Study On The Efficacy And Mechanism Of Xiaojin Pill In The Treatment Of Hashimoto’s Thyroiditisin Hypothyroidism Based On Amino Acid Metabolomics

Objective:This paper observes the clinical efficacy of Xiaojin pill in the treatment of Hashimoto’s thyroiditis in hypothyroidism through the curative effect of TCM symptoms.This paper explores the changes of serum amino acid metabolites before and after Xiaojin pills treatment by the targeted metabolomics techniques.From the perspective of amino acid metabolomics,explore the mechanism of Xiaojin pills in the treatment of Hashimoto’s thyroiditis,provide relevant theoretical basis,and further guide traditional Chinese medicine in the treatment of Hashimoto’s thyroiditis in hypothyroidism.Methods:1.47 patients with Hashimoto’s thyroiditis in hypothyroidism were randomly divided into two groups: the control group was treated with Xiaojin pills(n=25)on the basis of routine application of levothyroxine sodium tablets(n = 22).Both groups were treated for 60 days.Serum samples were collected before and after treatment to detect relevant parameters.2.Observe the clinical TCM syndrome performance of the two groups before and after treatment,and record the clinical TCM syndrome scores before and after treatment through the questionnaire to compare the curative effect of TCM syndrome.3.Electrochemiluminescence immunoassay was used to detect the changes of thyroid function parameters before and after treatment,including serum free triiodothyronine(FT3),free triiodothyronine(FT4),thyroid stimulating hormone(TSH),anti thyroid peroxidase antibody(TPOAb)and anti thyroglobulin antibody(TGAb).4.The levels of 14 amino acid metabolites in serum of patients before and after treatment were detected by ultra-high performance liquid chromatography tandem four-stage rod electrostatic field orbital trap mass spectrometry(UPLC-Q-Exactive Orbitrap MS).5.Through SPSS24.0 software to statistically analyze the clinical TCM symptom score,clinical curative effect and thyroid function level of the two groups before and after treatment.Xcalibur software is used to extract and preprocess the obtained map data,and then SIMCA(14.1)software is used to analyze the preprocessed data by principal component analysis and orthogonal partial least squares discriminant analysis.Later,statistical analysis was conducted using SPSS24.0 software,screening differential amino acid metabolites according to the variable projection importance(VIP)and the P value of Student’s t-test,comparing all normally distributed variables between groups by one-way ANOVA.Pearson coefficient was used to compare the correlation between serum thyroid function parameters and amino acid metabolites.Metaboanalyst was used to analyze differential metabolic pathways,enrichment analysis and topological analysis of metabolic pathways.Results:1.Both the control group and the experimental group can reduce the total score of clinical TCM symptoms and improve the curative effect of TCM symptoms.After treatment,the total effective rate of TCM symptoms in the experimental group was 96.0%,which was better than that in the control group(P<0.01).2.After treatment,the levels of serum TSH,TPOAb and TGAb in the experimental group decreased more significantly than those in the experimental group(P<0.01,P<0.05,P<0.05).3.Compared with the control group before and after treatment,there were7 different amino acid metabolites in the patient’s serum,which were up-regulated in histidine level and down-regulated in serine,proline,glutamate,glutamine,arginine and valine level respectively.Compared with before and after treatment,there were three different amino acid metabolites in the serum of the experimental group,which were up-regulated asparagine and down regulated serine and methionine.The horizontal difference between the two groups after treatment showed that there were four different amino acid metabolites in the serum of the patients,which were up-regulated in the levels of alanine,tryptophan and phenylalanine and down regulated in the level of methionine.Conclusion:Xiaojin pills in the treatment of Hashimoto’s thyroiditis in hypothyroidism can significantly reduce the score of traditional Chinese medicine symptoms and the level of thyroid autoantibody.From the perspective of amino acid metabolism,Xiaojin pills may participate in a variety of inflammation and immune reactions in the body by promoting the catabolism of serine and methionine and inhibiting the catabolism of asparagine,inhibit the inflammatory reaction,help maintain the function of the immune system,and significantly reduce the level of thyroid autoantibody,showing a better therapeutic effect than levothyroxine sodium tablets alone.At the same time,tryptophan and serine metabolism may become the landmark amino acid metabolites for the treatment of hypothyroidism of Hashimoto’s thyroiditis.