养阴散结汤对分化型甲状腺癌患儿行甲状腺次全切除术后T淋巴细胞亚群的影响
|
摘要
目的:观察养阴散结汤对分化型甲状腺癌患儿行甲状腺次全切除术后T淋巴细胞亚群的影响。方法:82例甲状腺次全切除术后分化型甲状腺癌患儿按随机数字表法分为对照组与观察组,每组各41例。对照组给予左甲状腺素钠,观察组在对照组治疗基础上给予养阴散结汤。两组均连续治疗3个月。治疗后,比较两组患儿临床症状改善时间、临床疗效、不良反应发生率、血清甲状腺球蛋白(thyroglobulin,TG)水平、促甲状腺激素(thyroid stimulating hormone,TSH)水平及T淋巴细胞亚群(CD_3~+、CD_4~+、CD_8~+、CD_4~+/CD_8~+)水平。结果:观察组大便干结、口疮、声嘶、心悸改善时间短于对照组,差异均有统计学意义(P <0. 05)。观察组改善率为87. 80%(36/41),高于对照组的60. 98%(25/41),差异有统计学意义(P <0. 05)。治疗后两组患儿血清TG、TSH水平较治疗前降低,且观察组治疗后低于对照组治疗后,差异均有统计学意义(P <0. 05)。治疗前两组CD_3~+、CD_4~+、CD_8~+、CD_4~+/CD_8~+比较,差异均无统计学意义(P> 0. 05);治疗后观察组CD_3~+、CD_4~+、CD_4~+/CD_8~+高于对照组,CD_8~+低于对照组,差异均有统计学意义(P <0. 05)。观察组不良反应发生率为9. 76%(4/41),低于对照组的26. 83%(11/41),差异有统计学意义(P <0. 05)。结论:养阴散结汤治疗分化型甲状腺癌患儿甲状腺次全切除术后临床疗效显著,可有效降低患儿血清TG、TSH水平,改善患儿机体免疫功能,缩短临床症状改善时间,且安全性较高。
Objective: To investigate the effect of Yangyin Sanjie Decoction on T lymphocyte subsets in children with differentiated thyroid cancer after subtotal thyroidectomy. Methods: 82 children with differentiated thyroid cancer after subtotal thyroidectomy were randomly divided into control group and observation group,41 cases each. The control group was given levothyroxine sodium,and the observation group was given Yangyin Sanjie Decoction on the basis of the control group. Both groups were treated continuously for 3 months. After treatment,the clinical symptoms improvement time,clinical efficacy,adverse reaction rate,serum thyroglobulin( TG) level,thyroid stimulating hormone( TSH) level and T lymphocyte subsets( CD_3~+,CD_4~+,CD_8~+,CD_4~+/CD_8~+)levels were compared between the two groups. Results: The improvement time of stool dryness,aphthous,hoarseness and palpitations in the observation group was shorter than that in the control group,and the difference was statistically significant( P <0. 05). The total improvement rate of the observation group was 87. 80%( 36/41),which was higher than 60. 98% of the control group( 25/41). The difference was statistically significant( P < 0. 05). The levels of serum TG and TSH in the two groups were lower than those before treatment,and the difference was statistically significant( P < 0. 05). There were no significant differences in CD_3~+,CD_4~+,CD_8~+,CD_4~+/CD_8~+between the two groups before treatment( P > 0. 05). After treatment,the CD_3~+,CD_4~+,CD_4~+/CD_8~+in the observation group were higher than the control group,and the CD_8~+was lower than the control group. The difference was statistically significant( P < 0. 05). The incidence of adverse reactions in the observation group was 9. 76%( 4/41),which was lower than 26. 83% in the control group( 11/41). The difference was statistically significant( P < 0. 05). Conclusion: Yangyin Sanjie Decoction has significant clinical efficacy in the treatment of children with differentiated thyroid cancer after subtotal thyroidectomy. It can effectively reduce the serum TG and TSH levels of patients,improve the immune function of children,shorten the time of the improvement of clinical symptoms,and has high safety.
