眶周注射曲安奈德治疗甲状腺相关眼病的临床研究

Clinical study of triamcinolone acetonide peri-orbital injection with and without oral prednisone therapy on thyroid associated ophthalmopathy

目的评价眶周注射曲安奈德治疗甲状腺相关眼病NOSPECSⅡ级患者的疗效。方法从169例甲状腺相关眼病连续病例中，随机选出NOSPECSⅡ级患者45例，其中38例为单眼发病，7例为双眼发病。第一组眶周注射曲安奈德，第二组予眶周注射曲安奈德同时口服强的松，第三组单纯口服强的松。每月记录CAS积分、睑裂大小、上睑迟落、角膜荧光素染色、泪膜破裂时间等，随访6月。结果三组治疗期间CAS积分、睑裂和上睑迟落均减小。第一组和第二组治疗后1～2月内CAS积分降至最小，而第三组于治疗后5月才降至最小，治疗后5月三组间CAS积分无明显差异。第一组和第二组于治疗后2月起睑裂开始缩小，第三组于治疗后3月起睑裂开始缩小，治疗后6月时第一组和第二组睑裂明显小于第三组。第一组和第二组于治疗后2月起上睑迟落开始减轻，第三组于治疗后3月起上睑迟落开始减轻，治疗后6月时第一组和第二组上睑迟落明显轻于第三组。三组治疗后角膜荧光索染色积分均减少，泪膜破裂时间改善，但三组间无明显差异。结论单纯上方眶周注射曲安奈德疗法与上方眶周注射曲安奈德联合口服强的松疗法较单纯口服强的松疗法能迅速、有效地改善甲状腺相关眼病NOSPECSⅡ级患者的症状和体征，第二种疗法与第一种疗法疗效相似，但存在全身副作用。

Objective To report the effect of triamcinolone acetonide peri orbital injection with and without prednisone on NOSPECS class Ⅱ thyroid associated ophthalmopathy. Methods We selected 45 patients who had NOSPECS Ⅱ class thyroid associated ophthalmopathy among 169 consecutive patients with thyroid associated ophthalmopathy. The 45 patients were randomized into 3 groups. In the first 15 patients, triamcinolone acetonide peri orbital injection therapy repeated 2-3 times for successive month, 1 time per month. In the second 15 patients triamcinolone acetonide peri orbital injection accompanied oral prednisone therapy （initial daily dose of lmg/kg, tapered to discontinuation）. The third 15 patients received only oral prednisone therapy. The clarification activity score （CAS）, eyelids height, upper eyelid lag, corneal fluoreseein dying, and tear film break up time （BUT） were documented every month and followed up for 6 months. Results Clinical findings at study entry were not significantly different among three groups. CAS were reduced to the least at 1 to 2 month after therapy in the first and second group, whereas reduced to the least at 5 month in the third group, No significant difference was found in CAS at 5 month among three groups. Eyelids height were significantly reduced at 1 to 2 month after therapy in the first and second group, whereas reduced at 3 month after therapy in the third group. Eyelids height of the first two groups were less than the third group at 6 month. Eyelids lag were significantly reduced at 2 month after therapy in the first and second group, whereas reduced at 3 month after therapy in the third group. Eyelids lag of the first two group were less than the third group at 6 month. No significant difference was found in corneal fluoreseein stain and BUT among three groups, although corneal fluorescein dying was diminished, and BUT was improved during treatment among three groups. Conclusions Triamcinolone acetonide peri - orbital injection therapy and triamcinolone acetonide peri orbital injection with oral prednisone therapy had the same beneficial therapeutic effects on CAS, eyelids height, and eyelids lag of active thyroid associated ophthalmopathy during 6 month follow- up period. But oral prednisone had systemic side effects.