活血消瘿方对大鼠结节性甲状腺肿的作用及其机制研究
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摘要
目的
     探索实验性大鼠结节性甲状腺肿模型的建立;探讨大鼠结节性甲状腺肿的发病机制及观察活血消瘿方对实验性大鼠结节性甲状腺肿的作用;分别从活血消瘿方对实验性结节性甲状腺肿大鼠甲状腺细胞凋亡、甲状腺细胞增殖、甲状腺血管生成、甲状腺细胞趋化的影响等角度,探讨活血消瘿方对实验性大鼠结节性甲状腺肿的作用机制。
     方法
     1实验性大鼠结节性甲状腺肿模型的制备和实验分组处理:SD雄性大鼠60只,体重120-140g。大鼠编号后随机分为6组,即正常组、模型对照组、L-T4组、低剂量活血消瘿方组、中剂量活血消瘿方组、高剂量活血消瘿方组,每组10只。正常组(按1m1/100g体重)灌服给予生理盐水,其余各组均分别(按1m1/100g体重)灌服给予浓度为0.1%的丙基硫氧嘧啶(PTU)溶液,各组连续灌服8周。第9周起,L-T4组(按1m1/100g体重)灌服给予浓度为0.1mg/L的左甲状腺素钠(L-T4)溶液,低、中、高剂量活血消瘿方组分别(按1m1/100g体重)灌服给予浓度为44g/L、88g/L、176g/L的活血消瘿方溶液,模型对照组(按1m1/100g体重)灌服给予蒸馏水,各组连续灌服8周,于造模结束后利用彩色多普勒判断模型均制备成功。于第17周将大鼠麻醉后处死,颈动脉采血2m1,分离血清以备ELISA检测;完整分离两侧甲状腺,分别将各只大鼠左侧甲状腺分成两部分:一部分用4%多聚甲醛固定,制作组织切片,用于免疫组化分析;一部分用2.5%戊二醛固定,制作超薄组织切片,用于电镜观察;分别将各只大鼠右侧甲状腺切开分成两部分,均-20℃冻存,一部分用于蛋白印迹分析,一部分用于流式细胞仪检测。
     2形态学观察:超薄组织切片标本经染色后采用电镜观察。
     3蛋白印迹法:检测大鼠甲状腺组织中PCNA的表达。
     4Annexin-V法结合流式细胞仪:检测大鼠甲状腺细胞的凋亡。
     5ELISA法:检测大鼠血清中VEGF的浓度。
     6免疫组织化学法:检测大鼠甲状腺组织中FGF-2、CXCR-4的表达,并用Image-Pro Plus6.0软件对结果进行定量分析。
     结果
     1电镜下观察超薄组织切片的结果表明:正常组大鼠的甲状腺组织细胞质内有较多的溶酶体,各处可见粗面内质网,粗面内质网表面可见密布的核糖体小颗粒,细胞间的交界复合体清晰可见,滤泡腔内充满大小较为均匀一致的细小颗粒状物质,滤泡腔边缘存在较多的微绒毛。模型对照组大鼠甲状腺组织的滤泡上皮细胞高度肿胀,内质网扩张,内质网的表面核糖体分布密集。与正常组相比,L-T4组及低、中、高剂量活血消瘿方组溶酶体较少;与模型对照组相比,L-T4组及低、中、高剂量活血消瘿方组大鼠甲状腺组织的滤泡腔可见,内质网的扩张较小,细胞质内多见游离的核糖体小颗粒。
     2蛋白印迹法检测PCNA表达的结果显示:与正常组相比,模型组大鼠甲状腺组织PCNA的表达显著增多(P<0.01);与模型对照组相比,L-T4及低、中、高剂量活血消瘿方组大鼠甲状腺细胞PCNA的表达均显著减少(P<0.01);与L-T4组相比,中、低剂量活血消瘿方组大鼠甲状腺细胞PCNA的表达均有显著差异(P<0.01),而高剂量活血消瘿方组大鼠甲状腺细胞PCNA的表达无显著差异;与低剂量活血消瘿方组相比,中、高剂量活血消瘿方组大鼠甲状腺细胞PCNA的表达均有显著差异(P<0.01);与低剂量活血消瘿方组相比,高剂量活血消瘿方组大鼠甲状腺细胞PCNA的表达有显著差异(P<0.01)。随活血消瘿方的浓度增大而PCNA的表达降低更为明显,即高剂量活血消瘿方对大鼠甲状腺组织PCNA表达的抑制作用最为显著。
     3Annexin-V法结合流式细胞仪检测细胞凋亡的结果显示:与正常组相比,模型对照组大鼠甲状腺细胞的凋亡率显著减少(P<0.01)与模型对照组相比,L-T4及低、中、高剂量活血消瘿方组大鼠甲状腺细胞的凋亡率均显著增大(P<0.01);与低剂量活血消瘿方组相比,中剂量活血消瘿方组大鼠甲状腺细胞的凋亡率增大(P<0.05),高剂量活血消瘿方组大鼠甲状腺细胞的凋亡率显著增大(P<0.01);与中剂量活血消瘿方组相比,高剂量活血消瘿方组大鼠甲状腺细胞的凋亡率有显著差异(P<0.01)。
     4ELISA法检测血清中VEGF浓度的结果显示:与正常组相比,模型对照组大鼠血清中VEGF的浓度显著增大(P<0.01);与模型对照组相比,低剂量活血消瘿方组大鼠血清中VEGF的浓度降低(P<0.05),L-T4及中、高剂量活血消瘿方组大鼠血清中VEGF的浓度均显著降低(P<0.01);与低剂量活血消瘿方组相比,高剂量活血消瘿方组大鼠血清中VEGF的浓度有明显差异(P<0.05),而中剂量活血消瘿方组无显著差异;与中剂量活血消瘿方组相比,高剂量活血消瘿方组大鼠血清中VEGF的浓度无明显差异。
     5免疫组织化学法检测FGF-2表达的结果表明:与正常组相比,模型对照组大鼠的甲状腺组织可见到FGF-2表达呈强阳性;与模型对照组相比,L-T4组及低、中、高剂量活血消瘿方组大鼠甲状腺组织FGF-2表达较少。定量的形态学分析结果显示,与正常组相比,模型对照组大鼠甲状腺组织的FGF-2阳性表达面积和累积光密度显著增大(P<0.01);与模型对照组相比,L-T4组及低、中、高剂量活血消瘿方组大鼠甲状腺组织的FGF-2阳性表达面积和累积光密度均显著降低(P<0.01);与L-T4组相比,低剂量活血消瘿方组大鼠甲状腺组织的FGF-2阳性表达的面积和累积光密度有显著差异(P<0.01),中、高剂量活血消瘿方组无显著差异;与低剂量活血消瘿方组相比,中、高剂量活血消瘿方组大鼠甲状腺组织的FGF-2阳性表达面积和累积光密度均显著降低(P<0.01);与中剂量活血消瘿方组相比,高剂量活血消瘿方组大鼠甲状腺组织的FGF-2阳性表达面积和累积光密度无显著差异。
