免疫抑制剂冲击治疗甲状腺相关性眼病的临床观察

Clinical Study on Immunosuppressive Stosstherapy for Thyroid Associated Ophthalmopathy

目的探讨免疫抑制剂冲击治疗甲状腺相关性眼病(TAO)的疗效及安全性。方法选取2006年2月至2010年2月在河北省玉田县医院就诊的TAO患者44例,依据随机数字表法分为冲击组和对照组,每组22例。冲击组连续3 d静脉滴注甲泼尼龙(1000 mg/d),而后连续10 d静脉滴注环磷酰胺(200 mg/d),每月1次,连续冲击3次。对照组采用口服泼尼松(60 mg/d)持续治疗,以后逐渐减量直至停药。观察两组的疗效、不良反应发生率及复发率。结果经过3个月治疗,冲击组疗效优于对照组,差异有统计学意义(Z=-2.679,P<0.05)。冲击组不良反应发生率为68.2%,1年内复发率为26.3%,2年内复发率为36.8%,对照组不良反应发生率为77.3%,1年内复发率为7.1%,2年内复发率为28.6%,两组相比差异均无统计学意义(P>0.05)。结论免疫抑制剂冲击治疗TAO有效且安全。

Objective To investigate the effect of immunosuppressive stoss therapy on thyroid associated ophthalmopathy（TAO）.Methods A total of 44 patients with TAO admitted in Yutian County Hospital from Feb.2006 to Feb.2010 were divided into stosstherapy group and control group according to random number table,with 22 cases in each group.Patients in the stoss therapy group received intravenous infusion of methyl-prednisolone（1000 mg/d） for the first 3 days and cyclophosphamide（200 mg/d） for the following 10 days every month, and were treated for 3 months.Patients in the control group orally took metacortandracin （60 mg/d） for 3 months,and the dosages were gradually decreased until withdrawal.Results After treat-ment of 3 months,the treatment effect of the stoss therapy group was better than that of the control group ,the difference was statistically significant（Z=-2.679,P〈0.05）.In the stoss therapy group,the incidence rate of adverse reaction was 68.2%,the reoccurrence rate in 1 year was 26.3%,and the reoccurrence rate in 2 years was 36.8%.While in the control group,the incidence rate of adverse reaction was 77.3%,the reoccur-rence rate in 1 year was 7.1%, and the reoccurrence rate in 2 years was 28.6%,there were no statistically significant differences between the two groups（P〉0.05）.Conclusion Immunosuppressive stoss therapy is safe and effective in treating thyroid associated ophthalmopathy.