糖皮质激素联合治疗在新发Graves病中的应用研究

Application of glucocorticoid combined therapy in new Graves'disease

目的探讨糖皮质激素联合标准治疗在新发Graves病患者中的有效性及安全性。方法采用前瞻性研究。将新发Graves病患者分为标准治疗(甲巯咪唑30 mg/d)的常规治疗组及糖皮质激素联合治疗(醋酸泼尼松30 mg/d+甲巯咪唑30 mg/d)的糖皮质激素联合组。观察治疗后2组患者甲状腺功能恢复时间、甲巯咪唑使用总剂量,以及合并症发生率、复发率、TRAb转阴率、免疫细胞因子水平及骨代谢等指标。结果糖皮质激素联合组较常规治疗组甲状腺功能恢复时间更快、甲巯咪唑的治疗总剂量更少,治疗后合并症发生率更低,复发率显著低于常规治疗组,18个月时TRAb的转阴率更高,显著降低了免疫细胞因子水平(IL-6、IL-17、TGF-β1)。治疗前后糖皮质激素联合组对新发Graves病患者的骨代谢指标无明显影响(P>0.05)。结论糖皮质激素联合治疗通过免疫抑制治疗,能够有效地治疗新发Graves病患者,是一种有效、安全的治疗方法。

Objective To study the efficacy and safety of glucocorticoid combined with standard therapy in patients with new Graves'disease.Methods The prospective study was used.The patients with new Graves'disease were divided into two groups:the standard treatment group(Methimazole 30mg/day)and the combined treatment group(Prednisone 30mg/day+Methimazole 30mg/day).The recovery time of thyroid function,the total dosage of Methimazole,the incidence of complications,the recurrence rate,TRAb negative rate,the level of immune cytokines and bone metabolism index were observed after treatment.Results Compared with the standard treatment group,the recovery time of thyroid function was faster in the glucocorticoid combined treatment group,the total dosage of methimazole was less,the incidence of complications was lower after treatment.The recurrence rate was significantly lower than that in the standard treatment group,the negative conversion rate of TRAb was higher in 18 months,and the level of immune cytokine(IL-6,IL-17,TGF-β1)were significantly reduced.Glucocorticoid combined treatment group had no effect on bone metabolism index of patients with new Graves disease.Conclusion Glucocorticoid combined with immunosuppressive therapy can effectively treat the patients with new Graves'disease and is an effective and safe treatment.