     6免疫组化三步法检测在各组大鼠甲状腺组织中CXCR-4表达水平的结果表明:与正常组相比,模型对照组大鼠的甲状腺组织可见到CXCR-4表达呈强阳性;与模型对照组相比,L-T4组及低、中、高剂量活血消瘿方组大鼠甲状腺组织CXCR-4表达较少。定量的形态学分析结果显示,与正常组相比,模型对照组大鼠甲状腺组织的CXCR-4阳性表达面积和累积光密度显著增大(P<0.01);与模型对照组相比,L-T4组及低、中、高剂量活血消瘿方组大鼠甲状腺组织的CXCR-4阳性表达面积和累积光密度均明显降低(P<0.01);与L-T4组相比,低、中剂量活血消瘿方组CXCR-4阳性表达的面积和累积光密度有显著差异(P<0.01),高剂量活血消瘿方组CXCR-4阳性表达的面积和累积光密度无显著差异;与低剂量活血消瘿方组相比,中、高剂量活血消瘿方组CXCR-4阳性表达的面积和累积光密度有显著差异(P<0.01);与中剂量活血消瘿方组相比,高剂量活血消瘿方组大鼠甲状腺组织的CXCR-4阳性表达面积和累积光密度无显著变化。
     结论
     1活血消瘿方可改善结节性甲状腺肿模型大鼠甲状腺的微观形态及结构。
     2活血消瘿方可通过抑制结节性甲状腺肿模型大鼠甲状腺细胞的增殖、促进结节性甲状腺肿模型大鼠甲状腺细胞的凋亡、抑制结节性甲状腺肿模型大鼠甲状腺血管生成、抑制结节性甲状腺肿模型大鼠甲状腺细胞的趋化等途径对大鼠结节性甲状腺肿发挥作用。
Objective:
     To explore the establishment of the experimental model of nodular goiter on rats. To investigate the pathogeny of nodular goiter in rats. To observe the effect of "Huo-Xue-Xiao-Ying" on nodular goiter model rats. To observed the effect of "Huo-Xue-Xiao-Ying" on form of thyroid in nodular goiter model rats; to approach the effect of "Huo-Xue-Xiao-Ying" on apoptosis of thyrocyte in nodular goiter model rats; to approach the effect of "Huo-Xue-Xiao-Ying" on cell proliferation of thyrocyte in nodular goiter model rats; to approach the effect of "Huo-Xue-Xiao-Ying" on vascularization of thyroid in nodular goiter model rats; to approached the effect of "Huo-Xue-Xiao-Ying" on chemotaxis of thyrocyte in nodular goiter model rats.
     Methods:
     1To prepare the model of nodular goiter in rats and grouping:60SD male rats,weighing120-140g, were separated into six groups at random, scilicet, normal control group.model control group,L-T4 group, low dose " Huo-Xue-Xiao-Ying " group,medium dose " Huo-Xue-Xiao-Ying" group,high dose " Huo-Xue-Xiao-Ying " group. The subsequence five groups had been drenched0.1%PTU solution and normal the control group drenched equivalent physiological saline until the end of experiment. After8weeks, the L-T4group was drenched0.1mg/l L-T4solution;low、medium、 high dose "Huo-Xue-Xiao-Ying" groups each were drenched44g/l、88g/l、176g/1"Huo-Xue-Xiao-Ying" solution; the model control group was drenched equivalent distilled water. Which continue after8weeks, the rats were sacrificed under pentobarbital anaesthesia.2ml blood were collected. The thyroid glands were devided inio three parts:one was fixed with4%paraf ormaidehyde; another was fixed with3%glutar aldehyde for electron mieroscopy;the third was preserved in-20℃for Western blot analysis or flow cytometer detecting.
