Clinical Observation And Mechanism Research On The Treatment Of Nodular Goiter Based On The Method Of Regulating Qi And Eliminating Gallbladder

ObjectiveThe purpose of clinical research is to observe the clinical efficacy of Liqi Xiaoying method in treating nodular goiter of the stagnation of Qi due to depression of the liver.On the premise of clinical effectiveness,MTT drug sensitivity test was used to explore the possible mechanism of Liqi Sanjie Xiaoying ointment in the treatment of nodular goiter,providing experimental evidence for the external treatment of nodular goiter with traditional Chinese medicine and improving the clinical efficacy of external medicineMethodClinical study:This study is an exploratory study.From October 2017 to December 2018,63 patients with nodular goiter of the stagnation of Qi due to depression of the liver in Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine were selected in the clinical trial according to the criteria of admission and drainage.Three patients fell out and 60 patients were eventually enrolled in the group.The patients were treated with Shugan Sanjie Xiaoying Decoction and Liqi Sanjie Xiaoying Ointment.The observation period was 3 months.The changes of therapeutic and safety indexes such as thyroid volume,maximum diameter of nodules,goiter degree,TCM syndrome score and malignant risk score of nodules were observed before and after treatmentExperimental research:By preparing Chinese herbal decoction and culturing thyroid follicular epithelial cells,11 concentrations of 0.002-4.Omg/ml were selected for MTT drug sensitivity test.The absorbance(OD)values were measured at 490nm on the enzyme label,and OD values were recorded for 6h,24h and 48h,respectively.The inhibition rate of proliferation of each group was calculated:inhibition rate=(1-ODexperimental/ODcontrol group)*100%ResultClinical researchAnalysis on Maximum diameter of thyroid nodules:The mean maximum diameter of thyroid nodules is lower after treatment,Statistical test showed that there was significant difference between the two groups(P<0.01).Comparison on thyroid volume:The maximum volume of thyroid was 89.57 cm3 before treatment,compared with 81.79 cm after treatment,statistical analysis shown that the difference was significant(P<0.01)Degree of goiter before and after treatment:Before thyroid treatment,19 cases had grade ?enlargement,36 cases had grade ? enlargement,5 cases had grade ? enlargement and 0 case had no enlargement.After treatment,29 cases had grade ? enlargement,23 cases had grade ?enlargement,0 cases had grade ? enlargement and 8 cases had no enlargement.The overall degree of goiter showed a downward trend.Chi-square test showed that there was significant difference after treatment(P<0.05).Analysis on integral of TCM syndromes:The average score before treatment was 16.07,and after treatment was 5.87.There was significant difference between with traditional Chinese medicine(P<0.01).Analysis on the total effective rate:Evaluation and analysis of disease efficacy:After treatment,18 cases(30%)were markedly effective,and 40 cases(66.67%)were effective,so the total effective rate of TCM symptoms reached 96.67%Comparison on malignant risk score of thyroid nodules:The average malignant risk score of thyroid nodules before treatment was 1.40 and after treatment was 0.95.There was significant difference in malignant risk score of thyroid nodules by rank sum test(P<0.01).Analysis on the Security:There were no abnormalities in blood routine,liver and renal function after treatment.All the indexes were within the normal range.According to the safety evaluation criteria,there were 59 cases in Grade 1 and 1 case in grade 25 and the safety was 98.33%.Experimental researchLiqi Sanjie Xiaoying ointment can inhibit the proliferation of human thyroid follicular epithelial cells.In a certain period of time,with the increase of drug concentration,the inhibition rate of cell proliferation shows a gradual upward trend,indicating that the inhibition rate of cell proliferation is positively correlated with drug concentration.Within a certain concentration of drugs,the inhibition rate of cell proliferation increased gradually with the prolongation of the action time,and the inhibition rate of cell proliferation was positively correlated with the action time of drugsWith the prolongation of drug action time,the optimal inhibition rate of cell proliferation was achieved,and the required drug concentration could be gradually reducedConclusionClinical study:The treatment of nodular goiter by regulating qi and eliminating gall can reduce the volume of thyroid gland,reduce the degree of goiter,reduce thyroid nodules;it can obviously improve the symptoms and signs of nodular goiter of liver depression and qi stagnation type,which is safe and effective in clinical applicationExperiment research:Liqi Sanjie Xiaoying ointment can inhibit the proliferation of thyroid follicular epithelial cells,and the inhibition rate of proliferation is positively correlated with drug concentration and action time;the optimal inhibition rate of proliferation is achieved.the action time is prolonged,and the required drug concentration is reduced;the drug concentration is increased,the action time is shortened;guiding clinical application,properly prolonging the application time,can reduce drug dosage;Increasing drug concentration can shorten the application time accordingly.Advantages:Reduce skin sensitivity and improve clinical efficiency.