不同免疫抑制剂治疗甲状腺相关眼病的疗效分析

Analysis of therapeutic effects of different immunosuppressive treatment for thyroid associated ophthalmopathy

目的:对比不同免疫抑制治疗甲状腺相关眼病的疗效及安全性。方法:将86例甲状腺相关眼病(TAO)患者随机分为3组:A组应用糖皮质激素(26例),B组应用甲氨蝶呤(31例),C组应用来氟米特(29例),疗程12周。治疗前后观察患者积分值的变化,比较各组间的临床疗效及不良反应的发生率。结果:12周末,各组治疗后的甲状腺相关性眼病积分值与治疗前相比下降差异均有统计学意义(P<0.05)。下降幅度从大到小依次为来氟米特、甲氨蝶呤和糖皮质激素;不良反应发生率:糖皮质激素组34.6%,甲氨蝶呤组12.9%,来氟米特组10.3%。结论:免疫抑制剂来氟米特用于治疗TAO的疗效优于糖皮质激素及甲氨蝶呤,且不良反应小,另一种免疫抑制剂甲氨蝶呤治疗甲状腺相关眼病的疗效与糖皮质激素相仿,且不良反应更少,患者的耐受性良好。

Objective:To compare the therapeutic effects and safety of different immunosuppressive treatment for thyroid associated ophthalmopathy.Methods:86 cases of patients with thyroid associated ophthalmopathy were randomly divided into 3groups:A group was treated with glucocorticoid(26 cases);B group was treated with methotrexate(31 cases);C group was treated with leflunomide(29 cases).The treatment course was 12 weeks.Before and after treatment,we observed the change of integral value,and compared the clinical efficacy and incidence of adverse reaction of the three groups.Results:At the end of the 12 week,compared with that before treatment,the integral value of integral thyroid associated ophthalmopathy of the three groups were decreased,and the difference was statistically significant(P<0.05).The decline from large to small in turn was leflunomide,methotrexate and corticosteroids.The incidence of adverse reaction:glucocorticoid group was 34.6%,methotrexate group was12.9%,leflunomide group was 10.3%.Conclusion:The curative effect of leflunomide in the treatment of TAO as a immune inhibitors was superior to glucocorticoids and methotrexate;the adverse reaction was small;the efficacy of methotrexate in the treatment of thyroid associated ophthalmopathy as a immune inhibitors was similar with glucocorticoid;the adverse reaction was less;patient tolerance was good.