黄芪对甲状腺功能正常的桥本甲状腺炎患者外周血T淋巴细胞亚群表达的影响

doi:10.3969/j.issn.1674-8115.2024.01.012

上海交通大学学报（医学版） ›› 2024, Vol. 44 ›› Issue (1): 108-115.doi: 10.3969/j.issn.1674-8115.2024.01.012

• 论著 · 临床研究 • 上一篇

黄芪对甲状腺功能正常的桥本甲状腺炎患者外周血T淋巴细胞亚群表达的影响

李自云¹(), 庄新娟¹(), 季业¹, 田海荣¹, 殷峻²()

^1.上海市第六人民医院金山分院内分泌代谢科，上海 201599
^2.上海交通大学医学院附属第六人民医院内分泌代谢科，上海市糖尿病临床医学中心，上海市糖尿病重点实验室，上海 200233

收稿日期:2023-07-26 接受日期:2023-10-25 出版日期:2024-01-28 发布日期:2024-02-28
通讯作者: 庄新娟,殷峻 E-mail:2558897955@qq.com;13918266832@163.com;yinjun@sjtu.edu.cn
作者简介:李自云（1978—），男，副主任医师，硕士；电子信箱：2558897955@qq.com。
基金资助:
上海市金山区卫生健康委员会课题(JSKT-KTMS-2019-20);上海交通大学医学院“双百人”项目(20172025)

Effects of Astragali Radix on T lymphocyte subsets expression in peripheral blood of Hashimoto′s thyroiditis patients with normal thyroid function

LI Ziyun¹(), ZHUANG Xinjuan¹(), JI Ye¹, TIAN Hairong¹, YIN Jun²()

^1.Department of Endocrinology and Metabolism, Jinshan Branch of Shanghai Sixth People′s Hospital, Shanghai 201599, China
^2.Department of Endocrinology and Metabolism, Shanghai Sixth People′s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai 200233, China

Received:2023-07-26 Accepted:2023-10-25 Online:2024-01-28 Published:2024-02-28
Contact: ZHUANG Xinjuan,YIN Jun E-mail:2558897955@qq.com;13918266832@163.com;yinjun@sjtu.edu.cn
Supported by:
Program of Health Commission of Jinshan District, Shanghai(JSKT-KTMS-2019-20);"Two-hundred Talents" Program of Shanghai Jiao Tong University School of Medicine(20172025)

摘要/Abstract

摘要：

目的·探讨黄芪对甲状腺功能正常的桥本甲状腺炎患者T淋巴细胞亚群及细胞因子表达的影响。方法·选择2020年1月—12月在上海市第六人民医院金山分院接受治疗且资料完整的甲状腺功能正常的桥本甲状腺炎患者120例，采用随机数字表将患者为干预组及对照组，每组各60例。对照组治疗方案为碘适宜状态饮食，干预组在对照组治疗方案基础上联合黄芪药液口服（150 mL/次，2次/d）治疗。连续治疗6个月，比较2组治疗前后外周血清T淋巴细胞亚群（CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺），细胞因子［包括白细胞介素2（interleukin-2，IL-2）、肿瘤坏死因子α（tumor necrosis factor-α，TNF-α）、IL-6、IL-10］，超敏C反应蛋白（hypersensitive C-reactive protein，hs-CRP），红细胞沉降率（erythrocyte sedimentation rate，ESR），以及甲状腺功能及自身抗体、肝肾功能等指标的变化。观察黄芪治疗期间不良反应。应用多因素线性回归分析甲状腺过氧化物酶抗体（thyroid peroxidase antibody，TPOAb）变化幅度的影响因素。结果·最终纳入118例患者，每组各59例。治疗6个月后，干预组CD4⁺T细胞比例，CD4⁺/CD8⁺比值，IL-2、TNF-α、IL-6、IL-10、hs-CRP、ESR、TPOAb和甲状腺球蛋白抗体（thyroglobulin antibody，TGAb）水平均较治疗前及其同期对照组显著改善，差异均有统计学意义（均P<0.05）。对照组治疗后上述指标与治疗前比较，差异均无统计学意义（P>0.05）。治疗后干预组未见严重不良反应。多因素线性回归分析结果显示，应用黄芪、CD4⁺T细胞、CD4⁺/CD8⁺比值升高幅度及hs-CRP下降幅度均是TPOAb下降幅度的独立影响因素（β=-0.393，P=0.029；β=-0.513，P=0.010；β=-0.351，P=0.035；β=0.434，P=0.023）。结论·黄芪可改善甲状腺功能正常的桥本甲状腺炎患者CD4⁺T细胞、IL-2、TNF-α、IL-6、IL-10水平及CD4⁺/CD8⁺比值，且安全性佳。

