chinese medicine syndrome scores,thyroid disease syndrome group scores,lower extremity localized edema scores of the observation group after treatment were significantly lower than those before treatment and of the control groups(all P<0.05).The serum levels of IL-2,IL-12,and MCP-1 of 30 patients of the observation group were significantly higher than those of the healthy group before treatment(all P<0.05),and they were significantly decreased after treatment compared with before treatment(all P<0.05).The total effective rate of Chinese medicine syndrome efficacy of the observation group was significantly higher than that of the control group after treatment[86.36%(38/44)vs.35.56%(16/45),P<0.05],and no adverse events occurred in patients of both the control and observation groups after treatment.Conclusion Decoction for clearing liver,dissipating binds,dispersing goiter combined with levothyroxine can obviously reduce the levels of thyroid antibodies,improve thyroid function and clinical symptoms,and alleviate inflammatory reactions in the treatment of CLT with hypothyroidism.
作者
李心爱
丁治国
耿文倩
袁姣姣
吴艳珂
钱嘉惠
户蕊
陈智
李哲
LI Xin’ai;DING Zhiguo;GENG Wenqian;YUAN Jiaojiao;WU Yanke;QIAN Jiahui;HU Rui;CHEN Zhi;LI Zhe(Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing 100700,China;SUN Simiao Hospital of Beijing University of Chinese Medicine,Tongchuan 727100,Shaanxi,China;Hospital Thyroid Disease Hospital of SUN Simiao Hospital of Beijing University of Chinese Medicine,Tongchuan 727100,Shaanxi,China;Thyroid Disease Institute of SUN Simiao Research Institute of Beijing University of Chinese Medicine,Tongchuan 727100,Shaanxi,China;Tongchuan Thyroid Disease Prevention Center,Tongchuan 727100,Shaanxi,China;Tsinghua Changgeng Hospital of Tsinghua University,Beijing 102218,China;Wuhan Hospital of Chinese Medicine,Wuhan 430050,Hubei,China)
出处
《现代中西医结合杂志》
CAS
2023年第22期3097-3103,共7页
Modern Journal of Integrated Traditional Chinese and Western Medicine
基金
陕西省科技厅科研项目(S2023-YF-ZDCXL-ZDLSF-0111)
陕西省中医药管理局科研项目(SZY-NLTL-2022-006,2023-ZQNY-014)
铜川市甲状腺病防治中心科研项目(TJF-2022-25)
北京市中医管理局北京中医药“薪火传承3+3工程”建设项目(2016-SZ-C-61)。
关键词
慢性淋巴细胞性甲状腺炎
甲状腺功能减退症
清肝散结消瘿方
炎症因子
chronic lymphocytic thyroiditis
hypothyroidism
decoction for clearing liver,dissipating binds,dispersing goiter
inflammatory cytokines
