Exploration Of The Clinical Effectiveness Of The Method Of Clearing The Liver, Strengthening The Spleen And Regulating Qi In The Treatment Of Non-hyperthyroidism Hashimoto's Thyroiditis

1ObjectiveThis study intends to observe the clinical efficacy of Qinggan Jianpi Liqi method in the non-hyperthyroidism stage of Hashimoto’s thyroiditis through clinical research,and explore its potential mechanism through network pharmacology research,and provide a basis for further in-depth research.2Methods2.1 Clinical researchAccording to the inclusion and exclusion criteria stipulated in the research protocol,no less than 60 patients with non-Mujiao Hashimoto’s thyroiditis who were admitted to Dongzhimen hospital from January 2017 to January 2019 were treated with Qinggan Jianpi Liqi method.Three months,serum TPOAb,TGAb titer level,thyroid gland volume,TCM syndrome score,anxiety state score were monitored,and statistical analysis was performed to determine its clinical efficacy and safety.2.2 Network Pharmacology ResearchThe chemical structure of the active constituents contained in Prunella vulgaris L.and Fritillaria ussuriensis was obtained through the comprehensive database of Chinese herbal medicines;the target site screening of Chinese herbal medicine active ingredient database and therapeutic target database was established,and the drug target database of Prunella vulgaris-Zhebei Fritillaria was established.The Hashimoto’s thyroiditis-related gene and protein targets were screened by the Mendelian genetic comprehensive database to establish a Hashimoto’s thyroiditis target database.Analyze the common target of "Prunella vulgaris-Zhebei" and Hashimoto’s thyroiditis to clarify its potential mechanism of action.3Results3.1 Clinical researchIn this study,62 patients were enrolled,2 patients were shedding,and 60 patients were actually enrolled and completed clinical observation.3.1.1serum TPOAb,TGAb titer①The average serum TPOAb titer before intervention was 210 IU/ml,and the average level after intervention was 193 IU/ml.Statistical analysis P<0.05,the difference was statistically significant.②The average serum TGAb titer before intervention was 522 IU/ml,and the average level after intervention was 448 IU/ml.Statistical analysis P<0.05,the difference was statistically significant.3.1.2thyroid gland volume change①The median volume of thyroid right lobe before intervention was 7.49;the median volume of right thyroid lobe after intervention was 5.99.After statistical analysis,P<0.05,the difference was statistically significant.②The median volume of left thyroid lobe before intervention was 6.18;the median volume of left thyroid lobe after intervention was 5.10.After statistical analysis,P<0.05,the difference was statistically significant.③The median anteroposterior diameter of the thyroid isthmus before intervention was 0.33;the median anteroposterior diameter of the thyroid isthmus was 0.3 after intervention.After statistical analysis,P<0.05,the difference was statistically significant.3.1.3Comparison of TCM Syndrome Points①The median score of TCM syndrome before intervention was 19.00,and the median score after intervention was 15.00.After statistical analysis,P<0.05,the difference was statistically significant.②According to the evaluation criteria of curative effect,Qinggan Jianpi Liqi method was used to treat 3 cases of Hashimoto’s thyroiditis in non-hyperthyroidism,42 cases were markedly effective,14 cases were effective,and 1 case was ineffective.The total effective rate was 98.33%.3.1.4 Anxiety Scale Points(SAS Score and HAMA Score)①SAS score:the median before intervention was 54.50,and the median after intervention was 42.00.After statistical analysis,P<0.05,the difference was statistically significant.②HAMA scores:The median before intervention was 14.00,and the median after intervention was 3.00.After statistical analysis,P<0.05,the difference was statistically significant.3.1.5Safety evaluationAccording to the safety evaluation criteria,the safety classification is:58 cases in 1 level,2 cases in 2 levels,and safety is 96.67%.Two of the two grades were characterized by mild itching of the skin,which was relieved by temporary withdrawal.3.2Network Pharmacology ResearchA total of 33 direct-target pathways related to "Prunella vulgaris-Zhebei" and Hashimoto’s thyroiditis were obtained by KEGG analysis.The key targets in the"drug-disease" network were screened by cytoHubba,and selected according to MCC values.20 targets.Combining the results of KEGG analysis with the key targets of cytoHubba screening,AKT1 and EGFR were in the first and second positions,and MCC-Score were 10726 and 10433,respectively.Tip:AKT1 and EGFR are the two most important targets for the common target of "Prunella vulgaris-Zhebei" and disease Hashimoto’s thyroiditis.In combination with the KEGG pathway list,AKT1 and EGFR are involved in multiple pathways.4Conclusions4.1Clinical researchThis study suggests that Qinggan Jianpi Liqi therapy for non-hyperthyroidism Hashimoto’s th yroiditis can reduce serum TPOAb,TGAb titer levels,reduce thyroid gland volume,improve anxiety,reduce TCM syndrome scores,SAS scores,HAMA scores.4.2Network Pharmacology ResearchBased on network pharmacology research,the predictive drugs have a total of 89 targets and 33 related pathways for Prunella vulgaris-Zhebei and X-ray thyroiditis.Phosphatidylinositol 3-kinase(PI3K)/Akt pathway and calcium ion The signal pathway is its potential action pathway.