【作者】 张丹；

【导师】 孙贻安；

【作者基本信息】 山东中医药大学 ， 中医外科学（专业学位）， 2015， 硕士

【摘要】 目的:观察临床温阳化痰中草药联合优甲乐对于脾肾阳虚型桥本氏甲状腺炎(HT)(甲减期)患者的干预作用,试从对Th2细胞因子白介素-6(Interleukin-6)表达水平的影响角度探讨中药对桥本氏甲状腺炎的作用机理,为传统医学治疗桥本氏甲状腺炎的作用机制提供理论依据。方法:选择临床脾肾阳虚型桥本氏甲状腺炎(甲减期)病例40例为研究对象,将患者随机分为2组,干预组、对照组,每组各20人。对照组采用口服优甲乐常规治疗;干预组在口服优甲乐的基础上加服温阳化痰中草药(颗粒剂)治疗。用药1月为一疗程,连续2个疗程。观察治疗前后患者临床证候评分、B超所示甲状腺厚度水平的变化,运用放射免疫分析法检测甲状腺激素、甲状腺球蛋白抗体、甲状腺过氧化物酶抗体水平的变化,运用ELISA检测IL-6水平的变化。结果:(1)治疗前,IL-6、A-TG、A-TPO在脾肾阳虚型桥本氏甲状腺炎(甲减期)干预组和对照组的阳性表达率(%)均为100%,差异均无统计学意义(P>0.05),说明两组患者病程分布无明显差异,具有可比性。(2)干预组治疗前患者临床证候评分为17.75±1.37,治疗后评分为6.60±1.54。对照组治疗前患者临床证候评分为17.70±1.78,治疗后评分为9.05±1.85。两组治疗前、后组内比较,差异有统计学意义(P<0.05),治疗后组间比较,差异有统计学意义(P<0.05),说明温阳化痰中草药联合优甲乐、单纯优甲乐治疗均可以改善脾肾阳虚型桥本氏甲状腺炎(甲减期)患者临床证候,温阳化痰中草药联合优甲乐治疗在改善临床证候评分方面明显优于单纯优甲乐治疗。(3)两组患者A-TG、A-TPO表达水平,治疗前、后组内比较,干预组差异有统计学意义(P<0.05),治疗后组间比较,差异均有统计学意义(P<0.05),说明温阳化痰中草药联合优甲乐可以明显降低脾肾阳虚型桥本氏甲状腺炎(甲减期)患者A-TG、A-TPO水平。(4)干预组治疗前患者IL-6水平为24.99±6.09,治疗后13.13±3.79。对照组治疗前患者IL-6水平为23.52±6.89,治疗后22.80±6.56。两组治疗前、后组内比较,干预组差异有统计学意义(P<0.05),治疗后组间比较,差异均有统计学意义(P<0.05),说明温阳化痰中草药联合优甲乐可以明显降低脾肾阳虚型桥本氏甲状腺炎(甲减期)患者IL-6水平。(5)临床用药安全,未发生不良反应。结论:温阳化痰法治疗脾肾阳虚型桥本氏甲状腺炎,能够明显减轻患者的临床自觉症状及体征、降低A-TG、A-TPO水平、有效改善甲状腺功能、有效降低Th2细胞因子IL-6的表达水平。温阳化痰中草药可能通过调节免疫系统中Th1/Th2细胞群的平衡,影响IL-6的表达水平,IL-6可诱导抗原特异性的B细胞分泌Ig E和Ig G1等抗体,而Ig G1是构成A-TG等抗体的主要成分,从而可能降低脾肾阳虚型桥本氏甲状腺炎(甲减期)患者的抗体水平,用药安全,疗效显著,无不良反应。更多还原

