利妥昔单抗眼眶注射联合甲泼尼龙静脉滴注对Graves眼病的疗效及免疫系统的影响  

Efficacy of rituximab orbital injection combined with intravenous drip of methylprednisolone in treating Graves′ophthalmopathy and its influence on immune system

作　　者：张发蓉 ZHANG Farong(Department of Endocrinology,Ziyang City People′s Hospital in Sichuan Province,Ziyang,Sichuan,641300)

机构地区：[1]四川省资阳市人民医院内分泌内科,四川资阳641300

出　　处：《实用临床医药杂志》2025年第4期11-15,22,共6页Journal of Clinical Medicine in Practice

基　　金：2021年四川省科研课题计划(S21216)。

摘　　要：目的探讨利妥昔单抗(RTX)眼眶注射联合甲泼尼龙静脉滴注对甲状腺眼病(Graves眼病)的治疗效果。方法将2021年7月-2023年1月资阳市人民医院收治的102例Graves眼病患者随机分为联合组(n=34)、甲泼尼龙组(n=34)和RTX组(n=34)。甲泼尼龙组给予糖皮质激素(甲泼尼龙)单药,RTX组给予RTX单药,联合组给予RTX联合甲泼尼龙。比较3组总有效率、眼征状况、甲状腺体积、甲状腺免疫抗体[抗甲状腺球蛋白抗体(TGAb)、抗促甲状腺素受体抗体(TRAb)、抗甲状腺过氧化物酶抗体(TPOAb)水平]、临床活动度量表(CAS)评分、外周血免疫球蛋白[免疫球蛋白G4(IgG4)、IgG4/IgG]水平及不良反应。结果联合组总有效率为97.06%(33/34),高于甲泼尼龙组的79.41%(27/34)和RTX组的76.47%(26/34),差异有统计学意义(P<0.05)。治疗4、8周后,联合组眼球突出度、球尖距、眼内压、球后软组织体积均低于甲泼尼龙组、RTX组,差异有统计学意义(P<0.05);联合组甲状腺体积、CAS评分均低于甲泼尼龙组、RTX组,差异有统计学意义(P<0.05);联合组TGAb、TRAb、TPOAb均低于甲泼尼龙组、RTX组,差异有统计学意义(P<0.05);联合组IgG4、IgG4/IgG均低于甲泼尼龙组、RTX组,差异有统计学意义(P<0.05)。3组不良反应发生比较,差异无统计学意义(P>0.05)。结论Graves眼病患者接受RTX眼眶注射联合甲泼尼龙静脉滴注可获得更好的疗效,有利于改善眼征状况,调节TGAb、TRAb、TPOAb及免疫球蛋白。Objective To explore the efficacy of rituximab(RTX)orbital injection combined with intravenous drip of methylprednisolone in treating Graves′ophthalmopathy.Methods A total of 102 patients with Graves′ophthalmopathy in the Ziyang City People′s Hospital from July 2021 to January 2023 were randomly divided into combination group(n=34),methylprednisolone group(n=34),and RTX group(n=34).The methylprednisolone group was given glucocorticoids(methylprednisolone)monotherapy,the RTX group was given RTX monotherapy,and the combination group was given RTX combined with methylprednisolone.The total effective rate,ophthalmic manifestations,thyroid volume,thyroid immune antibodies[thyroid globulin antibody(TGAb),thyrotropin receptor antibody(TRAb)and thyroid peroxidase antibody(TPOAb)levels],the Clinical Activity Scale(CAS),levels of immunoglobulins in peripheral blood[immunoglobulin G4(IgG4)and IgG4/IgG],and adverse reactions were compared among the three groups.Results The total effective rate was 97.06%(33/34)in the combination group,which was significantly higher than 79.41%(27/34)in the methylprednisolone group and 76.47%(26/34)in the RTX group(P<0.05).After 4 and 8 weeks of treatment,the exophthalmos degree,interocular distance,intraocular pressure,and retrobulbar soft tissue volume in the combination group were significantly lower than those in the methylprednisolone group and the RTX group(P<0.05);the thyroid volume and the CAS score in the combination group were significantly lower than those in the methylprednisolone group and the RTX group(P<0.05);the TGAb,TRAb and TPOAb levels in the combination group were significantly lower than those in the methylprednisolone group and the RTX group(P<0.05);the IgG4 and IgG4/IgG in the combination group were significantly lower than those in the methylprednisolone group and the RTX group(P<0.05).There was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion For patients with Graves′ophthalmopathy,therapeutic effect of

关 键 词：GRAVES眼病 利妥昔单抗 糖皮质激素 抗甲状腺球蛋白抗体 抗促甲状腺素受体抗体 抗甲状腺过氧化物酶抗体 

分 类 号：R770.4[医药卫生—眼科] R392[医药卫生—临床医学] R914