1、第 36 卷第 6 期2022 年12 月长治医学院学报JOUNALOFCHANGZHIMEDICAICOLLEGEVol36No6Dec2022 临床研究 作者单位:天津市滨海新区中医医院内分泌科(300451)作者简介:赵建美，女，硕士，副主任医师，研究方向:内分泌代谢性疾病的诊治;通信作者:庞晓晨，女，博士，主管药师，研究方向:中药及中药新剂型研究，Email:13194638841 163com。地衣芽孢杆菌对桥本甲状腺炎亚临床甲减患者甲状腺抗体的影响赵建美邹佳涵庞晓晨摘要目的:探讨地衣芽孢杆菌联合优甲乐对桥本甲状腺炎患者甲状腺自身抗体的影响。方法:回顾性选取经确诊为桥本甲状腺炎患者
2、80 例，分为 2 组，对照组为口服优甲乐治疗的患者，观察组为地衣芽孢杆菌活菌胶囊联合优甲乐治疗的患者，每组各 40 例。2 组连续治疗 12 周，分别于治疗前、治疗 4 周、治疗 12 周时检测患者的促甲状腺激素(TSH)、甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPO-Ab)水平，记录 2 组治疗 4 周和治疗 12 周时优甲乐用量，观察 2 组患者检测指标及优甲乐用量的差异。结果:2 组治疗 4 周、12 周后 TSH 较治疗前均明显下降(P0.05);对照组治疗 4 周、12 周后 TPOAb、TGAb较治疗前无明显差异(P0.05)，观察组治疗 4 周后 TPOAb、TG
3、Ab 较治疗前无明显差异(P0.05)，治疗12 周后 TPOAb、TGAb 较治疗前下降，差异有统计学意义(P0.05);观察组治疗 12 周后 TSH(3.470.85)vs(3.87 0.80)IUmL1、TPOAb (349.85 122.46)vs(424.18 165.57)IUmL1、TGAb(209.8586.96)vs(279.48149.44)IU mL1 均低于对照组，差异有统计学意义(P0.05);2 组患者治疗 4 周时优甲乐应用剂量差异无统计学意义(P0.05)，治疗 12 周时观察组患者优甲乐应用剂量明显低于对照组(P 0.05)。结论:地衣芽孢杆菌联合优甲乐治疗
4、不仅可以降低 HT 亚临床甲减患者的 TSH、TPOAb、TGAb 水平，还可以通过改变肠道菌群促进肠道对优甲乐药物的吸收，减少不良反应。关键词肠道菌群;甲状腺炎;亚临床甲减;甲状腺抗体中图分类号581.4文献标识码A文章编号10060588(2022)0642305Effect of Bacillus Licheniformis on Thyroid Antibodies in Subclinical Hypothyroidismof Hashimoto Thyroiditis PatientsZHAO Jianmei，ZOU Jiahang，PANG XiaochenDepartment
5、of Endocrinology，Binhai New District Hospital of Traditional Chinese medicineAbstractObjective:To investigate the effects of Bacillus licheniformis combined with Euthyrox on thyroid autoantibodies inpatients with Hashimoto Thyroiditis subclinical hypothyroidism Methods:A retrospective study of a tot
6、al of 80 Hashimoto Thyroiditissubclinical hypothyroidism patients were selected The patients were divided into the control group and the observation group accord-ing to the random number table method The control group was treated with Euthyrox，and the observation group was treated with Ba-cillus lic
7、heniformis viable capsule combined with Euthyrox，with 40 cases in each group The two groups were treated for 12 weeksThe levels of thyroid stimulating hormone(TSH)，thyroid globulin antibody(TGAb)，and thyroid peroxidase antibody(TPOAb)were detected before treatment，at 4 weeks of treatment and 12 week
8、s of treatment，respectively，and the dosage of Euthyrox was re-corded in the two groups at 4 weeks and 12 weeks of treatment to observe the differences in the test indexes and the dosage of Euthy-rox between the two groups esults:Before and after treatment，TSH in 2 groups decreased significantly afte