     2Morphological observation:section preparations were stained and electron microscope observed.
     3Western blotting:To detect the expression of PCNA in thyrocyte of rats.
     4Flow cytometer detecting:apoptosis of thyrocyte in rats.
     5ELISA method:to detect density of VEGF in serous of rats.
     6Immunohistochemical method:To detect the expression of FGF-2and CXCR-4in thyrocyte of rats. The results were analyzed quantified with the softwire Image-Pro Plus6.0.
     Result:
     1To observe ultrathin tissue slice on electron microscope indicated that.follicular cavity,the smaller expansion of endoplasmic reticulum.and the small particles of the common free ribosomes in the cytoplasm can be seen within the thyroid tissue of "Huo-Xue-Xiao-Ying" group rats compared with model group; there were more lysosomes compared with normal group.
     2The result of the expression of PCNA detected by Western blotting showed that,compared with model group,the expression of PCNA significantly decrease in normal group (P<0.01);L-T4and low,medium and high dose "Huo-Xue-Xiao-Ying" can decrease the expression of PCNA in thyroid cell of nodular goiter rats and it was reduced more significantly with the increased concentration of "Huo-Xue-Xiao-Ying", so the expression of PCNA in thyroid cell was the most significantly inhibited by high dose of "Huo-Xue-Xiao-Ying"(P<0.01).
     3Flow cytometer detecting apoptosis showed that,compared with model group, apoptosis rate significantly increased in thyroid cell of the normal group rat (P<0.01). L-T4and low, medium and high dose "Huo-Xue-Xiao-Ying" can promote apoptosis of thyroid cells in the model rat,and apoptosis is more obvious with the increase of the concentration of of " Huo-Xue-Xiao-Ying ", so high dose "Huo-Xue-Xiao-Ying" played the most significant role in promoting apoptosis in thyroid cells of rats (P<0.01).
     4The results of concentration of VEGF in serum detected by ELISA showed that, compared with the model group, the concentration of VEGF reduced in the serum of normal control rats (P<0.05); L-T4and low, medium and high dose can reduce the concentration of VEGF in the serum of rats, concentration of VEGF was reduced more significantly with the increase of the concentration of "Huo-Xue-Xiao-Ying", so the expression of VEGF in thyroid cell was the most significantly inhibited by high dose "Huo-Xue-Xiao-Ying"(P<0.01).
     5The result of the expression of FGF-2detected by the immunohistochemistry assay show that, compared with normal control group, expression of FGF-2was strongly positive in thyroid tissue of model group rat; compared with the model group,The expression of FGF-2decreased in thyroid tissue of L-T4, low,medium and high dose "Huo-Xue-Xiao-Ying" group rats. Quantitative morphological analysis showed that the area and integrated optical density of positive expression of FGF-2in the model group was significantly larger than the normal group, L-T4group and group (P<0.01); the area and integrated optical density of positive expression of FGF-2in the low dose "Huo-Xue-Xiao-Ying" group was significantly larger than high dose "Huo-Xue-Xiao-Ying" group (P<0.01).
     6The result of the expression of CXCR-4detected by the immunohistochemistry assay show that, compared with normal control group, expression of CXCR-4was strongly positive in thyroid tissue of model group rat; compared with the model group,The expression of CXCR-4decreased in thyroid tissue of L-T4, low,medium and high dose "Huo-Xue-Xiao-Ying" group rats. Quantitative morphological analysis showed that the area and integrated optical density of positive expression of CXCR-4in the model group was significantly larger than the normal group, L-T4group and group (P<0.01); the area and integrated optical density of positive expression of CXCR-4in the low dose "Huo-Xue-Xiao-Ying" group was significantly larger than high dose "Huo-Xue-Xiao-Ying" group(P<0.01).
     Conclusion:
     1"Huo-Xue-Xiao-Ying" can improve the morphology of thyreoid in nodular goiter model rats.
     2"Huo-Xue-Xiao-Ying" can inhibit cell proliferation of thyrocyte in nodular goiter model rats.
     3"Huo-Xue-Xiao-Ying" can promote apoptosis of thyrocyte in nodular goiter model rats,which takes on dose-effect relationship.
     4"Huo-Xue-Xiao-Ying" can inhibit vascularization of thyroid in nodular goiter model rats. Which takes on dose-effect relationship.
     5"Huo-Xue-Xiao-Ying" can inhibit chemotaxis of thyrocyte in nodular goiter model rats.
引文
[1]陈如泉.结节性甲状腺肿诊治的几个问题[J].中西医结合研究,2011,3(1):36.
    [2]邓建伟,师天雄,谭焕东.结节性甲状腺肿-癌前病变?[J].现代肿瘤医学,2006,1(14):18-19.
    [3]王吉耀.内科学[M].北京:人民卫生出版社,2006:877.
    [4]Knudsen N,Bulow I,Laurberg P,et al. Association of tobacco smoking with goiter in a low-iodine-intake area[J].Arch Intern Med,2002,162(4):439-443.
    [5]Pearce EN,Braverman LE. Environmental pollutants and the thyroid[J]. Best Pract Res Clin Endocrinol Metab,2009,23(6): 801-813.
    [6]Paschke R. Molecular pathogenesis of nodular goiter[J]. Langenbecks Arch Surg.2011,396(8):1127-1136.
