甲状腺功能亢进性Graves眼病全身和局部激素治疗效果分析  

Efficacy and clinical effectiveness of steroid therapy of all body and local application on hyperthyroid Graves ophthalmopathy

作　　者：张中宇[1] 何欣[2] 王秀云[1] 王雅[1] 孙大卫[1] 

机构地区：[1]哈尔滨医科大学第二附属医院眼科,150081 [2]佳木斯大学附属第二医院眼科

出　　处：《中国地方病学杂志》2012年第5期579-582,共4页Chinese Jouranl of Endemiology

基　　金：国家自然科学基金（81171381）;黑龙江省卫生厅科学基金（2006-148）

摘　　要：目的分析甲状腺功能亢进（甲亢）Graves眼病全身激素冲击疗法与局部长效激素治疗的临床效果。方法甲亢Graves眼病患者57例（106眼），来自于2008年3月至2011年10月哈尔滨医科大学附属第二医院眼科确诊的病例。其中男21例，女36例，年龄18～57岁，平均（37．28±11．63）岁。病程1个月至5年，平均（29．63±15．36）月。根据年龄、性别、病情将患者分为全身激素冲击疗法治疗组（全身激素组，29例，54眼）和局部长效激素治疗组（局部激素组，28例，52眼）。全身激素组采用甲基强的松龙0．5-1．0g静脉滴注，每日1次，滴3d、停7d；再滴3d、停7d，总剂量不超过5．0—20．0g。而后口服强的松40mg／a，逐渐减量至5mg／a，疗程3个月。局部激素组采用眼球周围注射曲安奈德20m只，每2周注射1次，疗程3个月。疗程结束后1个月，观察全部患者治疗前后体质量的变化和眼部视力、复视、眼压、眼球突出度及水平视睑裂宽度。结果全身激素组治疗后的体质量[（62．83±7．23）kg]高于治疗前[（57．03±7．13）kg]，也高于治疗后局部激素组[（59．89±10．67）kg．t值分别为25．25、2．08，P均〈0．05]。全身激素组治疗前、后眼压[（13．46±1．78）、（13．69±1．41）mmHg，1mmHg=0．133kPa]无改变（P〉0．05）；局部激素组治疗前、后眼压[（13．52±2．19）、（13．77±2．03）mmHg]也无改变（P〉0．05）。全身激素组和局部激素组治疗后眼球突出度[（18．63±2．22）、（14．85±2．61）ram]低于治疗前[（20．78±2．24）、（20．60±2．81）ram，t值分别为9．97、29．68，P均〈0．05]；治疗后局部治疗组眼球突出度明显低于全身治疗组（t=7．79，P〈0．05）。全身激素组和局部激素组治疗后水平视睑裂宽度[（15．00±1．80）、（11．65±2．45）mm]均低于治疗前[（17．22±1．89）、（17．44±2．37）mm，t值分�Objective To investigate the efficacy and clinical effectiveness of the steroid therapy with the all body and local application on hyperthyroid Graves ophthalmopathy. Methods A total of 57 patients（106 eyes） suffering from hyperthyroid Graves ophthalmopathy who hospitalized in the Department of Ophthalmology of the Second Affiliated Hospital of Harbin Medical University from Mar 2008 to Oct 2011 were enrolled in the study. Of the 57 patients, there＇were 21 males and 36 females, aged 18 to 57（average 37.28 ± 11.63）. The clinical course was from 1 month to 5 years（average 29.63 ± 15.36 months）. Based on the patient＇s age, sex and condition, the 57 patients were randomly divided into steroid pulse therapy with all body group（group SPT, 29 patients, 54 eyes） and peribulbar injection of long-term steraid group（group PI,28 patients, 52 eyes）. The patients in group SPT were treated with 0.5 - 1.0 g methylprednisolone by intravenous infusion daily for 3 days, and then stopped for 7 days, the treatment was repeated once. But the total application dose of methylprednisolone was not overruned 5.0 - 20.0 g. After that, the patients were treated with oral prednisone 40 mg/d. The dose of prednisone was reduced gradually to 5 mg/d. The total course of group SPT was 3 months. The patients in the group PI were treated with triamcinolone acetonide in periorbital injection of 20 mg once every two weeks for 3 months. After one month treated, all patients were visited. The patients＇ body weights of two groups were measured before the treatment and after one month treated. The ocular signs of the patients including visual acuity, diplopia, intraocular pressure, exophthalmos and horizontal visual palpebral fissure width were observed before and after the treatment. Results In the group SPT, the average body weight [ （62.83 ± 7.23）kg] after the treatment was higher than that before the treatment[ （57.03 ± 7.13）kg], and also higher than that of the group PI[ （59.89 ± 10.67）kg, t = 25.25, 2.08, a

关 键 词：甲状腺功能亢进 GRAVES眼病 甲基强的松龙 曲安奈德 

分 类 号：R581.1[医药卫生—内分泌]