基于MRI眼肌结构量化评估消瘿合剂联合糖皮质激素治疗活动期格雷夫斯眼病的临床疗效

Clinical efficacy of Xiaoying Mixture combined with glucocorticoid in the treatment of active Graves’ ophthalmopathy evaluated by quantitative ocular muscle structure measurement of MRI

目的:基于MRI眼肌结构量化评估消瘿合剂联合糖皮质激素治疗活动期格雷夫斯眼病(GO)的临床疗效。方法:将100例活动期GO患者随机分为治疗组和对照组,每组50例。治疗组予甲基强的松龙静脉注射联合消瘿合剂口服治疗,对照组予甲基强的松龙静脉注射联合消瘿合剂安慰剂口服治疗,两组疗程均3个月。治疗前后行3.0T MRI眼眶扫描,分别测量双侧眼球突出度、眼球内测脂肪厚度、最高信号强度眼外肌厚度、眼外肌与同侧颞肌最高信号强度比(SIR),同时观察临床疗效、GO病情分级(NOSPECS)、临床活动性评分(CAS)的变化情况。结果:经过治疗,两组双侧眼球突出度和双侧眼球内测脂肪厚度下降均不明显;但眼外肌/颞肌SIR和最高信号强度眼外肌厚度均较治疗前下降(P<0.05),且治疗组下降程度大于对照组(P<0.05)。治疗组、对照组临床总有效率分别为93.88%(46/49)和84.00%(42/50),治疗组优于对照组(P<0.05)。治疗后,两组病例的NOSPECS病情分级、CAS评分均较治疗前改善(P<0.05),且治疗组改善更显著(P<0.05)。结论:与单纯使用激素冲击疗法相比,联合消瘿合剂能够更加明显地改善活动期GO患者的局部炎症反应,缓解临床症状;MRI眼肌结构量化评估技术可辅助GO的疗效评估。

Objective:To observe the clinical efficacy of Xiaoying Mixture combined with glucocorticoid in the treatment of active Graves’ophthalmopathy(GO)evaluated by quantitative ocular muscle structure measurement of MRI.Methods:One hundred patients with active GO were randomly divided into the treatment group and control group,with fifty cases in each group.Both groups were treated with intravenous methylprednisolone.Meanwhile,the treatment group was orally treated with Xiaoying Mixture and the control group was orally treated with the placebo,with a course of three months.All the patients were enrolled for 3.0T MRI orbit scan before and after the treatment.Quantitative measurement of orbital structures including exophthalmos values,fatty tissue thickness of inner side in eye balls,thickness of extraocular muscles with maximum signal intensity and signal intensity ratios(SIR)of extraocular muscles to ipsilateral temporal muscles were compared before and after treatment.The clinical efficacy was observed,and the changes of NOSPECS grades and clinical activity scale(CAS)score were compared.Results:After the treatment,exophthalmos values and fatty tissue thickness of inner side in eye balls didn’t obviously changed,while SIR of extraocular muscles to ipsilateral temporal muscles,thickness of extraocular muscles with maximum signal intensity decreased significantly(P<0.05).The degree of decline in the treatment group was greater than that in the control group(P<0.05).The clinical total effective rate of the treatment group and control group was 93.88%(46/49)and 84.00%(42/50)respectively.The clinical efficacy of the treatment group was significantly better than that of the control group(P<0.05).After treatment,NOSPECS grades and CAS score of the two groups were improved compared with those before treatment(P<0.05),and the improvement of the treatment group was more significant(P<0.05).Conclusion:Compared with intravenous methylprednisolone therapy alone,Xiaoying Mixture combined with glucocorticoid can significantly improve the local inflammatory response and alleviate the clinical symptoms of patients with active GO.MRI quantitative ocular muscle structure measurement can assist in the evaluation of the efficacy of GO.