激素不同途径治疗甲状腺相关眼病的疗效比较

A comparison of the clinical efficacy on treatment of thyroid associated ophthalmopathy with periocular triamcinolone and high-dose oral prednisone

目的探讨曲安奈德球周注射与泼尼松口服方案治疗甲状腺相关眼病(thyroid associated oph-thalmopathy,TAO)的临床疗效。方法选择2005年11月至2009年12月在我院确诊的TAO初发期患者28例(46只眼),参考患者病情程度及依从性将其分为2组:曲安奈德球周注射组14例(24只眼)及大剂量泼尼松口服组14例(22只眼)。2组患者的性别、年龄、病程构成基本相似。比较2组患者治疗前后临床活动性积分(clinical activity score,CAS)及眼外肌厚度,并分析临床疗效。结果 1.CAS:曲安奈德球周注射组治疗前后的积分为5.2±1.5和2.6±1.4,泼尼松口服组为5.0±1.8和2.5±1.3。治疗前后比较,2组的组间差异无统计学意义(t=0.42,t=0.39,P>0.05),各组内差异有统计学意义(t=4.48和t=5.23,P<0.01)。2.眼外肌厚度(经眼眶CT水平位结合冠状位扫描):曲安奈德球周注射组治疗前后分别为(6.8±1.5)mm和(2.6±1.2)mm,泼尼松口服组为(6.6±1.8)mm和(2.5±1.3)mm。治疗前后,2组间比较差异无统计学意义(t=0.39,t=0.67,P>0.05),组内比较差异有统计学意义(t=3.87,t=3.61,P<0.01),2组治疗后病情均有不同程度缓解。结论对TAO初期患者,曲安奈德球周注射组与大剂量泼尼松口服组具有相近的疗效,而前者无明显副作用,初步认为曲安奈德球周注射方案在临床上更值得推广应用。

OBJECTIVE To investigate the clinical efficacy of peribulbar triamcinolone injection and oral prednisone in the treatment of thyroid associated ophthalmopathy （TAO）. METHODS Twenty-eight patients（46 eyes）with thyroid associated ophthalmopathy diagnosed in our hospital during November 2005 to December 2009, were divided into 2 groups based on reference level and compliance of patient＇s condition： triancinolone peribulbar injection group （14 cases, 24 eyes）, and high-dose oral prednisone（ 14 cases, 24 eyes）group. There was similar constituent ratio in two groups regarding patient＇ s age, gender and course of disease. Before and after the treatment, the clinical activity points （CAS）and extraocular muscle thickness were compared within group and between the two groups the clinical efficacy was analyzed. RESULTS CAS of peribulbar triamcinolone injection group before and after treatment were 5.2＋1.5 and 2.6＋1.4, respectively while oral prednisone group were 5.0_＋1.8 and 2.5＋1.3. There was no statistical significance between the two groups （t=0.42 and 0.39, P〉0.05）. However, there was statistical significance within groups （t=4.48 and 5.23, P〈0.01 ）. The extraocular muscle thickness （by the combination of the horizontal orbital and coronal CT scan ） of peribulbar injeetion group was （6.8 -＋ 1.5 ）mm and （2.6 -＋ 1.2 ）mm; prednisone group was （6.6_＋1.8）mm and （2.5 ＋l.3）mm. There was no statistical significance between the two groups （t= 0.39 and 0.67, P〉0.05）. However, there was statistical significance within groups （t=3.87 and 3.61, P〈0.01 ）. There were various degrees of ease in two groups after treatment. CONCLUSION Triamcinolone administered as a periocular injection was as effective as high-dose oral prednisone for improving TAO in the early stages. No systemic or ocular adverse effects were found. Therefore, the preliminary results indicated that periocular injection of triamcinolone was more worthy of promotion in clinical practice.