甲泼尼龙冲击联合曲安奈德球后注射治疗甲状腺相关眼病的临床效果

Clinical effect of methylprednisolone combined with triamcinolone acetonide retrobulbar injection in the treatment of thyroid-associated ophthalmopathy

目的探讨甲泼尼龙冲击联合曲安奈德球后注射治疗甲状腺相关眼病的临床效果。方法选取2010年1月-2013年12月本院的38例中重度甲状腺相关眼病患者作为研究对象,给予甲泼尼龙500 mg静脉滴注,隔日1次,连续3次联合1次曲安奈德球后注射作为1个疗程,每月1个疗程,连续3个疗程后评价眼部自觉症状、体征、临床活动性评分（CAS）、软组织炎症（NOSPECS）评分和不良反应发生率。结果甲泼尼龙冲击联合曲安奈德球后注射3个疗程后眼部畏光、流泪、眼胀、眼痛、复视等症状明显改善或消除。治疗10 d后、3个月后的CAS评分和NOSPECS评分显著低于治疗前,差异有统计学意义（P〈0.05）。治疗3个月后的突眼度、眼裂宽度显著小于治疗前,差异有统计学意义（P〈0.05）。结论甲泼尼龙冲击联合曲安奈德球后注射治疗甲状腺相关眼病疗效确切,安全可靠,不良反应轻。

Objective To explore the clinical effect of methylprednisolone combined with triamcinolone acetonide retrobulbar injection in the treatment of thyroid-associated ophthalmopathy. Methods 38 cases of moderate-severe thyroid-associated ophthalmopathy from January 2010 to December 2013 in our hospital were selected as the research group,all patients were given intravenous methylprednisolone 500 mg,once every other day,and sustained 3 times combined with 1 time of triamcinolone acetonide retrobulbar injection as 1 course.One month for one course.After sustained3 courses,eye symptoms,signs,clinical activity score（CAS）,NOSPECS score and the incidence rate of adverse effect was evaluated respectively. Results After using methylprednisolone combined with triamcinolone acetonide retrobulbar injection for 3 courses,the symptoms liked photophobia eye,lacrimation,eye distension,ophthalmalgia and diplopia obvious improved and eliminated.The CAS score and the NOSPECS score after treatment for 10 days and 3 months was lower than that before treatment,with significant difference（P〈0.05）.The degree of exophthalmos,eye fissure width after treatment for 3 months was less than that before treatment,with significant difference（P〈0.05）. Conclusion Methylprednisolone combined with triamcinolone acetonide retrobulbar injection in the treatment of thyroid-associated ophthalmopathy has exact effect,safe and with little adverse effect.