关键词: 桥本甲状腺炎, 黄芪, T淋巴细胞亚群, 细胞因子

Abstract:

Objective ·To investigate the effect of Astragali Radix on T lymphocyte subsets and cytokine expression in Hashimoto's thyroiditis patients with normal thyroid function. Methods ·A total of 120 Hashimoto′s thyroiditis patients with normal thyroid function and complete data were selected from January 2020 to December 2020 in Jinshan Branch of Shanghai Sixth People′s Hospital. The patients were randomly divided into intervention group (n=60) and control group (n=60) by the method of random number table. The treatment plan of the control group was iodine appropriate state diet, and the intervention group was combined with oral Astragali Radix solution (150 mL per time, twice/d) on the basis of the treatment of the control group. The two groups were treated for 6 months. The changes in peripheral blood serum T lymphocyte subsets (CD3⁺, CD4⁺, CD8⁺, and CD4⁺/CD8⁺), cytokines [interleukin-2 (IL-2), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10)], hypersensitive C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), thyroid function, autoantibody, liver and kidney function, and other biochemical indexes were compared before and after treatment between the two groups. Adverse reactions were observed during the treatment. The factors influencing the change amplitude of thyroid peroxidase antibody (TPOAb) were analyzed by multifactor linear regression. Results ·Finally, 118 patients, with 59 cases in each group, were included in the study. After 6 months of treatment, the intervention group showed significant improvements in the proportions of CD4⁺T cells, the ratio of CD4⁺/CD8⁺, and the levels of IL-2, TNF-α, IL-10, hs-CRP, ESR, TPOAb, and thyroglobulin antibody (TGAb) compared to the values before treatment and in the control group (P<0.05). There were no statistically significant differences on the above indicators before and after treatment in the control group (P>0.05). No serious adverse reactions were observed in the intervention group. Multiple linear regression analysis results showed that the use of Astragali Radix, increase of CD4⁺level, increase of CD4⁺/CD8⁺ ratio, and decrease of hs-CRP level were influencing factors for the decrease of TPOAb level (β=-0.393, P=0.029; β=-0.513, P=0.010; β=-0.351, P=0.035; β=0.434, P=0.023). Conclusion ·Astragali Radix can improve the levels of CD4⁺T cells, CD4⁺/CD8⁺ratio, IL-2, TNF-α, IL-6, and IL-10 in Hashimoto′s thyroiditis patients with normal thyroid function, and it is safe to use.

Key words: Hashimoto′s thyroiditis, Astragali Radix, T‐lymphocyte subsets, cytokine

中图分类号:

R581.4

李自云, 庄新娟, 季业, 田海荣, 殷峻. 黄芪对甲状腺功能正常的桥本甲状腺炎患者外周血T淋巴细胞亚群表达的影响[J]. 上海交通大学学报（医学版）, 2024, 44(1): 108-115.

LI Ziyun, ZHUANG Xinjuan, JI Ye, TIAN Hairong, YIN Jun. Effects of Astragali Radix on T lymphocyte subsets expression in peripheral blood of Hashimoto′s thyroiditis patients with normal thyroid function[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(1): 108-115.

