地塞米松及氨甲喋呤静脉冲击治疗Graves眼病的疗效观察

The Effects of Intensive DMPA Regimen in the Treatment of Graves' Ophthalmopathy

为改进Ｇｒａｖｅｓ眼病的疗效，作者对３５例病情较重或经常规治疗无效的患者，用地塞米松、氨甲喋呤静脉注射或点滴，每周１次，连续４周，并同服小剂量强的松（Ｐ）５日疗法／周，４周后加服硫唑嘌呤（Ａ）或６硫基嘌呤（６ＭＰ）。６周为一疗程，若病情需要，可重复１个疗程，然后用Ｐ＋Ａ巩固治疗并逐渐减量至第６月停药。结果：３３（９４．３％）例眼部症状改善，其眼球突度减少，与治前相比有显著性差异，突眼≤１年比＞１年者更明显。约半数闭目不全和复视者，以及５例暴露性角膜炎及２例溃疡穿孔者经治愈，仅留角膜云翳。

patients with Graves' ophthalmopathy were treated with DMPA regimen which included dexamethasone(D) 20 30mg and Methotrexate(M) 15 20mg iv once a week and prednisone(P)20mg/d p.o. 4 times a week for 4 weeks followed by addition of azathioprine (A) or 6 MP 75 100mg/d and the increment of prednisone (20mg/d) to 5 times a week in the fifth and sixth weeks.The full intensive course of therapy lasted for 6 weeks.If necessary ,the similar course of therapy might be repeated.Later on,each patient was mintainted on a therapy with P and A or P and 6 MP for another 1 2 months then the P and A or P and 6 MP for another 1 2 months,and then the P and A or 6 MP were tapered and finally discontinued at the end of sixth month.The symptoms and signs of the opthalmopathy were evaluated blindedly at the beginning and the end of the first and second courses of the therapy by two ophthalmologists.The results showed that the symptoms and signs were significantly improved in 33(94.3%)cases.A decrease of eyeball protrusion of 1.22 ±1.15 and 1.28±1.15mm in the left and right eyes respectively was shown by eophthalmometry reading (both P <0.0005,compared with before and after the therapy).The decrease of exophthalmos was more remarkable in the cases with ophthalmopathy for ≤ 1 year than that>1 year.11/22 patients recovered their ability to close eyes adequately.The diplopia was corrected in 8/15 cases.The mobility of eye ball returned to normal in 5/15 cases.Exposed lesion and/or ulceration of the cornea found in 7 patients were cured.Serious side and/or toxic effects of the drugs were not present during the course of therapy.It is suggested that DMPA regimen is an effective,safe and cheap approach to the treatment of Graves' ophthalmopathy.