甲巯咪唑片联合醋酸泼尼松片治疗甲状腺功能亢进性突眼的临床效果

Value of methimazole tablets combined with prednisone acetate tablets in treatment of hyperthyroid exophthalmia in improving thyroid function and exophthalmos score

目的探讨甲巯咪唑片联合醋酸泼尼松片治疗甲状腺功能亢进性突眼(甲亢性突眼症),对缓解临床症状和改善甲状腺功能的价值。方法选取自2018年5月—2019年5月间收治甲亢性突眼症患者64例(79只眼),按照随机数字表法分成对照组32例(38只眼)和观察组32例(41只眼),对照组予盐酸普萘洛尔片联合甲巯咪唑片口服治疗,观察组在对照组基础上予醋酸泼尼松片口服治疗,分别于治疗前、治疗后1个月测定2组患者甲状腺功能、眼部各指标的变化,不良反应发生情况。结果(1)临床疗效:观察组总有效率为81.58%,对照组为60.98%,2组比较,c2=4.057,P=0.044,差异有统计学意义。(2)BCVA:治疗后,观察组视力0.20±0.06,对照组0.12±0.04,2组比较,t=6.916,P=0.000,差异有统计学意义。治疗前后比较,观察组t=2.454,P=0.017;对照组t=9.877,P=0.000,差异均有统计学意义。(3)眼球突出度:治疗后,观察组为(17.03±1.66)mm,对照组为(17.83±1.84)mm,2组比较,t=2.032,P=0.046,差异有统计学意义。治疗前后比较,观察组t=3.121,P=0.019,差异有统计学意义;对照组t=1.818,P=0.059,差异无统计学意义。(4)睑裂高度:治疗后,观察组为(10.20±1.35)mm,对照组为(11.05±1.24)mm,2组比较,t=2.907,P=0.005,差异有统计学意义。治疗前后比较,观察组t=3.380,P=0.012,差异有统计学意义;对照组t=1.317,P=0.192,差异无统计学意义。(5)甲状腺功能:治疗后的FT3、FT4、TPOAb和TGAb水平,2组比较,差异均具有统计学意义(P<0.05)。观察组及对照组的FT3、FT4、TPOAb和TGAb水平治疗前后比较,差异均有统计学意义(P<0.05)。(6)不良反应:观察组不良反应发生率为15.63%;对照组为31.25%,2组比较,差异无统计学意义(P>0.05)。结论甲巯咪唑片联合醋酸泼尼松片治疗甲亢性突眼症可更好地缓解临床症状,改善患者甲状腺功能,安全性较高。

OBJECTIVE To explore the value of methimazole tablets combined with prednisone acetate in relieving clinical symptoms and improving thyroid function of hyperthyroid exophthalmia cases.METHODS Sixty-four patients(79 eyes)with hyperthyroidism exophthalmia from May 2018 to May 2019 were selected.According to the random number table,they were divided into 32 cases(38 eyes)in the control group and 32 cases(41 eyes)in the observation group.The control group was treated with propranolol hydrochloride combined with methimazole tablets,and the observation group was treated with prednisone acetate tablets on the basis of the control group.The changes of thyroid function and ocular indicators of the two groups of patients were measured on the day before treatment and a month after treatment,and the occurrence of adverse reactions during the treatment of the two groups was recorded.RESULTS(1)Clinical efficacy:The total effective rate of the observation group was 81.58%and that of the control group was 60.98%.Comparison between the two groups showed that the difference was statistically significant(c2=4.057,P=0.044).(2)BCVA:After treatment,the visual acuity of the observation group was 0.20±0.06 and that of the control group was(0.12±0.04).Comparison between the two groups showed that the difference was statistically significant(t=6.916,P=0.000).After treatment,the observation group(t=2.454,P=0.017)and the control group(t=9.877,P=0.000)both experienced statistically significant variation.(3)Eyeball protrusion:After treatment,the observation group was(17.03±1.66)mm and the control group was(17.83±1.84)mm.Comparison between the two groups showed that the difference was statistically significant(t=2.032,P=0.046).After treatment,the observation group experienced significant variation(t=3.121,P=0.019)while the control group did not get significant improvement(t=1.818,P=0.059).(4)Eyelid fissure height:After treatment,the visual acuity of the observation group was(10.20±1.35)mm and that of the control group was(11.05±1.24)mm.Comparison between the two groups showed that the difference was statistically significant(t=2.907,P=0.005).After treatment,the observation group experienced significant variation(t=3.380,P=0.012)while the control group did not get significant improvement(t=1.317,P=0.192).(5)Thyroid function:the levels of FT3,FT4,TPOAb and TGAb after treatment were compared between the two groups,and the differences were statistically significant(P<0.05).After treatment,the levels of FT3,FT4,TPOAb and TGAb in the observation group and the control group all got statistically significant improvement(P<0.05).(6)Adverse reactions:The incidence of adverse reactions was 15.63%in the observation group and 31.25%in the control group.There was statistical difference between the two groups.CONCLUSIONS The combination of methimazole tablets and prednisone acetate tablets in the treatment of hyperthyroid exophthalmia could relieve the clinical symptoms,improve the thyroid function of patients,and was of higher safety.