熄风缓急方联合眶周注射曲安奈德治疗TAO上睑退缩的临床研究

Treatment of upper eyelid retraction due to thyroid associated ophthalmopathy by Xifeng Huanji formula combined with orbital injection of triamcinolone acetonide

目的观察熄风缓急方联合眶周注射曲安奈德(TA)治疗甲状腺相关眼病(TAO上睑退缩的临床疗效。方法选择2015年1月至2016年12月在我院确诊的TAO初发期患者80例(95只眼)按NOSPECS分级法I级上睑退缩的TAO患者按照不同治疗方式分为3组。中药治疗组予口服熄风缓急方中药煎剂27例(32只眼);西药治疗组予曲安奈德(TA)眶周注射组26例(30只眼);中西医结合治疗组予口服熄风缓急方中药煎剂联合TA眶周注射组27例(33只眼)。对3组患者治疗前、治疗1个月后、治疗2个月后、治疗3个月后睑裂高度和上睑退缩值进行观察和分析。结果西药治疗组及中西医结合治疗组治疗1个月后睑裂高度及上睑退缩值较治疗前变小(P<0.05),中药治疗组在治疗2个月后睑裂高度及上睑退缩值较治疗前变小(P<0.05),治疗3个月后中西医结合治疗组睑裂高度及上睑退缩值小于中药治疗组和西药治疗组(P<0.05)。治疗3个月后,西药治疗组总有效率优于中药治疗组,差异有统计学意义(P<0.05),中西医结合治疗组总有效率优于西药治疗组,差异有统计学意义(P<0.05)。结论中西医结合治疗NOSPECS分级法I级TAO患者的上睑退缩的疗效更为优越。

OBJECTIVE To observe the clinical effect on upper eyelid retraction due to thyroid associated ophthalmopathy(TAO) by the combination of the Xifeng Huanji formula and the orbital injection with triamcinolone acetonide(TA). METHODS From January 2015 to December2016 in our hospital, 80 cases diagnosed in the early stage of TAO who was classified into Grade I by NOSPECS, were divided into 3 groups according to different treatment methods. Twenty-seven cases(32 eyes) in Chinese herbal medicine group were treated by Xifeng Huanji decoction;Twenty-six cases(30 eyes) in western medicine group was treated by orbital injection with triamcinolone acetonide(TA);Twenty-seven cases(33 eyes) in integrated Chinese and western medicine group was managed by oral administration of Chinese herbal decoction combined with TA orbital injection. The height of eyelid fissure and upper eyelid retraction value before treatment, 1 month,2 months and 3 months after treatment in 3 groups were observed and analyzed. RESULTS The height of the palpebral fissure and the upper eyelid retraction value decreased in the western medicine group and integrated Chinese and western medicine group 1 months after treatment(P<0.05). The height of the palpebral fissure and the upper eyelid retraction value in Chinese herbal medicine group shrank 2 months after treatment(P<0.05);Three months after the treatment, the two indexes of integrated Chinese and western medicine g roup were lower than Chinese herbal medicine group and western medicine group(P<0.05). Three months after treatment, the total efficiency of western medicine group was better than that of Chinese herbal medicine group(P<0.05). The total effective rate of integrated Chinese and western medicine group was better than that of western medicine group(P<0.05). CONCLUSIONS The combination of Chinese and western medicine treatment was more superior in management of NOSPECS Grade I upper eyelid retraction due to TAO.