Objective: To investigate the effect of Yangyin Sanjie Decoction on T lymphocyte subsets in children with differentiated thyroid cancer after subtotal thyroidectomy. Methods: 82 children with differentiated thyroid cancer after subtotal thyroidectomy were randomly divided into control group and observation group,41 cases each. The control group was given levothyroxine sodium,and the observation group was given Yangyin Sanjie Decoction on the basis of the control group. Both groups were treated continuously for 3 months. After treatment,the clinical symptoms improvement time,clinical efficacy,adverse reaction rate,serum thyroglobulin( TG) level,thyroid stimulating hormone( TSH) level and T lymphocyte subsets( CD_3~+,CD_4~+,CD_8~+,CD_4~+/CD_8~+)levels were compared between the two groups. Results: The improvement time of stool dryness,aphthous,hoarseness and palpitations in the observation group was shorter than that in the control group,and the difference was statistically significant( P <0. 05). The total improvement rate of the observation group was 87. 80%( 36/41),which was higher than 60. 98% of the control group( 25/41). The difference was statistically significant( P < 0. 05). The levels of serum TG and TSH in the two groups were lower than those before treatment,and the difference was statistically significant( P < 0. 05). There were no significant differences in CD_3~+,CD_4~+,CD_8~+,CD_4~+/CD_8~+between the two groups before treatment( P > 0. 05). After treatment,the CD_3~+,CD_4~+,CD_4~+/CD_8~+in the observation group were higher than the control group,and the CD_8~+was lower than the control group. The difference was statistically significant( P < 0. 05). The incidence of adverse reactions in the observation group was 9. 76%( 4/41),which was lower than 26. 83% in the control group( 11/41). The difference was statistically significant( P < 0. 05). Conclusion: Yangyin Sanjie Decoction has significant clinical efficacy in the treatment of children with differentiated thyroid cancer after subtotal thyroidectomy. It can effectively reduce the serum TG and TSH levels of patients,improve the immune function of children,shorten the time of the improvement of clinical symptoms,and has high safety.
引文
[1]BROSE M S,NUTTING C M,JARZAB B,et al. Sorafenib in radioactive iodine-refractory,locally advanced or metastatic differentiated thyroid cancer:a randomised,double-blind,phase 3 trial[J]. Lancet,2014,384(9940):319-328.
[2]张静.儿童分化型甲状腺癌术后辅助治疗效果观察[J].中华实用诊断与治疗杂志,2014,28(10):966-967.
[3]ZHANG W D,LIU D R,FENG C C,et al. Management of differentiated thyroid carcinoma with bone metastasis:a case report and review of the Chinese literature[J]. J Zhejiang Univ Sci B,2014,15(12):1081.
[4]景玺润.中医药治疗甲状腺癌研究近况[J].湖南中医杂志,2016,32(10):202-203.
[5]葛均波,徐永健.内科学[M]. 8版.北京:人民卫生出版社,2013:700-702.
[6]国家技术监督局.中医临床诊疗术语国家标准(证候部分)[S].北京:中国标准出版社,2004:1-88.
[7]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:226.
[8]LEPOUTRE-LUSSEY C,MADDAH D,GOLMARD J L,et al. Postoperative neck ultrasound and risk stratification in differentiated thyroid cancer patients with initial lymph node involvement[J]. Eur J Endocrinol,2014,170(6):837-846.
[9]瞿源,黄蕤,李林.儿童和青少年分化型甲状腺癌的131I治疗[J].中华核医学与分子影像杂志,2014,34(1):76-78.
[10]荆凡静,梁智勇,龙文,等.儿童及青少年分化型甲状腺癌的侵袭特征[J].中国医学科学院学报,2013,35(1):80-83.
[11]MIHALJEVIC O,RADIVOJEVIC S,DJUKIC S,et al. Protein and Lipid Concentrations in Patients with Differentiated Thyroid Cancer Treated with Radioactive Iodine-131[J]. Ser J Exper Clin Res,2014,15(4):197-203.
[12]江树舒,吴敏.益气化瘀法治疗分化型甲状腺癌术后的临床研究[J].现代肿瘤医学,2014,22(12):2830-2833.
