免疫抑制剂局部注射治疗弥漫性甲状腺肿伴甲亢的疗效观察

Topical intrathyroid injection of immunosuppressive agents in treatment of Graves' disease

目的 :评价甲状腺局部分别注射免疫抑制剂地塞米松 ( Dex)、环磷酰胺 ( CTX)、环孢素 A ( Cys A)或三药联合治疗甲状腺功能亢进 (甲亢 )的疗效及安全性。方法 :采用随机法将甲亢患者 5 0 0例分为 5组 :Dex、CTX、Cys A治疗组 ,三联治疗组 ,单独口服抗甲状腺药物组 (对照组 )。局部治疗 1次 /周 ,连续 3个月 ,然后每 2周一次共注射 4次 ,再改 1次 /月 ,共 2个月 ,观察甲状腺体积、甲状腺功能、甲状腺自身抗体、肝肾功能及血尿常规改变。结果 :局部注射治疗组甲状腺明显缩小 ,甲状腺激素恢复正常时间明显高于对照组 ,促甲状腺激素受体抗体 ( TRAb)、抗甲状腺球蛋白抗体 ( TGAb)、甲状腺线粒体抗体 ( TMAb)下降速度及程度也较对照组为大 ,以三联药物治疗组疗效最显著。治疗过程中肝、肾功能及血、尿常规无明显改变 ;未观察到明显不良反应 ,亦无甲低及喉返神经损伤。 结论 :免疫抑制剂甲状腺局部注射治疗甲亢疗效显著 ,可推广应用于临床。

Objective: To investigate the efficacy and safety of local injection with dexamethasone(Dex), cyclophosphamidum(CTX) and cyclosporin A(CysA) in hyperthyroidism. Methods: Five hundred patients with Graves' disease were randomly divided into 5 groups:(1) (3) patients treated with Dex,CTX,CysA,respectively;(4) patients treated with combination of Dex,CTX and CysA; (5) patients treated with antithyroid drugs orally(as control). In the former 4 groups immunosuppressive agents were injected once a week for 3 months, then once fortnight for 2 months. The changes of the thyroid volume, T 3 and T 4 level in plasma and antithyroid antibody were examined. Liver and kidney function, blood routine were also determined.Results: Enlargement of the thyroid ameliorated significantly in the local treatment, especially in the group 4. The thyroid hormone formation became normal more quickly than in the control, and the titer of TGAb, TNAb and TRAb decreased in a shorter time. The liver and kidney function, blood routine did not change. Hypothyroidism, injury of recurrent laryngeal nerve and other adverse effects was not found. Conclusion: The efficacy of topical intrathyroid injection of immunosuppressive agents in the treatment of Graves' disease is obvious,this method is a novel approach in thyrotoxicosis therapy.