激素冲击联合放射治疗重度活动期甲状腺相关眼病疗效观察  

Effect of pulsed glucocorticoids combined with orbital radiotherapy for the treatment of severe active thyroid-associated ophthalmopathy

作　　者：刘芳 朱豫[2] 张珂[2] 李志刚[2] 

机构地区：[1]驻马店市中心医院眼科,河南驻马店463000 [2]郑州大学第一附属医院眼科,河南郑州450052

出　　处：《新乡医学院学报》2016年第7期623-625,共3页Journal of Xinxiang Medical University

基　　金：河南省科技攻关资助项目(编号:082102310049)

摘　　要：目的探讨大剂量糖皮质激素冲击联合眼眶外放射治疗重度活动期甲状腺相关眼病(TAO)的临床效果。方法选择26例重度活动期TAO患者,静脉滴注甲泼尼龙12.5 mg·kg-1,连用3 d后改口服泼尼松40 mg,连用4 d,每4周重复1次;同时进行眼眶外放射治疗,每次2 Gy,共10次。于治疗结束后1、6个月进行随访观察,评价该治疗方案的临床疗效。结果联合治疗结束后1、6个月,治疗有效率分别为73.08%、84.62%,患者的自觉症状、视功能明显改善;治疗后1个月眼球突出度、睑裂高度、临床活动性评分(CAS)、血清透明质酸(HA)水平均较治疗前降低(P<0.001,P<0.05);治疗后6个月眼球突出度、睑裂高度、CAS、血清HA水平较治疗前进一步降低(P<0.001,P<0.05)。所有患者治疗过程中无严重不良反应及并发症发生。结论大剂量糖皮质激素冲击联合眼眶外放射治疗重度活动期TAO安全、有效。Objective To evaluate the therapeutic effects of pulsed glucocorticoids combined with orbital radiotherapy for the treatment of severe active thyroid-associated ophthalmopathy（ TAO）. Methods Twenty-six patients with severe active TAO were treated. Methylprednisolone was administered through intravenous instillation,12. 5 mg·kg- 1for three days. Then oral hydroprednisone was used with 40 mg·d- 1for four days,once every four weeks. In the meantime,orbital radiontherapy was given,2 Gy for 10 times. Therapeutic effects of the patients were observed at 1,6 months after treatment. Results At 1month and 6 months after the combined treatment,the effective rate was 73. 08%,84. 62% respectively. Patient＇ s symptoms and visual function were improved significantly. Compared with that before treatment,the degree of exophthalmus,palpebral fissure height,clinical activity score（ CAS） and the level of hyaluronic acid decreased significantly at one month after treatment（ P〈0. 001,P〈0. 05）; and all the indexes further decreased at six months after treatment（ P〈0. 001,P〈0. 05）. There was no serious side-effects and complications in all cases. Conclusion It is a safe and effective method that pulsed glucocorticoids combined with orbital radiotherapy for treating the severe active TAO.

关 键 词：甲状腺相关眼病 糖皮质激素 放射治疗 

分 类 号：R771.3[医药卫生—眼科]