【Abstract】 Objection:To observe the clinical Wenyang Huatan Chinese herbal medicine joint euthyrox intervention for patients with Pi Shen Yang Xu Xing Hashimoto’s thyroiditis(HT)(hypothyroidism stage),try from the angle of Th2 cytokines interleukin-6(Interleukin-6) expression level to explore the mechanism of traditional Chinese medicine on Hashimoto’s thyroiditis,to provide a theoretical basis for traditional medical treatment mechanism of Hashimoto’s thyroiditis.Methods:To select the clinical Pi Shen Yang Xu Xing Hashimoto’s thyroiditis(hypothyroidism stage) 40 cases for the study, patients were randomly divided into two groups,the intervention group and the control group,each group with 20 cases,people in the control group with oral euthyrox conventional treatment,people in the intervention group with Wenyang Huatan Chinese herbal medicine(granules) treatment on the basis of the oral euthyrox additional services,1 month for a period of treatment,for two consecutive quarters course of treatment.Observe patients with clinical syndromes score before and after the treatment,the changes of thyroid thickness level showned by thyroid ultrasound,detect the changes of thyroid hormone,thyroglobulin antibodies,thyroid peroxidase antibody levels by radioimmunoassay,and the changes of IL-6 levels by ELISA.Results:(1)Before the treatment,IL-6,A-TG,A-TPO in the Pi Shen Yang Xu Xing Hashimoto’s thyroiditis(hypothyroidism stage) positive expression rate(%)was 100% in the intervention group and the control group,the difference was not statistically significant(P> 0.05),described the course of distribution of the two groups have no significant difference and can be compared.(2)The intervention group patients symptom score was 17.75±1.37 before the treatment,after treatment score was 6.60±1.54.Control group patients before the treatment clinical symptoms score was 17.70±1.78,after the treatment score was 9.05±1.85.In the two groups before and after the treatment,the difference was statistically significant(P<0.05),described that both Wenyang Huatan Chinese herbal medicine joint euthyrox intervention,simple euthyrox treatment can improve Pi Shen Yang Xu Xing Hashimoto’s thyroiditis(hypothyroidism stage)clinical syndrome.Wenyang Huatan Chinese herbal medicine joint euthyrox intervention is significantly better than simple euthyrox treatment in improving clinical symptom score.(3)The A-TG,A-TPO expression levels in the two groups,compared to the intervention group difference was statistically significant(P<0.05) before and after the treatment,between the treatment group, the difference was statistically significant(P<0.05)after the treatment,described that Wenyang Huatan Chinese herbal medicine joint euthyrox intervention can significantly reduce the levels of A-TG,A-TPO in patients with Pi Shen Yang Xu Xing Hashimoto’s thyroiditis(hypothyroidism stage).(4)Before the treatment,patients in the intervention group IL-6 level was 24.99±6.09,13.13±3.79 after treatment.Before the treatment,the patients in the control group IL-6 level was 23.52±6.89,22.80±6.56 after treatment.Before and after treatment,compared to the intervention group difference was statistically significant(P<0.05),after the treatment between the two group,the difference was statistically significant(P<0.05),described that Wenyang Huatan Chinese herbal medicine joint euthyrox intervention can significantly reduce the levels of IL-6 in patients with Pi Shen Yang Xu Xing Hashimoto’s thyroiditis(hypothyroidism stage).(5)Clinical drug safety, adverse events occurred.Conclusions:Wenyang Huatan method of treating Pi Shen Yang Xu Xing Hashimoto’s thyroiditis(hypothyroidism stage),can significantly reduce the clinical symptoms and signs, lower A-TG,A-TPO levels,improve thyroid function,reduce the expression level of Th2 cytokine IL-6.Wenyang Huatan Chinese herbal medicine may balance Th1/Th2 cells in the immune system,affecting the expression levels of IL-6,IL-6 can induce antigen-specific B cells to secrete antibodies such as IgE and IgG1,and IgG1 constitutes A-TG and is the main components of the antibody,which may reduce the antibody levels of Pi Shen Yang Xu Xing Hashimoto’s thyroiditis(hypothyroidism stage) patients,drug safety,a significant effect, no adverse reactions.更多还原