| Hashimoto Thyroiditis(HT),also known as chronic lymphocytic thyroiditis,is the most common autoimmune thyroid disease(AITD).HT is associated with immune disorders and lack of effective treatments.This greatly affects the prognosis and quality of life of patients,especially for women of childbearing age,high titers of thyroid antibodies may cause adverse pregnancy outcomes[1].As an autoimmune thyroid disease,HT is closely related to the body’s immune disorders.Spleen is important to immune system in Traditional Chinese medicine(TCM)according to the related record of ’For five-zang viscera and six-fu organs,spleen was the defense of them’ in the part of Miraculous Pivot·Five Categories of Long Caused by Five Kinds of Fluid Dysbolism[2].Thus spleen deficiency may have close relationship with HT.Selenium yeast is a kind of organic selenium preparation,which is currently used as an adjuvant for HT,but its therapeutic effect is obviously different and the reason is unknown.The mode of TCM is helpful for us to analyze the source of the difference as a whole and grasp the application of drugs.Therefore,we integrate the selenium yeast into the theoretical system of traditional Chinese medicine.We conceive it can nourish the spleen due to it’s nature and flavour such as warm-natured,sweet and bland taste.What’s more,spleen deficiency is one of the pathogenesis of HT.This clinical experiment is to find whether selenium yeast has different therapeutic effects on HT patients by nourishing the spleen.Objective:This study was to observe the therapeutic effect of Selenium yeast in HT patients with and without spleen deficiency,and to evaluate whether selenium yeast can treat HT by improving the symptoms of spleen deficiency.This study is aimed to provide new ideas for the application of Selenium yeast from the perspective of TCM theory syndrome differentiation,and to further clarify and expand the clinical indications of Selenium yeast.Methods:1.Selenium yeast is sweet,bland,yellow and fragrant.it is known that Selenium yeast is similar to the five elements of the spleen based on the analogue thinking way and ’Tui Yan Luo Yi’ in TCM.Selenium yeast can be classified into the spleen meridian and may have the effect of nourishing the spleen.2.Patients with HT who regularly visited the Shandong Provicial Qianfoshan hospital from April 2019 to January 2020 were selected after screening general information.We recruited the eligible subjects according to the inclusion criteria and exclusion criteria(116 patients including 16 males and 100 females).The syndrome types of patients were determined according to the syndrome criteria.The degree of spleen deficiency was evaluated by the score of spleen deficiency syndrome,and they were divided into spleen deficiency group and non-spleen deficiency group.Two groups of patients were given selenium yeast 200ug,oral half an hour after breakfast and dinner.Observing titer of thyroid antibody(TPOAb,TGAb),thyroid function(FT3,FT4,TSH),thyroid gland size,thyroid ultrasound,spleen deficiency degree,etc for 3 months.Result:1.Comparison of baseline values:there was no significant difference in gender,age,BMI,course of disease,degree of goiter,liver function,blood cell analysis,blood selenium,blood lipid between the spleen deficiency group and non-spleen deficiency group(P>0.05);2.Comparison of thyroid antibody:(1)Self-control before and after treatment in the spleen deficiency syndrome group:The TPOAb titer of the spleen deficiency syndrome group was significantly lower after selenium yeast treatment(P<0.05),and its effective reduction rate was 62.3%.According to the syndrome type,the TPOAb reduction effect was found to be spleen-yang deficiency syndrome>Spleen deficiency syndrome Syndrome>Spleen Qi deficiency syndrome>Spleen Yin deficiency syndrome=Spleen incompatibility syndrome=Middle Qi depression syndrome,the difference between the six syndrome types is statistically significant(P<0.05);TGAb titer is significantly lower than before treatment(P<0.05).The TGAb effective reduction rate was 49.18%,and further stratification according to syndrome type found that the TGAb reduction effect had no statistical difference between the six syndrome types(P>0.05);(2)Self-control before and after treatment in the non-spleen deficiency syndrome group:The TPOAb titer of the non-spleen deficiency syndrome group did not change significantly after treatment(P>0.05),and its effective reduction rate was 14.55%;TGAb titer had no significant change after treatment(P>0.05),and its effective reduction rate was 23.64%;(3)Comparison between the spleen deficiency syndrome group and the non-spleen deficiency syndrome group before and after treatment:①Before the treatment with selenium yeast:the TPOAb and TGAb titers had no statistical difference between the two groups(P>0.05).②After selenium yeast treatment:the TPOAb titer decreased more in the spleen deficiency syndrome group(P<0.05)and the effective reduction rate was higher(P<0.05),and the TGAb titer also decreased more in the spleen deficiency syndrome group(P<0.05),but there was no statistically significant difference in the effective reduction rate of TGAb between the two groups(P>0.05);4.Comparison of thyroid function,goiter degree,number and size of thyroid nodule:after treatment,there was no significant difference in thyroid function,goiter degree,number and size of thyroid nodule between the spleen deficiency group and the non-spleen deficiency group(P>0.05);5.The change of the degree of spleen deficiency:the spleen deficiency syndrome in the spleen deficiency group was significantly lower after treatment(P<0.05).The scores of 12 symptoms in spleen deficiency group were significantly lower after treatment(P<0.05),such as anorexia,lassitude,mental fatigue,languor,sallow complexion,abdominal distention,etc;6.Correlation analysis of thyroid antibody change and spleen deficiency degree:the decrease of TPOAb titer was positively correlated with the improvement of spleen deficiency degree(P<0.05,r=0.65);the change of TGAb titer was not significantly correlated with the change of spleen deficiency degree(P<0.05,r=0.11);7.Analysis of the influence factors of selenium yeast on the efficacy of thyroid antibody:to analyze all HT patients,the degree of spleen deficiency affects whether selenium yeast can effectively reduce TPOAb and TGAb in HT patients(P<0.05,95%CI>1),while lymphocyte count,leukocyte count,LDL,HDL,age and other factors had no significant effect on the reduction of TPOAb and TGAb in HT patients(P>0.05).Conclusion:1.Selenium yeast is used in the adjuvant treatment of HT.Its effect is related to the improvement of spleen deficiency.2.Selenium yeast is more suitable for patients with spleen deficiency syndrome,can effectively reduce the TPOAb and the TGAb titer(especially for TPOAb)of HT patients with spleen deficiency syndrome,and alleviate the symptoms of spleen deficiency. |
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