甲基强的松龙免疫抑制在活动期甲状腺相关眼病治疗中的作用

Role of methylprednisolone immunosuppression in treatment of active thyroid associated ophthalmopathy

目的:探讨甲基强的松龙免疫抑制在活动期甲状腺眼相关病(TAO)治疗中的作用。方法:选择2015年8月至2017年12月在我院就诊的34例活动期中重度TAO患者作为研究对象,所有患者给予静脉甲基强的松龙冲击疗法。观察患者在输液前(T0)、输液时(T1)、输液结束时(T2)和输液结束30 min(T3)均时的心率、收缩压、动脉压,观察患者每次治疗前后血钾、血糖、炎症因子、体质量及血脂水平,观察患者的症状改善率、甲状腺功能及临床疗效。结果:患者治疗后畏光、流泪、异物感等临床症状体征均显著改善。患者治疗前CAS评分为(4.5±0.8)分,治疗后CAS评分为(1.6±0.9)分,差异有统计学意义(P<0.05),34例患者的治疗有效率为82.35%。患者T1、T2时收缩压、舒张压、心率与T0时相比较均显著降低,差异均有统计学意义(P<0.05);T3时收缩压低于T0,但差异无统计学意义(P>0.05);T3时患者舒张压、心率均低于T0,差异有统计学意义(P<0.05)。患者治疗后TSH水平显著高于治疗前,FT3、FT4水平显著低于治疗前,差异均有统计学意义(P<0.05)。患者治疗后血糖水平显著高于治疗前,血钾离子、CRP、TNF-α、IL-6水平显著低于治疗前,差异均有统计学意义(P<0.05)。结论:静脉甲基强的松龙冲击疗法治疗中重度TAO安全有效,对心率和血压具有轻微和非累积的效应,对血糖、血钾、炎症因子、甲状腺功能有明显影响,临床应用过程中应做好针对性监测。

Objective:To investigate the role of methylprednisolone immunosuppression in the treatment of thyroid active ophthalmopathy.Methods:Thirty-four patients with moderate to severe thyroid-associated ophthalmopathy in active period from August 2015 to December 2017 were selected as the study subjects.All patients were given intravenous methylprednisolone pulse therapy.The heart rate,systolic blood pressure and arterial pressure were observed before infusion(T0),during infusion(T1),at the end of infusion(T2)and after 30 min of infusion(T3).The levels of blood potassium and blood sugar were observed before and after each treatment,inflammatory factor,the improvement rate of symptoms,thyroid function and clinical efficacy were observed.Results:After treatment,the clinical symptoms and signs such as photophobia,tears and foreign body sensation were significantly improved.The CAS score of patients before treatment was(4.5±0.8)score and after treatment was(1.6±0.9)score,and the difference was statistically significant(P<0.05).The effective rate of 34 patients was 82.35%.The systolic blood pressure,diastolic blood pressure and heart rate at T1 and T2 were significantly lower than those at T0(P<0.05).Systolic blood pressure at T3 was lower than that at T0,but there was no statistical significance(P>0.05).The diastolic blood pressure and heart rate at T3 were lower than those at T0,and the difference was statistically significant(P<0.05).The level of TSH after treatment was significantly higher than that before treatment.The levels of FT3 and FT4 were significantly lower than those before treatment(P<0.05).The blood glucose level of patients after treatment was significantly higher than that before administration.The levels of potassium,CRP,TNF-αand IL-6 were significantly lower than those before treatment(P<0.05).Conclusion:The intravenous methylprednisolone pulse therapy is safe and effective in the treatment of moderate to severe TAO.It has slight and non-cumulative effects on heart rate and blood pressure,and has obvious effects on blood sugar,blood potassium and inflammatory factor,thyroid function,which should be monitored in clinical application.