| Hashimoto’s thyroiditis,or chronic lymphocytic thyroiditis,is an autoimmune thyroid disease.It has various clinical manifestations due to its different stages of development.It can manifest as hyperthyroidism,normal or hypothyroidism.In fact,the clinical manifestations are mainly normal or hypothyroidism,often accompanied by thyroid nodules,and the canceration rate of nodules is as high as 23%-25%.Therefore,it is very important to take effective preventive measures.At present,the prevention and treatment measures mainly include hormone therapy(thyroxine suppression therapy)and selenium supplementary therapy.However,due to its high side effects and low efficiency,TCM has unique advantages in the prevention and treatment of this disease.Therefore,it is of great significance to study the preventive and therapeutic effects of traditional Chinese medicine on Hashimoto’s thyroiditis complicated with thyroid nodules in order to improve the basic state of patients,slow down the occurrence of thyroid nodules,reduce the canceration rate of thyroid nodules and avoid the side effects of preventive measures of Western medicine.Objective: In order to explore the risk factors of thyroid nodules in Hashimoto’s thyroiditis patients within one year,and finally establish a predictive model of Hashimoto’s thyroiditis complicated with thyroid nodules.To explore the effect of Western medicine combined with traditional Chinese medicine on Hashimoto’s thyroiditis complicated with thyroid nodules within one year,and to explore the role of traditional Chinese medicine in the prevention and treatment of Hashimoto’s thyroiditis complicated with thyroid nodules.Method: A retrospective study was conducted on 151 patients with Hashimoto’s thyroiditis from October 2014 to October 2017 in Dongzhimen Hospital affiliated to Beijing University of Traditional Chinese Medicine.The independent risk factors of thyroid nodules within 1 year were analyzed by COX single factor and multifactor analysis.Finally,the predictive model of Hashimoto’s thyroiditis complicated with thyroid nodules was established.According to the measures taken to prevent and treat thyroid nodules,they were divided into70 cases in the traditional Chinese medicine treatment group and 81 cases in the non-traditional Chinese medicine treatment group.To study the preventive effect oftraditional Chinese medicine on Hashimoto’s thyroiditis complicated with thyroid nodules,thyroid nodules were observed in two cohorts within one year.Result:1.In this paper,151 cases of Hashimoto’s thyroiditis were analyzed by Cox single factor and multi factor analysis.The significant single factor variables in Cox single factor analysis were: history of hypertension,family history of thyroid disease,BMI classification,TGAb,TPOAb,TC,LDL-C and traditional Chinese medicine treatment.Finally,hypertension was found History,TGAb,TPOAb,BMI index classification,family history of thyroid disease and traditional Chinese medicine treatment were the independent influencing factors of Hashimoto’s thyroiditis complicated with thyroid nodule within one year(P < 0.05).The cut off values of the above six independent influencing factors were calculated and the scoring model was established: after BMI index classification,the score of non obesity or overweight was 0,and after BMI index classification,the score of obesity or overweight was 1;TPOAb <204.125iu/ml was 0,TPOAb ≥ 204.125iu/ml was 3;TGAb < 68.24iu/ml was 0,and TGAb≥ 68.24iu/ml was 3;no previous history of hypertension was 0,and previous history of hypertension was 3 History: 2 points;family history without thyroid disease: 0 point;family history with thyroid disease: 2 points;treatment without Chinese medicine: 3 points;treatment with Chinese medicine: 0 point.The score range of the model is 0-14.The prediction model predicted that the area under ROC curve of thyroid nodule in Hashimoto’s thyroiditis within one year was 0.905.According to the cut off value,patients with Hashimoto’s thyroiditis were divided into two groups: high risk group(predictive score 5-14)and low risk group(predictive score 0-5).There was a significant statistical difference between the two groups(P < 0.001).2.Univariate and multivariate analysis of COX was performed in 151 Hashimoto’s thyroiditis patients.After adjusting for other factors,traditional Chinese medicine treatment was still an independent influencing factor for Hashimoto’s thyroiditis patients complicated with thyroid nodules within one year(HR = 0.104,95% CI = 0.047-0.232,P< 0.001).K-M analysis showed that combined traditional Chinese medicine treatment could significantly reduce Hashimoto’s thyroiditis patients complicated with thyroid within one year.Nodule risk(P < 0.001).This study was divided into two subgroups according to whether or not to take Chinese medicine.Comparing the occurrence time of nodules between the two groups,it was found that the median occurrence time of nodules in the Chinese medicine group was 10(8.75-10),while that in the non-Chinese medicine group was 5(4-8),P < 0.001,which showed that taking Chinese medicine could delay the occurrence time of nodules.3.After analyzing and counting the Chinese medicine prescriptions in the Chinese medicine cohort,it was found that 110 Chinese medicine prescriptions were sorted out,involving 145 different Chinese medicines,and the cumulative total frequency of drug use was 1913 times.Among them,52 medicines with frequencies over 10 were used,and the cumulative frequencies were 1555,with the cumulative frequencies being 82.85%.In addition,54 Chinese medicines with frequencies of more than 10 were used according to the four qi,five flavors and meridian tropism of traditional Chinese medicine.It was found that the frequencies of cold,warm and peaceful medicines and bitter,pungent and sweet medicines were higher.From the point of meridian tropism of traditional Chinese medicine,the frequencies of liver medicines were the highest,followed by spleen,lung,heart,kidney,gallbladder and stomach meridians.From the perspective of classification of traditional Chinese medicine,the use frequency of tonifying deficiency drugs,clearing away heat drugs,promoting blood circulation and removing blood stasis drugs,antiepileptic drugs and Qi-regulating drugs is higher.Conclusion:1.Baseline history of hypertension,TGAb,TPOAb,BMI index classification,family history of thyroid disease and traditional Chinese medicine treatment were the independent influencing factors of Hashimoto’s thyroiditis complicated with thyroid nodule within one year.On this basis,the prediction model can well identify the high-risk group with thyroid nodules within one year.The prediction model is more suitable for Hashimoto ’s thyroiditis patients with normal or hypothyroidism.2.Hashimoto’s thyroiditis patients treated with western medicine combined with traditional Chinese medicine can significantly reduce the risk of concurrent thyroid nodules within one year,and combined with traditional Chinese medicine treatment can not onlyreduce the risk of concurrent thyroid nodules but also delay their occurrence.From the Kaplan-Meier curve,we can see that the incidence of thyroid nodules in Hashimoto’s thyroiditis patients decreased within one year with the increase of dose level < 28 cDD,28-90 cDD,91-180 cDD and > 180 cDD dose groups,and the incidence of thyroid nodules in one year was 49.4%,33.3%,34.8% and 28.9%(log P=0.032),respectively.3.Through statistical analysis of the prescriptions of 70 patients in the Chinese medicine group during the observation period,it was found that in the prevention and treatment of Hashimoto’s thyroiditis complicated with thyroid nodules,the traditional Chinese medicines such as mild temperature,mild cold,calm,bitter taste,bitter taste,sweet taste,liver meridian,spleen meridian,lung meridian,heart meridian,kidney meridian,gallbladder meridian and stomach meridian were mostly used in clinic.The efficacy of resolving exterior symptoms and dispersing wind,resolving phlegm and dispersing knots,nourishing qi and nourishing Yin accords with the pathogenesis of Hashimoto’s thyroiditis complicated with thyroid nodules. |
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