图/表 5

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Index	Before treatment (n=59)			After treatment (n=59)
Index	Intervention group	Control group	P value	Intervention group	Control group	P value
Male/female/n	3/56	4/55	0.726
Age/year	46±13	44±15	0.852
Duration of HT/month	23 (7, 31)	26 (8, 34)	0.607	29 (13, 37)	32 (14, 40)	0.607
Smoke/[n(%)]	0 (0)	0 (0)	1.000	0 (0)	0 (0)	1.000
Drink/[n(%)]	0 (0)	0 (0)	1.000	0 (0)	0 (0)	1.000
BMI/(kg·m^-2)	22.4±3.5	23.2±3.1	0.624	22.7±3.6	23.5±3.4	0.655
Scr/(μmol·L^-1)	61.2±15.4	59.1±16.1	0.682	60.4±14.8	60.7±17.5	0.832
eGFR/(mL·min^-1·1.73^-1·m^-2)	117.1±24.3	120.4±25.1	0.734	114.7±23.5	117.8±23.3	0.855
GPT/(U·L^-1)	24±12	23±10	0.567	23±11	24±10	0.786
AST/(U·L^-1)	21 (16, 31)	23 (14, 29)	0.301	20 (12, 28)	24 (14, 43)	0.243
γ-GT/(U·L^-1)	32.5 (17.5, 41.0)	35.3 (18.1, 43.4)	0.661	31.2 (15.7, 42.2)	37.9 (19.0, 45.6)	0.318
TC/(mmol·L^-1)	5.12±1.34	4.96±1.60	0.620	4.84±1.40	4.91±1.28	0.701
TAG/(U·L^-1)	2.56 (1.26, 4.07)	2.69 (1.42, 3.93)	0.734	2.47 (1.16, 4.22)	2.78 (1.67, 4.33)	0.796
MUI/(μg·L^-1)	145 (106, 187)	149 (110, 190)	0.864	128 (95, 171)	135 (108, 178)	0.764
Thyroid gland/cm³	25.53 (18.79, 28.35)	24.35 (17.02, 26.23)	0.805	23.47 (17.43, 26.18)	23.05 (16.53, 25.62)	0.909

Index	Before treatment (n=59)			After treatment (n=59)
Index	Intervention group	Control group	P value	Intervention group	Control group	P value
Male/female/n	3/56	4/55	0.726
Age/year	46±13	44±15	0.852
Duration of HT/month	23 (7, 31)	26 (8, 34)	0.607	29 (13, 37)	32 (14, 40)	0.607
Smoke/[n(%)]	0 (0)	0 (0)	1.000	0 (0)	0 (0)	1.000
Drink/[n(%)]	0 (0)	0 (0)	1.000	0 (0)	0 (0)	1.000
BMI/(kg·m^-2)	22.4±3.5	23.2±3.1	0.624	22.7±3.6	23.5±3.4	0.655
Scr/(μmol·L^-1)	61.2±15.4	59.1±16.1	0.682	60.4±14.8	60.7±17.5	0.832
eGFR/(mL·min^-1·1.73^-1·m^-2)	117.1±24.3	120.4±25.1	0.734	114.7±23.5	117.8±23.3	0.855
GPT/(U·L^-1)	24±12	23±10	0.567	23±11	24±10	0.786
AST/(U·L^-1)	21 (16, 31)	23 (14, 29)	0.301	20 (12, 28)	24 (14, 43)	0.243
γ-GT/(U·L^-1)	32.5 (17.5, 41.0)	35.3 (18.1, 43.4)	0.661	31.2 (15.7, 42.2)	37.9 (19.0, 45.6)	0.318
TC/(mmol·L^-1)	5.12±1.34	4.96±1.60	0.620	4.84±1.40	4.91±1.28	0.701
TAG/(U·L^-1)	2.56 (1.26, 4.07)	2.69 (1.42, 3.93)	0.734	2.47 (1.16, 4.22)	2.78 (1.67, 4.33)	0.796
MUI/(μg·L^-1)	145 (106, 187)	149 (110, 190)	0.864	128 (95, 171)	135 (108, 178)	0.764
Thyroid gland/cm³	25.53 (18.79, 28.35)	24.35 (17.02, 26.23)	0.805	23.47 (17.43, 26.18)	23.05 (16.53, 25.62)	0.909

Index	Intervention group (n=59)		Control group (n=59)
Index	Before treatment	After treatment	Before treatment	After treatment
FT3/(pmol·L^-1)	4.26±0.46	4.28±0.43	4.19±0.41	4.09±0.35
FT4/(pmol·L^-1)	15.46±3.21	15.38±3.16	15.71±3.30	15.36±3.26
TSH/(pmol·L^-1)	2.35±0.43	2.43±0.39	2.41±0.46	2.52±0.41
TPOAb/(IU·mL^-1)	410.31±43.35	310.22±47.76^①③	398.43±41.16	356.48±39.30
TGAb/(IU·mL^-1)	348.23±35.93	281.01±33.10^②④	362.08±31.24	332.07±29.07

