免疫抑制剂不同用法治疗甲状腺相关性眼病对照研究  

Different usages of immunosuppressive agents for treating thyroid-associated eye disease

作　　者：张艳姣[1] 王群[1] 刘志民[2] 杨晓玲[1] 

机构地区：[1]宜昌市第一人民医院内分泌科,宜昌443000 [2]第二军医大学附属长征医院内分泌科

出　　处：《上海医学》2005年第12期1033-1036,共4页Shanghai Medical Journal

摘　　要：目的探讨免疫抑制剂在甲状腺相关性眼病(GO)治疗中应用方法.方法 120例确诊为弥漫性甲状腺肿(Graves病)伴GO患者随机分为A、B、C、D 4组,A组为对照组,口服常规抗甲亢药(丙基硫氧嘧啶、他巴唑、甲状腺片)等,不服用糖皮质激素类药;B组口服常规抗甲亢药同时接受甲泼尼龙0.5 g加入生理盐水250ml及环磷酰胺0.2 g加入生理盐水500 ml中静脉滴注,每日1次,连用3 d,问隔5～7 d重复用,共3～5个疗程,冲击间歇期未行其他治疗;C组在B组治疗方案的基础上在间隔期于甲状腺内注射地塞米松5 mg加环磷酰胺50 mg,1次/d;B、C两组冲击结束后肌肉注射二丙酸倍他米松7 mg,第1个月时,间隔15 d用1次,第2个月时,间隔1个月用1次,第3个月后停用.D组:在口服常规抗甲亢药同时接受地塞米松5 mg加环磷酰胺50mg甲状腺内注射,1次/d×10 d,以后改为每周2次×4次,每周1次×4次,每2周1次×2次,每月1次×2次后停用.结果 B、C组治疗前、后突眼度的差异有显著性(P＜0.01);A、D组治疗前、后突眼度的差异无显著性(P＞0.05).B、C、D组平均突眼度减轻(2.0±1.3)mm、(2.1±1.2)mm和(1.0±0.3)mm;B、C、D组分别与A组的差异有显著性(P＜0.01).A、B、C、D组治疗前、后甲状腺体积显著缩小(P值分别为＜0.05和＜0.01),C、D组甲状腺体积缩小差值分别为(18.7±8.2)mm3和(19.4±9.2)mm3,显著高于A组(4.7±1.2)mm3、B组(7.5±22.2)mm3(P＜0.01).A、B、C、D组甲状腺功能恢复时间分别为(2.8±1.3)、(2.6±1.1)、(1.3±0.8)、(1.2±0.7)个月,其中C、D组显著短于A、B组(P＜0.01).结论免疫抑制剂静脉冲击联合甲状腺内注射治疗GO、甲状腺肿疗效肯定,不良反应小,患者较易耐受.联用比单一种用法更值得推广.Objective To appraise the methods of using immunosuppressive agents for controlling thyroid- associated eye disease. Methods 120 patients of Graves disease accompanied by exophthalmos and goiters were divided into four groups randomly： group A served as control treated by oral antithyroid drugs only; group B received high dose intravenous methylprednisolone（0.5 g/d） and Cyclophosphamide（0.2 g/d） for three consecutive days at 5-7 days intervals ,a total of 3 5 courses, together with antithyroid drugs;group C was treated the same as group B but with additional intrathyroid injection of Dexamethasone （5 mg/d） and Cyclophosphamide （50 mg/d） ; Group D received oral antithyroid drugs and intrathyroid Dexamethasone（5 mg/d） and Cyelophosphamide （50 mg/d） once a day for 10 days,then twice a week for two weeks ,and then once a week for four weeks,once every two weeks for two times, ended by once per month for two months. Results The different in degree of exophthalmos between groups B and C was significant before and after the treatment（P〈0.01） ; but not significant between group A and D（P〉O. 05）. The average decrease of exophthalmos in group B.C.D was （2.0±1.3）mm, （2.1 ± 1.2）mm and （1.0± 0.3）mm, there was significant difference in these compared with group A（P〈0.01 ）. The thyroid volumes of group A,B,C,D were significantly decreased after the treatment（P〈0.05 or P〈0.01）. The thyroid volumes decrease of group C and D were （18.7 ± 8.2）mm^3 and （19.4±9.2）mm^3 , significantly greater than those of group A （4.7±1.2） mm^3 and group B （7. 5±2.2） mm^3 （P〈0.01）. The recovery period of thyroid function of group A,B,C,D were （2.8± 3）,（2.6±1.1）,（1.3±0.8）,（1.2±0.7）months respectively,with those of among them,group C,D significantly shorter than group A and B（P〈0.01）. Conclusions The efficacy of combined pulsatile immunosppressive therapy and intrathyroid injection treatment is valid with few side effects,and being mor

关 键 词：甲状腺相关性眼病 免疫抑制剂 冲击治疗 甲状腺内注射 

分 类 号：R771.3[医药卫生—眼科] R979.5[医药卫生—临床医学]