    [7]Medeiros-Neto G, Camargo RY, Tomimori EK. Approach to and treatment of goiters[J]. Med Clin North Am,2012,96(2):351-368.
    [8]Fuhrer D,Bockisch A,Schmid KW. Euthyroid goiter with and without nodules--diagnosis and treatment[J]. Dtsch Arztebl Int,2012,109(29-30):506-515.
    [9]Brenta M, Schnitman M,Fretes 0, etal. Comparative efficacy and side effects of the treatment of euthyroid goiter with levo thyroxine or triiodothyroacetic acid[J]. J Clin Endocrinol Metab,2003,88:5287-5292.
    [10]邹汉青,金涛,朱旬.左旋甲状腺素抑制老年女性结节性甲状腺肿术后复发的观察[J].中国老年学杂志,2012,14(51):3019-3020.
    [11]黄伟华.左甲状腺素在预防结节性甲状腺肿术后复发中的应用[J]. 海南医学院学报,2009,1(15):56-57.
    [12]Bonnema SJ, Fast S, Hegedus L. Non-surgical approach to the benign nodular goiter:new opportunities by recombinant human TSH-stimulated 131I-therapy[J]. Endocrine.2011,40(3):344-353.
    [13]孙尧,于杰,房学东.碘131在甲状腺疾病中的应用[J].中国地方病防治杂志,2012,5(27):391-393.
    [14]Famdon JR. Thyroid surgery from one millennium to the next[J].Asian J Surg,2001,24(2):79-81.
    [15]Zambudio A,Rodriguez J,Riquelme J,etal. Prospective study of post-operative complications after total thyroidectomy for multlnodular goiters by surgeons with experience in endocrine surgery[J]. Ann Surg,2004,240 (1):18-25.
    [16]林思园,张利华,李想娣等.甲状腺结节的手术治疗浅析[J].中国医疗前沿,2011,7(6):38-39.
    [17]卢永洪.中药消瘿汤治疗结节性甲状腺肿36例临床分析[J].中药材,2008,8(31):1296-1297.
    [18]张越.疏肝散结方治疗肝气郁结型结节性甲状腺肿的临床疗效观察[D].南京:南京中医药大学,2009.
    [19]陈如泉.甲状腺疾病的中西医诊断与治疗[M].北京:中国医药科技出版社,2001:3-514.
    [20]吴淑琼,左新河,陈如泉等.活血消瘿片治疗结节性甲状腺肿的临床价值[J].武汉大学学报(医学版),2010,31(3):394-397.
    [21]胡俊杰.活血消瘿片的制备工艺及质量标准研究[D].湖北:湖北中医药大学,2011.
    [22]高天舒,齐腾澈.海藻玉壶汤及其拆方对大鼠碘缺乏致甲状腺肿的干预作用[J].中医杂志,2012,19(53):1671-1676.
    [23]齐腾澈,高天舒.碘与海藻玉壶汤对碘缺乏致甲状腺肿干预机制的比较研究[J].中华中医药学刊,2012,6(30):1211-1214.
    [24]韩勇.抗甲丸抗血管生成效应观察及对甲状腺肿大鼠甲状腺细胞凋亡和增殖的影响[D].山东:山东大学,2009.
    [25]涂久生,李宁.胃泌素、生长抑素与胃肠肿瘤细胞增殖和凋亡关系的研究进展[J].医学综述,2011,1(17):78.
    [26]王洪超,高霭峰,梁成华.甲状腺癌nm23和PCNA表达的意义[J].临床与实验病理学杂志,1997,13(3):287.
    [27]Miyachi K,Fritzler MJ,Tan EM. Autoantibody to a nuclear antigen in Proliferating cells[J].J Immunol,1978,121 (6):2228-2234.
    [28]van Dierendonck JH,Wijsman JH,Keijzer R,etal. Cell-cycle-related staining pattems of anti-proliferating cell nuclear antigen monoclonal antibodies. Comparison with BrdUrd labeling and Ki-67 staining[J]. Am J Pathol,1991,138(5):1165-1172.
    [29]Miao-Miao Fu,Rui Sun,Zhi-Gang Tian,etal. Increased susceptibility to experimental steatohepatitis induced by methionine-choline deficiency in HBs-Tg mice[J]. Hepatobiliary & Pancreatic Diseases International,2010,5(9):513-518.
    [30]王爱洁.白花蛇舌草和半枝莲微粉配伍对小鼠H22肝癌细胞PCNA表达的影响[J].时珍国医国药.2012,4(23):907-908.
    [31]刘晓莉,邹啸威,孙辉,张德恒.缺碘地区甲状腺肿演变模式的探讨[J].中国普外基础与临床杂志.2011,8(18):809-814.
    [32]张洪海,杨焕杰,丁毅等.内消连翘丸含药血清对体外人结节性甲状腺肿细胞增殖及分泌的影响[J].北京中医药大学学报,2006(07).
    [33]Kerr JF, Wyllie AH, Currie AR. Apoptosis:a basic biological phenomenon with wide-ranging implications in tissue kinetics [J]. Br J Cancer,1972,26(4):239-257.
    [34]Vermeulen K,Van Boekstaele DR,Berneman ZN. Apoptosis: mechanisms and relevance in cancer[J]. Ann Hematol,2005,84(10): 627-639.
    [35]郭炳冉,鲍淑兰.细胞凋亡[J].生物学教学,2012,4(37):64.