[13]李旭枝,安小莉,董雯,等.平消胶囊辅助治疗分化型甲状腺癌术后131I放疗患者的临床观察[J].陕西中医,2016,37(4):456-458.
[14]孙伯菊,董莉莉,魏军平.中医药治疗甲状腺癌临床研究概述[J].中医杂志,2016,57(21):1882-1885.
[15]蒙雯雯,黄雪梅,卢德成,等.夏枯草联合山慈姑对甲状腺癌细胞的抗增殖作用[J].中国现代医学杂志,2012,22(28):46-50.
[16]陆淑瑾.“养阴散结汤”联合左甲状腺素钠治疗甲状腺癌术后32例临床研究[J].江苏中医药,2015,47(4):22-24.
[17]宋润波,孟增智,贾清雨.分化型甲状腺癌的治疗新进展[J].现代中西医结合杂志,2015,24(24):2728-2730.
[18]张惠明,邹一夫,苏琼川.甲状腺癌术后应用左甲状腺素钠配合养阴散结汤的疗效[J].中国肿瘤临床与康复,2016,23(4):443-445.
[2]张静.儿童分化型甲状腺癌术后辅助治疗效果观察[J].中华实用诊断与治疗杂志,2014,28(10):966-967.
[3]ZHANG W D,LIU D R,FENG C C,et al. Management of differentiated thyroid carcinoma with bone metastasis:a case report and review of the Chinese literature[J]. J Zhejiang Univ Sci B,2014,15(12):1081.
[4]景玺润.中医药治疗甲状腺癌研究近况[J].湖南中医杂志,2016,32(10):202-203.
[5]葛均波,徐永健.内科学[M]. 8版.北京:人民卫生出版社,2013:700-702.
[6]国家技术监督局.中医临床诊疗术语国家标准(证候部分)[S].北京:中国标准出版社,2004:1-88.
[7]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:226.
[8]LEPOUTRE-LUSSEY C,MADDAH D,GOLMARD J L,et al. Postoperative neck ultrasound and risk stratification in differentiated thyroid cancer patients with initial lymph node involvement[J]. Eur J Endocrinol,2014,170(6):837-846.
[9]瞿源,黄蕤,李林.儿童和青少年分化型甲状腺癌的131I治疗[J].中华核医学与分子影像杂志,2014,34(1):76-78.
[10]荆凡静,梁智勇,龙文,等.儿童及青少年分化型甲状腺癌的侵袭特征[J].中国医学科学院学报,2013,35(1):80-83.
[11]MIHALJEVIC O,RADIVOJEVIC S,DJUKIC S,et al. Protein and Lipid Concentrations in Patients with Differentiated Thyroid Cancer Treated with Radioactive Iodine-131[J]. Ser J Exper Clin Res,2014,15(4):197-203.
[12]江树舒,吴敏.益气化瘀法治疗分化型甲状腺癌术后的临床研究[J].现代肿瘤医学,2014,22(12):2830-2833.
[13]李旭枝,安小莉,董雯,等.平消胶囊辅助治疗分化型甲状腺癌术后131I放疗患者的临床观察[J].陕西中医,2016,37(4):456-458.
[14]孙伯菊,董莉莉,魏军平.中医药治疗甲状腺癌临床研究概述[J].中医杂志,2016,57(21):1882-1885.
[15]蒙雯雯,黄雪梅,卢德成,等.夏枯草联合山慈姑对甲状腺癌细胞的抗增殖作用[J].中国现代医学杂志,2012,22(28):46-50.
[16]陆淑瑾.“养阴散结汤”联合左甲状腺素钠治疗甲状腺癌术后32例临床研究[J].江苏中医药,2015,47(4):22-24.
[17]宋润波,孟增智,贾清雨.分化型甲状腺癌的治疗新进展[J].现代中西医结合杂志,2015,24(24):2728-2730.
[18]张惠明,邹一夫,苏琼川.甲状腺癌术后应用左甲状腺素钠配合养阴散结汤的疗效[J].中国肿瘤临床与康复,2016,23(4):443-445.