相对低剂量甲泼尼龙联合99Tc-MDP治疗老年Graves眼病的疗效观察  

Efficacy of combined 99Tc-methylenediphosphonate and lower-dose meth ylprednisolone in the treatment of old patients with moderate-to-severe Graves ophthalmopathy

作　　者：郭树龙[1] 张久君[2] 

机构地区：[1]福建医科大学附属泉州第一医院内分泌科,362000 [2]福建医科大学附属泉州第一医院核医学科,362000

出　　处：《国际放射医学核医学杂志》2009年第5期287-290,共4页International Journal of Radiation Medicine and Nuclear Medicine

摘　　要：目的评价相对低剂量甲泼尼龙短程疗法联合99Tc-亚甲基二膦酸盐（99Tc-MDP）治疗老年活动性中重度Graves眼病（GO）的临床疗效及安全性。方法24例老年活动性中重度GO患者先配对后随机分入对照组及试验组各12例。对照组应用常规大剂量甲泼尼龙问断静脉短程冲击治疗，累积剂量达800．1200mg。试验组应用相对低剂量甲泼尼龙（累积剂量为300-480mg）联合99Tc-MDP的治疗方案。治疗前及开始治疗后每1～4周进行定期随访观察，并根据眼病临床活动性评分及美国甲状腺协会提出的甲状腺相关眼病分度分级标准评定眼部病情变化，同时监测治疗后的不良反应。应用Ridit检验进行统计分析，比较两组疗效。结果试验组10例患者有效，对照组6例患者有效，两组的疗效有统计学差异（t=2．121，P〈0．05）。对照组的不良反应明显增多，主要体现于消化道症状，引起或加重水钠潴留与糖代谢紊乱。结论对于老年活动性中重度GO应用相对低剂量甲泼尼龙短程疗法联合99Tc-MDP是一种临床疗效及安全性较好的治疗方案。Objective To assess the efficacy and safety of combined 99Tc-methylenediphosphonate （99Tc-MDP） and lower-dose methylprednisolone in the treatment of old patients with active moderate-to- severe Graves ophthalmopathy. Methods Twenty-four old patients with active moderate-to-severe Graves ophthalmopathy were randomly divided into two groups, that were methylprednisolone group （control group） and combination of 99Tc-MDP and methylprednisolone group （experimental group） . The two groups were similar in age, sex, duration and severity of ophthalmopathy. Patients in control group were treated with intravenous high-dose methylprednisolone pulse therapy （cumulative dose of 800-1200 mg） . experimental group were treated with combination therapy of 99Tc--MDP and lower-dose methylprednisolone （cumulative dose of 300-480 mg）. At 12-week follow-up, therapeutic outcome was assessed by the change in clinical activity score and severity classified using Americom Thyroid Association of thyroid-associated ophthalmopathy indexing classification stcmdard. The adverse effects were observed and recorded in all patients. Results The remarkably effective outcome was observed in 6/12 （50.0%） cases in control group and 10/12 （83.3%） cases in experimental group. There were significant differences in the degree of improvements in ocular involvements. Less frequent and severe adverse effects were observed with the addition of 99Tc-MDP to lower-dose methylprednisolone therapy. Conclusion A combination of 99Tc-MDP and lower-dose methylprednisolone may be better tolerated and more effective than high-dose methylprednisolone alone in the treatment of old patients with active moderate-to-severe Graves＂ ophthalmopathy.

关 键 词：GRAVES眼病 99M锝美罗酸盐 甲泼尼龙 药物疗法 老年人 

分 类 号：R77[医药卫生—眼科] R5[医药卫生—临床医学]