    [36]张洪海.内消连翘丸治疗结节性甲状腺肿的临床及作用机理研究[D].北京:北京中医药大学,2006.
    [37]赵明,杜宏,王坚,等.非毒性结节性甲状腺肿与细胞凋亡关系的探讨[J].天津医药,2001,29(9):553-554.
    [38]El May MV,Zekri S,Boubaker S,etal. Chronic iodine overload and apoptosis in cold nodules from endemic multinodular goiters[J].Arch Inst Pasteur Tunis.2005,82(1-4):69-74.
    [39]张广智,胡长敏, 陈颖钰等.细胞凋亡的主要检测方法研究进展[J].动物医学进展.2011,32(8):89-92.
    [40]Danyang Ren a,Quan Zhu b, Jiantao Li a,etal. Overexpression of angiopoietin-1 reduces doxorubicin-induced apoptosis in cardiomyocytes[J]. Journal of Biomedical Research,6(26):432-438.
    [41]Xing-An Liu Effects of salvianolic acid B on in vitro growth inhibition and apoptosis induction of retinoblastoma cells[J].2012,3(5):272-276.
    [42]Mitsugi Shimoda,Yoshimi Iwasaki,Toshie Okada,etal. Edaravone inhibits apoptosis caused by ischemia/reperfusion injury in a porcine hepatectomy model[J]. World Journal of Gastroenterology,2012,27(18):3520-3526.
    [43]Hai-yang Zheng, Xiao-yang Zhang, Xing-fen Wang, etal. Autophagy Enhances the Aggressiveness of Human Colorectal Cancer Cells and Their Ability to Adapt to Apoptotic Stimulus[J]. Cancer Biology & Medicine,2012,2 (9):105-110.
    [44]George G Chen. Ent-11 α-Hydroxy-15-oxo-kaur-16-en-19-oic-acid Inhibits Growth of Human Lung Cancer A549 Cells by Arresting Cell Cycle and Triggering Apoptosis[J]. Chinese Journal of Cancer Research.2012,24(2):109-116.
    [45]YUAN Yan,BIAN Jian Chun, LIU Xue Zhong,etal. Oxidative Stress and Apoptotic Changes of Rat Cerebral Cortical Neurons Exposed to Cadmium in Vitro[J]. Biomedical and Environmental Sciences,2012,2(25):172-181.
    [46]Folkman J. Tumor angiogenesis:therapeutic implications[J]. N Engl J Med,1971,285(21):1182-1186.
    [47]Carmeliet P.Angiogenesis in life,disease and medicine[J]. Nature,2005,438(7070):932-936.
    [48]邹文远,刘源源,李胜等.不同性质甲状腺结节与微血管密度关系的研究[J].现代生物医学进展,2012,34(12):6702-6703.
    [49]Eggo,Margaret C. Angiogenesis in goitrogenesis[J]. Current opinion in Endocrinology & Diabetes,2003,10(5):341-346.
    [50]Gerard AC, Poncin S, Caetano B,etal. Iodine deficiency induces a thyroid stimulating hormone-independent early phase of microvascular reshaping in the thyroid[J]. Am J Pathol,2008, 172 (3):748-760.
    [51]杨向红.生长因子的协同作用与新血管形成的研究进展[J].中国动脉硬化杂志,2011,19(1):2-3.
    [52]Jaequeline A,Panline J,Sarah D,etal.Vaseular endothelial growth factor in breast cancer:comparison of plasma,serum and tissue VEGF and microvessel density and effects of Tamoxifen[J]. Cancer Ras,2000,60:2898-2905.
    [53]Ferrara N, Henzel WJ. Pituitary follicular cells secrete a heparin binding growth factor specific for vascular endothelial cells[J].Biochem Biophys Res Commun,1989,161 (2):851.
    [54]Ferrara N,Houck K,Jakeman L,etal. Molecular and biological properties of the vascular endothelial growth factor family of proteins[J]. Endocr ReV,1992,13(1):18-32.
    [55]Mohammed KA,Nasreen N,Hardwick J,etal. Bacterial induction of pleural mesothelial monolayer barrier dysfunction[J]. Am J Physiol Lung Cell Mol Physiol,2001,281 (1):119-125.
    [56]Thiekett DR, Armstrong L,Millar AB. Vascular endothelial growth factor(VEGF)in inflammatory and malignant pleural effusions[J]. Thorax,1999,54(8):707-710.
    [57]Gault J,Sarin H,Awadallah NA, etal. Pathobiology of human cerebro vascular malformations:basic mechanisms and clinical relevance[J].Neurosurgery,2004,55(1):1-16.
    [58]Dvorak HF,Vascular permeability factor/vascular endothelial growth factor:a critical cytokine in tumor angiogenesis and a potential target for diagnosis and therapy[J].J Clin Oncol,2002, 20 (21):4368-4380.
    [59]Aoyagi A,Nishikawa K,Saito H, etal. Charaeterization of basic f ibroblast growth factor-mediated aceeleration of axonal branching in cultured rat hippocampal neurons[J]. Brain Res,1994,661(112): 117-126.
    [60]黄巨恩,陈维平.碱性成纤维细胞生长因子的基础与应用研究[J].解剖学进展,1996,2(2):133-137.
    [61]Dimmeler S,Zeiher AM. Endothelial cell apoptosis in angio-genesis and vessel regression[J]. Circ Res,2000,87(6):434-439.
