^(99)Tc-MDP与免疫抑制疗法治疗Graves’眼病的对比研究  

Immunosuppression in Graves' ophthalmopathy

作　　者：田蓉[1] 匡安仁[1] 秦卫仕 张辉敏 

机构地区：[1]华西医科大学第一临床医学院核医学科,成都610041

出　　处：《中华核医学杂志》2000年第6期250-253,共4页Chinese Journal of Nuclear Medicine

摘　　要：目的　评价99Tc 亚甲基二膦酸盐 (99Tc MDP ,“云克”)与免疫抑制疗法治疗Graves’眼病(GO)的疗效。方法　 42例中～重度GO患者 ,随机分为试验组与对照组 ,试验组采用静脉推注“云克” ,对照组采用免疫抑制治疗。治疗前及治疗后 4个月由同一眼科医生检查患者眼部情况 ,同时测定患者甲状腺激素水平及TSH (TRAb)受体抗体、甲状腺球蛋白抗体 (TGA)和甲状腺微粒体抗体(MCA)水平。治疗 4个月后 ,采用NOSPECS分类标准及眼病指数判断疗效。采用SPSS 7 5统计软件进行统计分析。结果　免疫抑制治疗组 6 7% (14/ 2 1例 )的患者有效 ,而“云克”治疗组 6 2 % (13/ 2 1例 )的患者有效。两组治疗前后总的眼病指数差异无显著性 (t=0 5 6 4,P >0 5 0 )。两组间总的治疗效果差异无显著性 (χ2 =0 0 2 ,P >0 5 0 ) ,但免疫抑制治疗组软组织炎症改善较“云克”治疗组快。两组疗效与TRAb、TGA、MCA及治疗前GO活性程度有相关关系。“云克”治疗组未发生副作用 ,免疫抑制治疗组有明显副作用。结论　“云克”是治疗GO的一种具有潜力的药物 ,对于内科治疗与131I治疗甲亢后的GO患者均有效。Objective Graves' ophthalmopathy (GO) is a disease that seriously threatens the health of patients But up to now, no optimal therapies have been established Immunosuppressive treatment is usually used in the management of GO, but they may cause side effects Recently, 99 Tc MDP, commecially named Yun Ke', is used in the management of autoimmune disease Therefore, a randomized trial was done to compare the values in the treatment of GO with between Yun Ke and immunosuppression Methods 42 consecutive patients with moderate or severe GO were randomly assigned to receive either Yun Ke therapy or immunosuppressive therapy The degree of ocular involvement and responses to the treatment were evaluated by numerical scoring (opthalmopathy index, OI) and clinical assessment Therapy outcome was assessed 4 months after the start of treatment by the change in the highest NOSPECS class and OI Data analysis was performed with the SPASS statistic software Chi square test was used to compare percentages, logistic regression was performed to identify which variables might correlated with the treatment outcome Results The remarkably effective outcome was observed in 14 (67%) cases in immunosuppression treated group and 13 (62%) cases in Yun Ke treated group There were no significant differences in the degree of improvements in ocular involvements There was a marked decrease of thyroid antibody titres in both groups The variables found to correlated significantly with treatment outcome were thyroid antibody titres and GO activity Side effects were more frequent and severe during immunosuppressive therapy No side effects were found during Yun Ke treatment Conclusion Yun Ke and immunosuppression appeared to be equally effective in the management of GO, but Yun Ke is safer for patients during treatment

关 键 词：免疫抑制剂 ^99TC-MDP 放射疗法 突眼性甲状腺肿 

分 类 号：R581.1[医药卫生—内分泌]