9、r 4 weeks and 12 weeksof treatment compared with before treatment(all P0.05)There were no significant differences in TPOAb and TGAb in the controlgroup after 4 weeks and 12 weeks of treatment compared with that before treatment(P0.05)，while there were no significantdifferences in TPOAb and TGAb in t
10、he observation group after 4 weeks of treatment compared with that before treatment(P0.05)After 12 weeks of treatment，TPOAb and TGAb decreased significantly compared with that before treatment(P0.05)Comparison324长治医学院学报2022 年第 36 卷between groups:There were no significant differences in TSH，TPOAb，and
11、 TGAb between the two groups before and after 4 weeksof treatment(P0.05)，but there were significant differences in TSH，TPOAb，and TGAb between the two groups after 12 weeksof treatment(P0.05)Comparison of dosage of Euthyrox in two groups:there was no significant difference in the dose of the twogroup
12、s at 4 weeks of treatment(P0.05)，and the dose of the observation group was significantly lower than that of the control groupat 12 weeks of treatment(P0.05)Conclusions:Bacillus licheniformis combined with Euthyrox can not only reduce the levels ofTSH，TPOAb and TGAb in HT subclinical hypothyroidism p
13、atients but also promote intestinal absorption of the drug through changingintestinal flora，reduce the dosage of the drug and reduce adverse reactionsKey wordsintestinal flora;hashimoto thyroiditis;subclinical hypothyroidism;thyroid antibody桥本甲状腺炎(Hashimoto thyroiditis，HT)是一种自身免疫性甲状腺疾病，主要特点为血清中出现过氧化
14、物酶抗体(TPOAb)和甲状腺球蛋白抗体(TGAb)1。我国甲状腺疾病的发病率在 11%以上，其中 HT 占 20%25%2。HT 是引发亚临床甲减最常见的病因3。近年来，随着 HT 的患病率逐渐增加，桥本亚临床甲减的患病数量也随之增加。目前临床上对 HT 的治疗仍局限于对甲状腺功能的治疗，针对抗体治疗的效果并不确切。因此，在临床中寻求一种能够有效降低 HT 抗体、阻止或延缓疾病向甲减转化的治疗方法，成为当代医学研究的热点。有研究显示，通过口服特定自身抗原的益生菌改变肠道微生物群的构成，能够改善自身免疫性疾病的免疫功能，表明在益生菌治疗 HT 方面有望取得一定疗效4。活性地衣芽孢杆菌是一种高活
15、性益生菌，当它进入人体肠道后能快速定植、生长并耗氧，低氧环境为人类肠道内有益细菌的生长创造了有力条件，与此同时控制了有害细菌的繁殖，进而调节人体肠道菌群失调状态。本研究将探讨地衣芽孢杆菌对桥本亚临床甲减患者抗体及 TSH 的影响，以期为临床治疗桥本亚临床甲减提供新的诊治思路。1资料与方法1.1研究对象回顾性分析 2020 年 7 月至 2021 年 12 月于我院内分泌科就诊的桥本亚临床甲减患者临床资料。仅口服优甲乐的患者为对照组，优甲乐联合地衣芽孢杆菌活菌治疗的患者为观察组，每组各40 例。纳入标准:(1)符合桥本甲状腺炎的诊断标准且处于亚临床甲减状态。HT 诊断标准5:弥漫性甲状腺肿大;血
16、清 TPOAb 和 TGAb 阳性;甲状腺细胞学检查符合 HT 的病理表现。符合+或+即可确诊。亚临床甲减诊断:促甲状腺激素(TSH)高于正常(TSH4 IUmL1)，而游离甲状腺素(FT4)水平正常。(2)年龄 1865 岁。排除标准:(1)排除合并其他甲状腺疾患。(2)患有自身免疫性疾病的患者。(3)哺乳期、怀孕或正准备怀孕的女性。(4)正在服用可能危害甲状腺功能的药物者。(5)影响药物吸收的严重胃肠道疾患。(6)严重心脑血管病及肝病。(7)精神类疾患。1.2治疗方法1.2.1基础治疗限碘低脂饮食，避免服用能够引起甲状腺肿大的食物(如卷心菜、黄豆、豌豆、花生等);注意规律作息;情志调摄。1.2.2药物治疗对照组和观察组均服用优甲乐 默克雅柏药业(中国)有限公司生产，注册证号:H20140052。优甲乐起始剂量为 25 50 g，每日 1 次，每 12 周增加 25 g，具体用量结合患者自身 TSH 水平，以达到 TSH 水平正常为准。晨起空腹顿服，避免服用影响优甲乐吸收的药品及食物。常见的药品有消胆胺、考来替泊、胃黏膜保护剂、影响胃液 pH 值的药物等;食物有葡萄柚、豆浆、浓咖啡、