    [62]Patel VA,Logan A,Watkinson JC,etal. Isolation and characterization of human thyroid endothelial cells[J]. Am J Physiol Endocrinol Metab,2003,284:E168-176.
    [63]Seghezzi G,Patel S, Ren CJ, etal. Fibroblast growth factor-2 (FGF-2) induces vascular endothelial growth factor (VEGF) expression in the endothelial cells of forming capillaries:an autocrine mechanism contributing to angiogenesis[J]. J Cell Biol,1998,141(7):1659-1673.
    [64]Saadeh PB, Mehrara BJ, Steinbrech DS, etal. Mechanisms of fibroblast growth factor-2 modulation of vascular endithelial growth factor expression by osteoblastic cell[J]. Endocrinology, 2000,14:2075-2083.
    [65]Ley CD,Olsen MW,Lund EL,etal. Angiogenic synergy of bFGF and VEGF is antagonized by Angiopoietin-2 in a modified in vivo Matrigel assay[J]. Microvasc Res,2004,68 (3):161-168.
    [66]Joanna Kalupa, Krzysztof Kuzdak,Krzysztof Kolomecki. Assessment of peripheral blood concentration of angiopoietin 1, angiopoietin 2 and Tie-2 (a tyrosine kinase receptor) of patients with goitre treated surgically[J]. Videosurgery and other mini invasive techniques,2011,6(2):64-72.
    [67]Jebreel A,England J,Bedford K,etal. Vascular endothelial growth factor(VEGF), VEGF receptors expression and microvascular density in benign and malignant thyroid diseases[J]. Int J ExP Pathol,2007,88(4):271-277.
    [68]Viglietto G,Romano A, Manzo G, etal.Upregulation of the angiogenic factors PIGF,VEGF and their receptors(Flt-1,Flk-1/KDR) by TSH in cultured thyrocytes and in the thyroid giand of thiouracil-fed rats suggest a TSH-dependent paracrine mechanism for goiter hypervascularization[J]. oncogene,1997,15(22): 2687-2698.
    [69]钟霞,赵家军,戴晓华等.VEGF、IGF-1与Graves病患者甲状腺内血管形成的关系[J].中华内分泌代谢杂志,2006,22(2):119-120.
    [70]Murphy PM. Chemokines and the molecular basis of cancer metastasis[J].N Eng J Med,2001,345(11):833-835.
    [71]刘春蓉,李兰英.趋化因子与自身免疫性甲状腺疾病[J].武警医学院 学报.2010,7(19):581-590.
    [72]王传强.细胞粘附分子CXCR4等在不同类型甲状腺肿瘤组织中的表达及意义[D].山东:青岛大学,2012.
    [73]Rossi D,Zlotnik A. The biology of ehemokines and their recptors[J].Annu Rev Immunol,2000,18:217-242.
    [74]Cooper MA, Fehniger TA, Caligiuri MA. The biology of human natural killer-cell subsets[J]. Trends Immunol,2001,22:633-640.
    [75]王明华,惠震,王耕等.趋化因子受体CXCR-4在甲状腺良性疾病中的表达[J].中国全科医学,2009,12(10A):1769-1770.
    [76]CastelloneMD, GuarinoV, De FalcoV, etal Functional expression of the CXCR-4 chemokine receptor is induced by RET/PTC oncogenes and is a common event in human papillary thyroid carcinomas [J]. Oncogene,2004,23(35):5958-5967.
    [77]黄倩芳,金宇飚,邢晋放等.易误诊为亚急性甲状腺炎的结节性甲状腺肿伴结节内出血的诊断与治疗(附3例临床病例)[J].世界临床药物,2012,11(33):674-676.
    [78]Cooper DS, Doherty GM, Haugen BR, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer [J]. Thyroid,2006,16(2):109-142.
    [79]de Camargo RY, Tomimori EK. Usefulness of ultrasound in the diagnosis and management of well-differentiated thyroid carcinoma[J]. Arq Bras Endocrinol Metabol,2007,51(5):783-792.
    [80]Armengol MP, Cardoso-Schmidt CB, Fernandez M, etal. Chemokines determine local lymphoneogenesis and a reduction of circulating CXCR-4 (+) T and CCR7 B and T lymphocytes in thyroid autoimmune diseases [J]. J Immunol,2003,170(12):6320-6328.
    [81]李晓静.甲状腺癌临床及病理学特点的回顾性分析[D].山东:山东大学,2012.
    [82]王旭林,王红梅,金晓燕等.浙江省台州市甲状腺癌临床流行病学特征分析[J].实用肿瘤杂志,2011,5(26):514-515.
    [83]李晓曦,王深明,常光其.结节性甲状腺肿合并甲状腺癌25例[J].中国现代普通外科进展,2001,3(4):173-174.
    [84]刘池拽,师天雄,邓建伟等.结节性甲状腺肿和甲状腺癌关系的临床研究[J].中华普通外科学文献(电子版).2011,2(5):137-142.
    [85]刘楠楠,董志恒,刘絮等.结节性甲状腺肿与甲状腺癌关系的探讨[J].中国地方病防治杂志,2009,3(24):173-175.
    [86]苟志林,华桦,邓治文等.解毒散结方对丙基硫氧嘧啶致大鼠甲状腺肿的作用研究[J].中药药理与临床.2012,10(5):46-47.
    [87]Buriak VN, Murashko ES. Peculiarities of thyroid pathology in the childhood[J]. Lik Sprava,2012,7(5):58-63.
