Graves病治疗的困惑与希望

Difficulties and prospects in the treatment of Graves′disease

Graves病(GD)传统治疗方案虽然有一定疗效,但仍然有必要探究新型疗法。针对GD发病机制,通过消耗B淋巴细胞和作用于促甲状腺素受体(TSHR)所研发的生物制剂,如单克隆抗体,TSHR拮抗剂以及抗原表位等特异性治疗,部分新药有望投入临床使用,通过恢复受损的免疫系统,维持正常甲状腺功能,弥补传统疗法长期用药、诱发或加重Graves眼病以及导致永久性甲状腺功能减退等一系列并发症的不足。甲状腺热消融技术在难治性GD患者中的初步尝试表明其有效且安全。中医药在改善GD患者症状与甲状腺功能方面亦发挥作用。上述方法为未来GD的治疗展现了美好前景,也为临床医师制定最佳治疗方案提供了更多选择。

Although traditional treatment for Graves′disease(GD)displays some effects,it is imperative to explore new treatment methods.Based on the pathogenesis of GD,biologic agents developed by consumption of B lymphocytes and acting on thyroid stimulating hormone receptor(TSHR),such as monoclonal antibodies,TSHR antagonists and epitopes,can provide more options for patients with GD,and some new drugs are expected to be put into clinical practice.By restoring the damaged immune system and maintaining normal thyroid function continuously,it can avoid the disadvantages of conventional therapies such as long-term treatment,induction or aggravation of Graves ophthalmopathy,permanent hypothyroidism,and other complications.Preliminary experience suggests that thermotherapy is effective and safe for patients with refractory GD.In addition,the traditional Chinese medicine improves the symptoms and thyroid function of GD patients.The emergence of new therapeutic modalities and techniques will provide new approaches for the future treatment of GD and help clinicians to make the best decision.