甲肿消治疗格雷夫氏病甲状腺肿的研究

【作者】 陈光星；

【导师】 黄仰模；

【作者基本信息】 广州中医药大学 ， 金匮要略， 2000， 硕士

【摘要】 格雷夫氏病（Graves’病，简称GD）是由多种病因引起的甲状腺功能增强，甲状腺激素（TH）分泌过多所致的一种自身免疫性疾病。临床多表现为甲状腺肿大、突眼、高代谢症群、胫前粘液性水肿等症状。甲状腺素分泌过多会造成心血管、消化、内分泌等多系统的损害，严重危害人民身体健康，因此针对病因有效疗法成为研究的迫切需要。而甲状腺肿大是Graves’病的重要特征之一，其对于评估疗效，判断预后具有重要的价值。 本文综述了近年来中西医对于本病在病因病机、治疗方法、药理研究等方面的研究进展，认为中医药在改善症状、调节免疫功能方面具有一定的优势，而且副作用小，复发率低。GD甲状腺肿的发生与TRAb密切相关，由于TRAb与甲状腺细胞结合使TSH受体被激活，在甲状腺内通过腺苷环化酶——cAMP和（或）磷脂酰肌醇—Ca²⁺二个级联反应途径而产生生物学效应，导致甲状腺组织增生、功能亢进。中医认为GD甲状腺肿是由于情志内伤、饮食及水土失宜所致。初期以肝郁火旺、脾虚胃热为特点，随着病情的发展逐渐演变为肝肾不足，气阴两虚证，而甲状腺肿大则是以气郁痰凝血瘀贯穿始终，其主要病理是气、痰、瘀壅结。甲肿消正是针对GD甲状腺肿的病机病理特点研制而成的中成药，具有滋阴降火，行气化痰，活血消瘿之功效，能够很好的改善GD症状，消除或减轻甲状腺肿大。 本研究旨在明确甲肿消的治疗作用，初步阐明甲肿消的作用机理，为进一步开发研制治疗GD甲状腺肿的中成药提供临床和——实验依据。研究中将64例GD甲状腺肿患者随机分为甲肿消组 （32例）和左旋甲状腺素组(32例人 观宠甲状腺B超的体积、TRAb、甲状腺功能（T卜 T卜 fT、TSH）和临床症状等指标。经过六个月的治疗后，结果表明：甲肿消能显著降低TRAb的活性o＜o．05卜左旋甲状腺素亦有类似作用，但不如甲肿消明显炉＜o．05＊ 甲肿消消除或缩小甲状腺肿的作用明显，与左旋对比，具有显著性差异o＜0刀5卜证明甲肿消对甲状腺细胞和浆细胞具有较强的兔疫抑制作用，预示治疗GD病情的逐渐缓解以及停药后复发率可能会较低。研究中发现TRAb的活性与甲状腺体积呈正比，与甲状腺功能无明显关系，说明TR人上可以作用为反映患者免疫功能状态，而不能作为为反映病情的指标。同时，在以他巴哩作为基础治疗的前提下，治疗组和对照组在甲状腺功能方面无明显差异（P＞0刀5），而甲肿消却能明显的改善GD患者的症状，说明中药对于GD的作用可能不是通过抑制甲状腺功能来实现的，而是对机体进行整体的调节，减弱靶器官靶组织对甲状腺激素的反应，或是调节口或p受体的最大结合容量，减弱外周组织对肾上腺素的生物效应，从而达到改善症状的目的。 我们的研究证实甲肿消能够较好地缩小GD甲状腺肿，降低TRAb的活性，缀解G D症状，总有效率达 78％。为进一步研究中药治疗该病症的作用机理奠定了临床基础。更多还原

【Abstract】 G raves?Disease (GD) is a autoimmune disease, induced to hyperthyreosis and excessive thyroid hormone by sever kinds of causes of disease. There are clinical manifestations in main such as goiter, esophthalmos, and hyermetabolism. Excessive thyroid hormone would damage cardiovascular system, digestive system and endocrine system, etc. GD undermined health so seriously that there is a great need for an etiological treatment. Be one of primary characters, goiter is an important index to evaluate the effect and judge the prognosis. This paper summarized the last progress of pathogeny, pathogensis, treatment and pharmacological study on GD with goiter. It is considered that TCM had good effect on symptoms and immunity with less side-effect and lower recurrence rate. The studies showed TSH- receptor antibodies (TRAb) was related to GD and lead to goiter and hyperthyreosis. TCM considers emotional upsets, irregular food intaking, natural environment as the nosogenesis of GD with goiter. In the early days, fife-syndrome derived from stagnation of liver-energy, spleen-asthenia and stomach-heat is important of differential diagnosis. By degrees, it graduated to impairment of the liver and kidney or deficiency of energy and yin while Goiter forms due to energy- stagnation, accumulation of phlegm and blood stasis all the time. That is mostly pathology. As a Chinese medcine, Jia-Zhong-Xiao(JZX) is of the function such as nourishing yin to purge fire-evil, activating vital 4 energy to eliminate phlegm and removing blood stasis to dispel goiter, to relieve the symptoms and minify goiter. It is intent to approve the effect and explore the mechanism of action of JZX. In the future, new Chinese medicine is going to be exploited and manufactured as a foundation, Sixty-four GD with goiter cases were allocated to the JZX group (thirty two cases treated with JZX for six months) and the Levothyroxine group (thirty two cases treated with Levothyroxine for six months), to test volume of thyroid gland, TRAb and throid function and examine symptoms. The result showed that JZX and Levothyroxine could reduce activity of TRAb (p<O.05), and yet, the effect of JZX is better (p<O.05). JZX minified goiter significantly (p<O.O5). It is proved that JZX could suppress thyroid gland cells and plasma cells significantly to imply the state of illness would mend and recurrence rate of would be lower. We found activity of TRAb seems to be in direct ratio to volume of throid gland and no related to throid function that indicate TRAb could reflect state of immunity or not state of illness. Treated with Tapazol, throid function were similar in the two groups (p>O.05), nevertheless, symptoms were more markedly relieved in JZX group. It is suggested that JZX could regulate immunologic function and weaken the responses to target organ for thyroid hormone, or regulate the greatest binding capacity of a -ceptor and $ -cepter to weaken the responses to peripheral organ for adrenalin, to relieve symptoms of GD. 5 ~ It is improved that JZX could minify goiter, reduce activity TRAb and relieve symptoms of GD significantly. This research established as clinic更多还原