    [88]Giacomo. Total thyroidectomy:the procedure of choice for multi-nodular goitre[J]. Eur J Surg,2002,168(3):196.
    [89]武正炎,沈美萍.结节性甲状腺肿诊治进展[J].中国普外基础与临床杂志,2004,11(6):483-485.
    [90]Liu G,Zhang W,Jiang P.etal.Role of nitric oxide and vascular endothelial growth factor in fluoride-induced goitrogenesis in rats[J]. Environ Toxicol Pharmacol,2012,34(2):209-217.
    [91]Banu SK.Govindarajulu P,Aruldhas MM. Developmental Profiles of TSH,sex steroids,and their receptors in the thyroid and their relevance to thyroid growth in immature rats[J]. Steroids,2002, 67 (2):137-144.
    [92]李建国,陈善红.人工免疫组化的注意事项及影响因素[J].中国实用医药.2012,19(7):141-142.
    [93]王文勇,黄晓峰,王映梅等.免疫组化技术标准化的探讨[J].细胞与分子免疫学杂,2011,8(27):927-929.
    [94]廖德贵,黄世章.不同的抗原修复方法对免疫组化染色结果的影响 [J].临床医学工程,2009,3(16):62-63.
    [95]韩涛,秦津,韩忠燕等.影响免疫组化染色的因素分析[J].中国畜牧兽医,2009,3(36):63-65.
    [96]田君才,杜国亮,张桂霞.人工免疫组化判定结果与灰度值相关性[J].临床与实验病理学杂志.2010,1(26):112-113.
    [97]吴立明,程晓卫.张仲景方剂中虫类药功用探析[J].时珍国医国药,2010,21,(12):3372.
    [98]高学敏.中药学[M].北京:中国中医药出版社,2005:389.
    [99]房广星,耿晖.蜈蚣临床应用研究进展[J].山东中医杂志,2004,23(8):509-511.
    [100]周永芹.韩莉.中药蜈蚣的研究进展[J].中药材,2008,2(2):315-319.
    [101]余成浩,彭成,余葱葱.川产道地中药材蓬莪术的研究进展[J].时珍国医国药,2008,19(2):388-389.
    [102]国家药典委员会.中国药典,Ⅰ部[S].北京:中国医药科技出版社.2010:260.
    [103]吴淑琼.活血消瘿片治疗结节性甲状腺肿的临床疗效及其作用机制研究[D].湖北:湖北中医药大学,2010.
    [1]陈如泉.结节性甲状腺肿诊治的几个问题[J].中西医结合研究,2011,3(1):36.
    [2]Cooper DS, Doherty GM, Haugen BR, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer[J]. Thyroid,2006,16(2):109-142.
    [3]de Camargo RY, Tomimori EK. Usefulness of ultrasound in the diagnosis and management of well-differentiated thyroid carcinoma[J]. Arq Bras Endocrinol Metabol,2007,51(5):783-792.
    [4]Armengol MP, Cardoso-Schmidt CB, Fernandez M, etal. Chemokines determine local lymphoneogenesis and a reduction of circulating CXCR-4 (+) T and CCR7 B and T lymphocytes in thyroid autoimmune diseases [J]. J Immunol,2003,170(12):6320-6328.
    [5]李晓静.甲状腺癌临床及病理学特点的回顾性分析[D].山东:山东大学,2012.
    [6]王旭林,王红梅,金晓燕等.浙江省台州市甲状腺癌临床流行病学特征分析[J].实用肿瘤杂志,2011,5(26):514-515.
    [7]李晓曦,王深明,常光其.结节性甲状腺肿合并甲状腺癌25例[J].中国现代普通外科进展,2001,3(4):173-174.
    [8]刘池拽,师天雄,邓建伟等.结节性甲状腺肿和甲状腺癌关系的临床研究[J].中华普通外科学文献(电子版).2011,2(5):137-142.
    [9]刘楠楠,董志恒,刘絮等.结节性甲状腺肿与甲状腺癌关系的探讨[J].中国地方病防治杂志,2009,3(24):173-175.
    [2]李晓曦,王深明,常光其.结节性甲状腺肿合并甲状腺癌25例[J].中国现代普通外科进展,2001,3(4):173-174.
    [10]陈如泉.甲状腺疾病的中西医诊断与治疗[M].北京:中国医药科技出版社,2001:3-514.
    [11]Knudsen N,Bulow I,Laurberg P,et al. Association of tobacco smoking with goiter in a low-iodine-intake area[J].Arch Intern Med,2002,162(4):439-443.
    [12]张荣梅,壮而萍,彭志海等.多结节性甲状腺的分子遗传学研究进展[J].中华医学遗传学杂志,2000,17(5):359-361.
    [13]Giacomo. Total thyroidectomy:the procedure of choice formulti-nodular goitre[J]. Eur J Surg,2002,168(3):196.
    [14]白耀.甲状腺病学:基础与临床[M].北京:科学技术文献出版社,2003,5:328-402.
    [15]尹满香,叶孝乾,林波,等.沿海地区添加碘盐与结节性甲状腺肿相关性探讨[J].武警医学院学报,2010,9(19):714-719.
    [16]刘邦民,陶春蓉.艾儒棣教授治疗甲状腺腺瘤经验[J].四川中医,2006,24(12):7-8.
