中重度甲状腺相关眼病单纯激素冲击及激素冲击联合放疗远期疗效观察  

Long-term clinical outcomes of pulsed corticosteroids with or without orbital irradiation for moderate to severe Graves’ ophthalmopathy

作　　者：郭玲玲[1] 杨国庆[1] 谷伟军[1] 杜锦[1] 臧丽[1] 郭清华[1] 沈蕾[1] 李萍[1] 窦京涛[1] 巴建明[1] 吕朝晖[1] 母义明[1] 

机构地区：[1]解放军总医院内分泌科,北京100853

出　　处：《中华内分泌代谢杂志》2015年第6期506-509,共4页Chinese Journal of Endocrinology and Metabolism

基　　金：中华医学会临床医学科研专项资金.施贵宝内分泌糖尿病研究项目（12020360326）;

摘　　要：目的：观察中重度甲状腺相关眼病糖皮质激素静脉治疗或联合眼眶放疗远期疗效及不良反应。方法对38例中重度甲状腺相关眼病患者治疗前后畏光、流泪、眼睛疼痛、眼部软组织充血、水肿、眼球突出、复视等比较，对联合放疗组和单纯激素冲击治疗组眼部症状表现、总体疗效、患者满意度进行比较，并对不良反应进行观察。结果38例患者治疗后畏光、流泪、眼睛疼痛、眼部软组织充血、水肿、眼球突出、复视等均得到改善，联合放疗组与单纯激素冲击组在上述症状方面未见差别，联合放疗组总体有效率高于单纯激素冲击治疗组。结论远期随访发现对于中重度甲状腺相关眼病糖皮质激素静脉冲击联合放疗效果优于单纯激素冲击治疗，远期不良反应应警惕严重骨质疏松。Objective To investigate long-term clinical efficacy and side effects of intravenous glucocorticoid therapy with or without orbital radiotherapy in moderate to severe Graves’ ophthalmopathy. Methods A total of 38 patients with moderate to severe Graves’ ophthalmopathy were investigated. 19 of them were treated with intravenous glucocorticoid only; in the other 19 patients glucocorticoid treatment was followed by orbital radiotherapy. Eye tearing, eye pain, soft tissue congestion, edema, exophthalmos, and diplopia were compared before and after treatment. These symptoms, general curative effect, and patients satisfaction were compared between the 2 groups, and side effects were recorded. Results Photophobia, tearing, eye pain, soft tissue congestion, edema, exophthalmos, and diplopia were all improved after treatment. Hormone combined with radiotherapy and hormone therapy alone did not yield a difference in these symptoms. Patients in the 2 groups showed the same satisfaction rate. However, in regard to the general curative effect, the group with orbital radiotherapy showed a better response rate. Of all these patients, 7 patients developed severe osteoporosis and complained bone pain, 7 patients put on body weight more than 2. 5 kg each, and 1 patient developed diabetes. There was no severe liver damage or cardiovascular event. Conclusion The project of intravenous glucocorticoid given on 3 consecutive days every 4 weeks in one to 3 circles is an effective treatment for patients with moderate to severe Graves’ ophthalmopathy. Intravenous glucocorticoid combined with orbital radiotherapy is more effective than intravenous glucocorticoid alone for moderate to severe Graves’ ophthalmopathy patients. Strict assessment before treatment may avoid severe side effects, and in a long-time follow-up, osteoporosis is the main side effect which should be alerted.

关 键 词：甲状腺相关眼病 糖皮质激素 放射治疗 

分 类 号：R581[医药卫生—内分泌] R771.3[医药卫生—内科学]