甲泼尼龙联合吗替麦考酚酯治疗中重度活动性Graves眼病

Observation on the therapeutic effect of methylprednisolone combined with mycophenolate mofetil in the treatment of moderate to severe active Graves eye disease

目的 评估甲泼尼龙联合吗替麦考酚酯治疗中重度活动性Graves眼病(GO)的疗效及安全性,并对比该联合治疗与单独使用甲泼尼龙的疗效差异。方法 回顾性选取中重度活动性GO患者,分为联合组(甲泼尼龙联合吗替麦考酚酯)和单药组(甲泼尼龙)。比较两组患者之间的视觉评分、外貌评分、临床活动性评分(CAS)、突眼度、眼裂宽度及眼球活动度方面的变化,记录不良事件。结果 研究共纳入98例患者,其中联合组32例患者,单药组61例患者。两组治疗后的生活质量评分、CAS、突眼度较治疗前改善。在治疗12周时,两组治疗前后视觉评分、外貌评分、CAS、突眼度、眼裂宽度的差值及眼球活动度减少比例的比较差异无统计学意义(P> 0.05)。联合组眼球运动时疼痛及眼睑充血改善比例高于单药组(P <0.001)。在治疗终点,两组治疗前后外貌评分、突眼度、眼裂宽度的差值及眼球活动度减少比例比较差异无统计学意义(P> 0.05),联合组视觉评分及CAS改善幅度高于单药组(P <0.05),其中眼睑水肿改善比例高于单药组(P <0.05)。12周时,单药组有效率为65.0%,联合组有效率为66.7%。24周时,联合组有效率为80.0%。两组在第12周及各自治疗终点的总体有效率差异无统计学意义(P> 0.05)。联合组未出现白细胞减少或严重感染的情况。结论 甲泼尼龙联合吗替麦考酚酯治疗中重度活动性GO是有效、可耐受且安全的,联合治疗的总体有效率可能并不优于单用激素治疗,但联合用药在视觉评分、眼睑充血、眼睑水肿及眼球运动性疼痛的改善上可能优于单用激素。

Objective To assess the effectiveness and safety of combining methylprednisolone with mycophenolate mofetil in managing moderate to severe active Graves' ophthalmopathy(GO),and to compare its efficacy against methylprednisolone monotherapy.Methods A retrospective study was conducted to select patients with moderate to severe active GO who received treatment at the Department of Endocrinology and Metabolism,Guizhou Medical University Affiliated Hospital,from January 2019 to January 2024.The patients were divided into two groups:a combination group receiving methylprednisolone combined with mycophenolate mofetil,and a monotherapy group receiving methylprednisolone alone.The objective was to compare changes in visual score,appearance score,clinical activity score(CAS),eye protrusion,eye fissure width,and eye movement between the two groups of patients while documenting any adverse events.Results A total of 98 patients were enrolled in the study,comprising 32 patients in the combination group and 61 patients in the monotherapy group.Both groups exhibited improvements in quality of life scores,CAS,and degree of protrusion following treatment compared to baseline.However,at the end of the 12-week treatment period,there was no statistically significant difference(P > 0.05) observed between the two groups regarding changes in visual scores,appearance scores,CAS,protrusion degree,fissure width,and proportion of reduced eye movement before and after treatment.Notably though,the combined therapy group demonstrated a significantly higher improvement rate for pain relief and reduction of eyelid congestion during eye movement when compared to the monotherapy group(P < 0.001).At the endpoint of treatment,there were no statistically significant differences in appearance score,protrusion degree,tear width,and reduction in eye movement between the two groups before and after treatment(P > 0.05).The combination group exhibited higher visual scores and greater improvement in CAS compared to the monotherapy group(P < 0.05),along with a higher rate of eyelid edema improvement(P < 0.05).At 12 weeks,the monotherapy group had an effective rate of 65.0%,while the combination group had an effective rate of 66.7%.By week 24,the combined group achieved an effective rate of 80.0%.The overall effectiveness at week 12 and treatment endpoints did not show any statistically significant differences between the two groups(P > 0.05).No cases of leukopenia or severe infection occurred in the combination group.Conclusions The combination therapy of methylprednisolone and mycophenolate mofetil demonstrates efficacy,tolerability,and safety in the treatment of moderate to severe active GO.While the overall effectiveness of this combination may not surpass that of hormone therapy alone,it exhibits potential superiority in improving visual scores,eyelid congestion,eyelid edema,and eye movement pain when compared to hormone therapy alone.