局部放疗与球后注射治疗Graves眼病的临床疗效观察

Observation on Regional Radiation and Retrobulbar Injection Therapy for Treatment of Patients with Graves' Ophthalmopathy

【目的】寻找治疗Graves眼病较为有效的方法 ,研究联合应用眶内局部放疗与长效糖皮质激素球后注射治疗Graves眼病的疗效。【方法】随机选取在本科住院治疗的Graves眼病患者 5 2例 90眼 ,根据治疗方法不同随机分为联合治疗组 (糖皮质激素球后注射治疗 +眶内放疗 ) 2 6例 4 6眼 ,对照组 (糖皮质激素球后注射治疗 ) 2 6例 4 4眼。治疗前后分别测量两组患者患眼的眼球突出度与睑裂宽度并观察症状及眼征情况。【结果】对照组治疗前后眼球突出度差异有显著性 (P <0 .0 5 ) ;睑裂宽度差异无显著性 (P >0 .0 5 )。联合治疗组治疗前后眼球突出度及睑裂宽度差异均有显著性 (均P <0 .0 5 )。同时 ,联合治疗组眼球突出度及睑裂宽度下降均较对照组明显 ,两组比较差异均有显著性 (均P <0 .0 5 )。联合治疗组症状改善率为 96 .2 % ,对照组症状改善率为 84 .6 %。【结论】联合应用眶内局部放疗与长效糖皮质激素球后注射治疗Graves眼病是一种较为有效的治疗方案 ,其治疗效果优于单独使用糖皮质激素。

Objective To search a more effective therapeutic measure for the treatment of Graves' ophthalmopathy (GOP) and investigate the clinical outcome of intraorbital regional radiation combined retrobulbar injection of persistently effective glucocorticoid.Fifty-two cases (90 eyes) with GOP admitted in our department were randomly selected. According to different methods of therapy, these inpatients were randomly divided into two groups:①Group of combined therapy , 26 cases (46 eyes) were subjected to retrobulbar injection of glucocorticoid plus intraorbital radiation; ②Control group, retrobulbar injection of glucocorticoid alone was scheduled in 26 cases(44 eyes).Then the degree of exophthalmus and width of palpebral fissure in two groups were measured and their symptoms and ocular signs were observed before and after treatment. In control group, there was significant difference in the degree of exophthalmus before and after treatment (P<0.05), but distinct difference in the width of palpebral fissure was not found (P>0.05).The rate of symptom improvement in this group was 84.6%. As for group of combined therapy, both degree of exophthalmus and width of palpebral fissure before and after treatment showed obvious differences (P<0.05).The rate of symptom improvement reached as high as 96.2%. In addition, the degree of exophthalmus and width of palpebral fissure in group of combined therapy decreased more prominently than those in control group (P<0.05).[Conclusion]Combined application of intraorbital regional radiation and retrobulbar injection of persistently effective glucocorticoid is an efficient project of therapy for the treatment of GOP. Its therapeutic efficacy is also much better than administration of glucorticoid alone.