Index	Intervention group (n=59)		Control group (n=59)
Index	Before treatment	After treatment	Before treatment	After treatment
FT3/(pmol·L^-1)	4.26±0.46	4.28±0.43	4.19±0.41	4.09±0.35
FT4/(pmol·L^-1)	15.46±3.21	15.38±3.16	15.71±3.30	15.36±3.26
TSH/(pmol·L^-1)	2.35±0.43	2.43±0.39	2.41±0.46	2.52±0.41
TPOAb/(IU·mL^-1)	410.31±43.35	310.22±47.76^①③	398.43±41.16	356.48±39.30
TGAb/(IU·mL^-1)	348.23±35.93	281.01±33.10^②④	362.08±31.24	332.07±29.07

Index	Intervention group (n=59)		Control group (n=59)
Index	Before treatment	After treatment	Before treatment	After treatment
CD3⁺/%	59.23±4.12	68.14±4.52	57.15±5.38	60.45±5.70
CD4⁺/%	34.36±5.54	44.56±4.26^①⑤	32.17±5.16	34.11±5.06
CD8⁺/%	22.20±4.23	21.12±4.01	22.48±3.35	22.15±2.26
CD4⁺/CD8⁺	1.55 (1.10, 2.03)	2.11 (1.63, 2.82)^①⑤	1.43 (1.13, 1.92)	1.54 (1.21, 1.91)
IL-2/(pg·mL^-1)	4.27 (2.23, 9.27)	2.99 (2.01, 6.48)^②⑥	4.20 (2.00, 8.99)	4.13 (2.01, 8.78)
TNF-α/(pg·mL^-1)	8.92 (3.59, 17.47)	7.71 (3.25, 15.42)^③⑥	8.71 (4.05, 17.69)	8.59 (3.32, 17.43)
IL-6/(pg·mL^-1)	3.74 (1.05, 7.99)	5.04 (2.25, 11.45)^④⑦	3.45 (1.34, 8.11)	3.50 (1.15, 8.03)
IL-10/(pg·mL^-1)	7.08 (3.05, 17.14)	8.71 (4.11, 18.09)^②⑧	7.17 (3.43, 17.01)	7.03 (3.21, 16.31)
hs-CRP/(mg·L^-1)	6.46 (1.55, 8.78)	3.27 (0.76, 5.16)^①⑤	6.76 (1.78, 9.68)	6.37 (1.97, 9.77)
ESR//(mg·L^-1)	15.5 (8.4, 23.0)	12.6 (8.3, 19.5)^④⑨	14.9 (8.9, 22.6)	14.1 (9.1, 21.4)

黄芪对甲状腺功能正常的桥本甲状腺炎患者外周血T淋巴细胞亚群表达的影响

Effects of Astragali Radix on T lymphocyte subsets expression in peripheral blood of Hashimoto′s thyroiditis patients with normal thyroid function

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Metrics

Index	Intervention group (n=59)	Control group (n=59)
CD3⁺T cells increase/%	8.65 (3.42, 15.20)^①	2.83 (1.14, 5.23)
CD4⁺T cells increase/%	9.05 (4.20, 16.81)^①	1.95 (-0.43, 5.96)
CD8⁺T cells decrease/%	0.69 (-0.21, 1.75)^②	0.35 (-0.79, 1.42)
CD4⁺/CD8⁺increase	0.55 (-0.20, 1.41)^①	0.11 (-0.30, 0.37)
TPOAb decrease/(IU·mL^-1)	97.12 (42.35, 170.58)^①	38.91 (19.33, 80.14)
TGAb decrease/(IU·mL^-1)	64.17 (33.77, 130.10)^①	26.54 (11.74, 68.09)
hs-CRP decrease/(mg·L^-1)	2.81 (0.75, 3.29)^①	0.38 (-0.21, 0.73)
ESR decrease/(mg·L^-1)	2.5 (0.1, 3.3)^①	0.8 (-0.3, 1.3)

Variable	β	SE	Standard	t value	P value
CD4⁺T cells increase	-0.513	0.231	-0.407	-2.709	0.010
hs-CRP decrease	0.434	0.201	0.365	2.351	0.023
Astragali Radix	-0.393	0.178	-0.321	-2.209	0.029
CD4⁺/CD8⁺ increase	-0.351	0.133	-0.300	-2.010	0.035

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