    [17]许少辉,练志明.廖世煌教授治疗甲状腺腺瘤临床经验[J].中国中医药信息杂志,2009(1):59-60.
    [18]吴淑琼,左新河,陈如泉等.活血消瘿片治疗结节性甲状腺肿的临床价值[J].武汉大学学报(医学版),2010,31(3):394-397.
    [19]简小兵,戴莲仪.甲1方治疗甲状腺良性结节临床观察[J].中国中医药信息杂志,2004,11(1):72-73.
    [20]卢永洪.中药消瘿汤治疗结节性甲状腺肿36例临床分析[J].中药材,2008,31(8):1296-1297.
    [21]黄文智.外用消瘿膏治疗甲状腺肿临床观察及护理[J].湖北中医杂志,2007,29(8):46.
    [22]劳丹华,康志强.夏枯草膏治疗结节性甲状腺肿疗效观察[J].广西医学,2005,27(8):1255.
    [23]蒋为国.化瘤膏外敷治疗甲状腺肿的实验研究[J].中国中药科技,2004,11(1):42.
    [24]Cooper DS, Doherty GM, Haugen BR, etal. Revised American Thyroid Association Management Guidelines for Patients With Thyroid Nodules and Differentiated Thyroid Cancer[J]. Thyroid, 2009,19(11):1167-1214.
    [25]Cooper DS,Doherty GM,Haugen BR,et al. Management guide-lines for patients with thyroid nodules and differentiated thyroid cancer[J]. Thyroid,2006,16 (2):1-33.
    [26]Costante G, Crocetti U, Schifino E, etal. Slow growth of benign thyroid nodules after menopause:no need for long-term thyroxine suppressive therapy in post-menopausal women[J]. Endocrinol Invest,2004,27:31-36.
    [27]Castro MR,Caraballo PJ,Morris J C. Effectiveness of thyroid hormone suppressive therapy in benign solitary thyroid nodules:a meta-analysis. J Clin EndocrinolMetab,2002,87:4154-4159.
    [28]Bonnema SJ, Bennedbaell FN, Ladenson PW, etal. Managt-ment of thenontoxic multinodular goiter:a North American surrey. J Clin EndocrinolMetab,2002,87:112-117.
    [29]Brenta M, Schnitman M,Fretes 0, etal. Comparative efficacy and side effects of the treatment of euthyroid goiter with levo thyroxine or triiodothyroacetic acid[J]. J Clin Endocrinol Metab,2003,88:5287-5292.
    [30]Hoogendoorn EH, den Hei jer M, van Di jk AP, etal. Subclinical hyperthyroidism:to treat or not to treat?[J]. Postgrad Med,2004, 80:394-398.
    [31]Kay TW, d Emden MC, Andrews JT, etal. Treatment of non-toxic multinodular goiter with radioactive iodine[J].Am J Med,1998,19-20.
    [32]Wesche M F,Tiel-V Buul M M,Lips P,et al.A Randomized Trial Comparing Levo-Thyroxine with Radioactive Iodine in the Treatment of Sporadic Nontoxic Goiter[J].J Clin Endocrinol Metab,2001, 86 (5):998-1005.
    [33]Maurer AH, Charkes D. Radioiodine treatment for nontoxic moltinodalar goiter[J].J Nucl Med,1999,40:1313-1316.
    [34]卢倜章.131I治疗甲状腺肿疾病的研究趋向[J].国外医学放射医学核医学分册,2000,24(3):97-99.
    [35]袁吕荣.手术治疗结节性甲状腺肿的体会[J].现代中西医结合杂 志,2009,18(33):4127.
    [36]孙备.甲状腺大部切除术2200例临床体会[J].中国实用外科杂志,2000,22(10):630.
    [37]李力波.双侧结节性甲状腺肿手术治疗的临床分析[J].山西医科大学学报,2008,39(2):162-163.
    [38]许军.腔镜甲状腺切除术临床应用[J].哈尔滨医科大学学报,2004,38(1):90-91.
    [39]谭宏涛.地方性甲状腺肿外科治疗进展[J].中国地方病学杂志,2006,25(2):233-234.
    [40]Al-Suliman NN, Ryttov N, Qvist N, etal. Experience in a specialist thyroid surgery unit:a demographic study, Surgical complications, and outcome[J]. Eur J Surg,1997,163:13-20.
    [41]王慎田.单纯结节性甲状腺疾病的治疗进展[J].医学内分泌学分册,2005,11(6):371-373.
    [42]Dossing H, Bennedbaek FN, Karstrup S. Benign solitary solid cold thyroid nodules:US-guided interstitial laser photocoagulation initial experience [J]. Radiology,2002,225:53-57.
    [43]彭彩碧,文重远,李竞等.射频消融猪甲状腺毁损灶形成的实验研究及意义初探[J].实用医学杂志,2005,21(23):2604-2606.
    [44]Monchik JM,Donatini G,Iannuccilli J,etal. Radio frequency ablation and percutaneous ethanol injection treatment for recurrent local and distantwell-differentiated thyroid carcinoma[J]. Ann Surg,2006,244:296-304.
    [45]孙云钢,蒋宁一,孙云风等.甲肿散联合甲状腺素片治疗良性多发性甲状腺结节[J].广东医学,2010,31(2):241-242.
    [46]尹继全,宋新安.化结散联合左旋甲状腺素治疗良性、多发性甲状腺结节[J].中国医药指南,2008,6(17):208-209.

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