标准剂量泼尼松联合谷氨酰胺对^(131)I治疗后Graves眼病的保护作用

Protective effects of standard dose prednisone combined with glutamine on Graves ophthalmopathy after ^(131)I treatment

目的探讨泼尼松联合谷氨酰胺(2g/d)对^(131)I治疗后Graves眼病(GO)的保护作用。方法将行^(131)I治疗伴轻-中度活动性或暂无活动性GO但有高危因素的Graves甲状腺功能亢进患者分为两组,试验组(n=59)治疗后2d开始口服泼尼松(0.44±0.13)mg/kg同时补充谷氨酰胺,泼尼松每2周逐渐减量5mg至2个月停药;对照组(n=57)泼尼松起始剂量为(0.43±0.14)mg/kg,不补充谷氨酰胺,其余同试验组。评估两组患者治疗后2、4、6个月时GO变化以及不良反应。结果两组患者基线特征无明显差异,治疗后6个月试验组除突眼度外CAS评分(2.8±0.8 vs.3.5±0.9)、眼球突出度[(19.6±8.1)mmvs.(21.7±3.0)mm]、睑裂宽度[(11.3±2.9)mmvs.(13.8±3.1)mm],改善程度均优于对照组(P<0.01)。两组均无GO新发或者恶化;两组疗效比较差异无统计学意义(P>0.05)。对照组比试验组不良反应更多(63.1%vs.30.5%,P<0.01),体质量增加更明显[(3.8±1.8)kg vs.(1.4±1.2)kg,P<0.01],两组患者收缩压和舒张压均轻度上升[(10±4)mm Hg vs.(9±5)mm Hg,P>0.05]。结论 ^(131)I治疗后使用起始约0.4mg/kg、2个月的泼尼松,同时口服补充谷氨酰胺(2g/d)能有效改善轻-中度GO,并且有效降低不良反应。

Objective To investigate the protective effect of standard dose prednisone（starting dose about 0.4mg/kg bw）combined with glutamine（2g/d）for Graves′ophthalmopathy（GO）after 131I treatment.Methods The prospective randomized controlled trial was performed and included 116 consecutive patients with mild-to-moderate GO or no active GO after 131I treatment,but with high risk factors.The experimental group（59cases）started to take oral prednisone（0.44±0.13）mg/kg at 2datter theatment,meanwhile replenishing glutamine,and prednisone was gradually decreased by 5mg per 2weeks and stopped until 2months;the control group（57cases）received the initial dose prednisone（0.43±0.14）mg/kg without replenishing glutamine,and the rest was same as the experimental group.The GO change and prednisone adverse reactions in 2,4,6months after treatment were evaluated in the two groups.Results The baseline characteristics had no significant difference between the two groups.In comparison of the experimental group and control group after 6-month treatment,the CAS score was（2.8±0.8 vs.3.5±0.9）,exophthalmos degree was（19.6±8.1）mmvs.（21.7±3.0）mm,eyelid width was（11.3±2.9）mmvs.（13.8±3.1）mm,the improvement degree in the experimental group except for degree was superior to the control group（P〈0.01）.No new onset GO or deterioation occurred in the two groups;the experimental group had 42cases（71.2%）of GO improvement and 17cases（28.8%）of stability,while the control group had 39cases（68.4%）of GO improvement and 18cases（31.6%）of stability,and the curative effects had no sttistical difference between the two groups（P〉0.05）.The side effects in the control group were more than those in the experimental group（63.1% vs.30.5%,P〈0.05）.the body mass increase was more obvious[（3.8±1.8）kg vs.（1.4±1.2）kg,P〈0.01],and SBP and DBP in the two groups were slightly increased[（10±4）mm Hg vs.（9±5）mm Hg P〉0.05].Conclusion Using the initial dose of oral prednisone（about 0.4mg/kg）for 2months and simultaneously replenishing glutamine（2g/d）can effectively improve mild-moderate GO,and effectively reduce the adverse reactions of GC.However it is needed to extend the follow-up time to assess whether it can truly prevent the deterioration of GO,and to conduct a further study for the role of glutamine.