甲泼尼龙联合甲氨蝶呤治疗Graves眼病的临床效果观察

Clinical effect of methylprednisolone combined with methotrexate in the treatment of Graves＇ ophthalmopathy

目的 探讨甲泼尼龙联合甲氨蝶呤治疗Graves眼病的效果及应用价值.方法 将82例Graves眼病患者采用随机数字表法分为观察组和对照组各41例,对照组给予激素治疗,观察组联合甲氨蝶呤治疗,对比两组疗效.结果 观察组治疗总有效率为87.80％,对照组治疗总有效率为68.29％,两组差异有统计学意义（χ2=4.555,P〈0.05）.观察组治疗后甲状腺体积（24.68±1.25）g、突眼度（17.13±1.01）mm,对照组治疗后甲状腺体积（28.84±2.89）g、突眼度（18.79±2.12）mm,两组差异均有统计学意义（t=8.459、4.526,均P〈0.05）.观察组发生糖尿病2例,高血压1例,失眠4例,消化道反应4例;对照组发生糖尿病1例,高血压2例,失眠5例,消化道反应3例,两组差异均无统计学意义（χ2=0.346、0.346、0.124、0.156,均P〉0.05）.结论 甲泼尼龙联合甲氨蝶呤治疗Graves眼病能够提升治疗效果,减少突眼度和甲状腺体积,安全性高,值得在临床上推广应用.

 Objective The effect and application value of the treatment of Graves eye disease were discussed.Methods 82 patients with Graves ophthalmopathy were divided into observation group and control group by random number method . The control group was given hormone therapy , the observation group was given methylprednisolone combined with methotrexate therapy .The clinical effect was compared between the two groups . Results The total effective rate of the observation group was 87.80%,which was significantly higher than 68.29%of the control group（χ2 =4.555,P〈0.05）.After treatment,the thyroid volume,eye level of the observation group were （24.68 ±1.25） g,（17.13 ±1.01） mm,respectively,which of the control group were （28.84 ±2.89） g, （18.79 ±2.12）mm,respectively,and the differences between the two groups were statistically significant （t=8.459, 4.526,all P〈0.05）.In the observation group,there were 2 cases of diabetes,1 case of hypertension,4 cases of insomnia,4 cases with digestive tract.In the control group,1 case of diabetes,2 cases of hypertension,5 cases of insomnia,3 cases of gastrointestinal tract ,and the differences between the two groups were not statistically significant （χ2 =0.346,0.346,0.124,0.156,all P〉0.05）.Conclusion Methylprednisolone combined with methotrexate in the treatment of Graves ophthalmopathy can improve the treatment effect , reduce the degree of exophthalmus and thyroid volume,and without increase in adverse reactions ,it is worthy of popularization and application in clinic .