霉酚酸酯治疗活动性甲状腺相关性眼病的临床疗效观察  

Mycophenolate mofetil for active thyroid-associated ophthalmopathy

作　　者：胡潇豪 叶小珍[1] 柏晓勇[1] 卢斌[1] 彭丽[1] 李洁[1] 许一新[1] 王燕燕[1] 王坚[1] 

机构地区：[1]南方医科大学南京临床医学院(南京军区南京总医院)内分泌科,南京医学硕士研究生210002

出　　处：《医学研究生学报》2015年第3期268-271,共4页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81070626);南京军区南京总医院科研基金(2012012)

摘　　要：目的目前对甲状腺相关性眼病(thyroid associated ophthalmopathy,TAO)尚无理想的治疗方法。文中比较霉酚酸酯(mycophenolate mofetil,MMF)和泼尼松对活动性TAO的安全性和疗效。方法连续收集2010年1月至2014年10月间于南京军区南京总医院门诊及住院治疗后定期随访的40例活动性TAO患者。按照不同治疗方案分为MMF组(n=22)和泼尼松组(n=18),疗程共12周。疗效评定采取临床活动性评分及TAO分级变化进行综合评定。对于治疗12周后单用泼尼松无效及眼病复发者采用MMF与泼尼松联合治疗。结果 12周治疗结束时统计发现,MMF组22例患者中1例(4.5%)显效,18例(81.8%)有效,3例(13.6%)无效;泼尼松组18例患者中1例(5.6%)显效,9例(50%)有效,7例(38.9%)无效,1例(5.6%)加重。MMF组总有效率(显效+有效)为86.4%,高于泼尼松组的55.6%(P<0.05)。治疗后2组活动度积分均较治疗前显著降低(P<0.05),下降幅度MMF组大于泼尼松组[(1.09±0.68)vs(0.67±0.91),P<0.05]。泼尼松组中3例(16.7%)胃部不适,2例(11.1%)月经紊乱;MMF组未发现不良反应者。治疗12周后发现3例单用泼尼松治疗无效者,且2组各1例的眼病复发者采用MMF与泼尼松联合治疗后突眼情况明显改善。结论新型免疫抑制剂MMF治疗TAO疗效优于泼尼松,且不良反应较少。联合治疗对单药治疗无效者及复发者有效。Objective Up to the present time , there has been no desirable therapy for thyroid-associated ophthalmopathy （ TAO） .This study was to compare the efficacy and safety of mycophenolate mofetil （ MMF） and prednisone in the treatment of active TAO. Methods This study involved 40 cases of active TAO , which were randomly assigned to receive MMF （ n=22 ） and oral prednisone （n=18） for 12 weeks.The therapeutic results were evaluated according to the improvement in the clinical activity scores and the grades of TAO. Results By the end of the 12-week treatment, 1 （4.5%） of the 22 cases was markedly improved, 18 （81.8%） improved, and 3 （13.6%） failed to respond in the MMF group .In comparison, 1 （5.6%） of the 18 cases was markedly improved, 9 （50%） improved, 7 （38.9%） unchanged, and 1 （5.6%） aggravated in the prednisone group .The total effectiveness rate was significantly higher in the MMF than in the prednisone group （86.4%vs 55.6%, P〈0.05）.The mean clinical activity score was remarkably decreased in both groups after treatment as compared with the baseline （P〈0.05）, even more remarkably in the for-mer than in the latter group （1.09 ±0.68 vs 0.67 ±0.97, P〈0.05）.Adverse reactions occurred in 5 cases （stomach discomfort in 3 and mild menstrual abnormality in 2） in the prednisone group , but none in the MMF group .For the 3 failed cases in the prednisone

关 键 词：甲状腺相关性眼病 免疫治疗 霉酚酸酯 泼尼松 

分 类 号：R771.3[医药卫生—眼科]