Different Role Of TgAb And TmAb In The Dysfunction Of Thyroid And Therpeutical Rule Of Traditional Chinese Medicine

Objective:The aim of this study is to Explore the different role of TgAb(anti-thyroglobulin antibody)and TmAb(anti-thyroid microsomal antibody)in the dysfunction of thyroid among the first diagnosed thyroid nodules or goiter.Investigate whether the TgAb(anti-thyroglobulin antibody)has a significant influence on thyroid function or not.To provide theoretical reference of the Traditional Chinese medical treatment of hashimoto’s thyroiditis,summarize the regularity of Traditional Chinese medicine treating which can reduce the level of thyroid autoantibodies.Methods:A cross-sectional survey was undertaken among the 727 patients which first diagnosed thyroid nodules or goiter from the outpatient department of the hospital affiliated to Nanjing university of Chinese Medicine.According the excludsion criteria,25 subjects were excluded because of Graves Disease,trasient hyperthyroidism,subacute thyroiditis and thyroid cancer.Finally,A total of 702 subjects were involved in this study.All of the 702 subjects were divided into two groups,Hashimoto’s thyroiditis(HT)group(n=361)and non-Hashimoto’s thyroiditis(non-HT)group(n=341),according to the diagnostic criteria for hashimoto’s thyroditis.In line with the concentration of the thyroid autoantibodies,subjects were divided into positive TmAb group(n=362)and positive TgAb group(n=340),according to the reference range from the clinical laboratory of Jiangsu Province Hospital of Chinese Medicine.The participants provided their personal information and clinical data.The sera were assayed by the clinical laboratory of Jiangsu Province Hospital of Chinese Medicine in the early morning to measured the concentiation of anti-thyroid microsomal antibody(TmAb),anti-thyroglobulin antibody(TgAb),thyroid stimulating hormone(TSH),free triiodothyronine(FT3),free thyroxine(FT4),total triiodothyronine(TT3),total thyroxine(TT4),thyroglobulin(Tg).Thyroid gland size was measured in ultrasound department of Jiangsu Province Hospital of Chinese Medicine.Thyroid volume was calculated by using anteroposterior,transverse and axial diameters of each thyroid gland.The level of TSH and the other factors were compared between the HT group and non-HT group.The correlation of the TmAb,TgAb,TSH,FT3,FT4,TT3,TT4,Thyroidgobulin and thyroid volume were analyzed.Binary logistic regression was used to analyze whether the TgAb was a risk factor of hypothyroidism in patients with hashimoto’s thyroiditis.Our study got 65 literatures by searching the database of China National Knowledge Infrastructure,WangFang Data,Vip Data and so on,finally 55 literatures were involved in our study and 10 literatures were excluded according to exclusion criteria.Traditional Chinese Medicine were recorded in Excel and SPSS tables,using the same drug name recorded in"Chinese materia medica" as the "12th five-year plan textbook" published by China press of traditional Chinese medicine.Frequency analysis and correlation analysis were used to get the commonly used Traditional Chinese Medicine and Traditional Chinese Medicine pairs.Results:(1)The TSH level of llashimoto’s thyroiditis group was significantly higher than the non-Hashimoto’s thyroiditis group.At the same time,there were significantly statistical differences between the Hashimoto’s thyroiditis group and the non-Hashimoto’ thyroiditis group,according to the age,FT4,TT4,Tg,and thyroid volume(P<0.01).(2)There was a significantly positive correlation between the TmAb and TSH whether the other factors were controlled(P<0.01).There was also a correlation between the TgAb and TSH(P<0.05),but when TmAb was controlled,this correlation was disappeared.(3)Subjects were divided into four groups and compared with each other,according to the concentrations of the thyroid autoantibodies from low to high.There were significant differences among the four groups of TmAb compared with TSH and FT4 respectively(P<0.01),and the higher the concentrations of TmAb were,the higher the TSH was.There was also a statistical difference among the four groups of TgAb(P<0.05).(4)Using binary logistic regression analysis,TmAb was founded to be the risk factor of hypothyroidism whether the other factors were controlled or not,and the higher the concentrations of TmAb were,the greater the OR value was.While the TgAb was not the risk factor of hypothyroidism.(5)According to the thyroid autoimmue antibodies,subjects were divided into four groups as follows:both negative group(n=341),only positivie TgAb group(n=110),only positive TmAb group(n=21)and both positive group(n=230).The only positivie TgAb group and the only positive TmAb group were respectively statistically different from the both positive group(P<0.01),while there was no statistical difference from the negative group.(6)Subjects from the only positivie TgAb group and the both positive group were divided into four groups according to age,and every group was divided into three sub-groups according to the level of TgAb.There was no difference between the only positivie TgAb group and the both positive group when compared at the same levels of age and TgAb.There was neither no difference between male and female.(7)Multivariate regression analysis was conducted by taking hypothyroidism as the dependent variable and the TmAb,TgAb,gender,age,Tg and thyroid volume as the independent variables.Regression equation:y=1.785+0.005TmAb.Only TmAb was included into the regression equation as the risk factor of hypothyroidism.(8)Frequency analysis showde that among the reported literatures,the commonly used Traditional Chinese Medicine which can reduce the level of thyroid autoantibodies were Huangqi,Xiakucao,Chaihu and so on.(9)Correlation analysis showed that the commonly used Traditional Chinese Medicine pairs were Fuling-Chenpi,Xiakucao-Sheshecao,Xianlinpi-Xianmao,Chaihu-Baishao-Danggui,Chaihu-Chuangxiong-Fuling,Chaihu-Baizhu-Danggui and so on.Conclusions:1.In patients with newly diagnosed Hashimoto’s thyroiditis,TmAb is the risk factor of hypothyroidism,and the higher the TmAb titer is,the more severe the dysfuction of thyroid is.2.TgAb has a scarcely influence on the thyroid function and the role of TgAb in the process of hashimoto’s thyroiditis remans to be further studied.3.Tonifying herbs,Qi regulating herbs,blood activating herbs and phlem removing herbs are in the majority of TCM treating HT and reducing the thyroid autoimmune antibodies.The compatibility of tonifying herbs with Qi regulating and phiem removing herbs is commonly used.Most of the herbs used belong to liver,spleen and kidney channel tropism.