甲狀腺相關(guān)性眼病大劑量激素沖擊治療前后療效觀察及安全性評估
發(fā)布時間：2018-09-10 07:37
【摘要】：目的:甲狀腺相關(guān)性眼病(Thyroid associated ophthalmopathy,TAO)為最常見的自身免疫性疾病的甲狀腺外并發(fā)癥,在Graves病(Graves’Disease,GD)患者中,發(fā)病率可高達25%[1],TAO的早期診斷可以使疾病得到有效的治療,大劑量糖皮質(zhì)激素靜脈治療是活動期的TAO的一線治療方法[2],目前靜脈激素治療應(yīng)用較為廣泛的方案:前6周,每周應(yīng)用500mg甲潑尼龍,后6周,每周應(yīng)用250mg甲潑尼龍,共計12周,累積劑量達4.5mg[3]。本研究將探討甲狀腺相關(guān)性眼病大劑量激素沖擊治療前后療效及安全性。方法:1、選取2013年1月至2017年1月在我院內(nèi)分泌2科住院,符合TAO活動期診斷、入組標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)的患者共計17例為病例組,收集患者的姓名、年齡、性別、身高、體重、腹圍、是否吸煙、既往主要病史、TAO病史及家族史。2、沖擊前后行眼科檢查,明確患者治療期間眼部變化,包括:突眼度、雙眼的視力、眼壓,沖擊前后對患者進行CAS評分,通過對以上幾項的對比來觀察治療的有效性。3、檢測患者沖擊治療前后血常規(guī)、尿常規(guī)、電解質(zhì)、肝功能、OGTT實驗、皮質(zhì)醇節(jié)律以及骨量的變化,并持續(xù)觀察患者有無反酸、燒心、噯氣、呃逆、腹脹、腹痛等消化道潰瘍等癥狀;患者有無咳嗽咳痰等呼吸系統(tǒng)感染的癥狀;有無尿頻、尿急等;泌尿系感染的癥狀;通過對以上幾項的對比來評估治療的安全性。4、所有數(shù)據(jù)使用spss17.0統(tǒng)計軟件進行統(tǒng)計分析,符合正態(tài)分布的資料采用均數(shù)±標(biāo)準(zhǔn)差(x(-)±s)表示,組間比較采用t檢驗進行分析。不符合正態(tài)分布的數(shù)據(jù),采用m(q25-q75)表示,組間比較采用mann-whitney秩和檢驗。采用pearson相關(guān)分析進行相關(guān)性分析。p0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:1、大劑量激素沖擊治療后與治療前相比較,突眼度及cas評分顯著降低。左突眼度為[p0.01;16(15-17)vs18(16.5-19.5)mm],右突眼度為[p0.01;16(14-18)vs17(16-20)mm],cas評分為[p0.01;8(7.5-9)vs5(4-6)],另外,患者眼壓明顯降低,視力也有明顯好轉(zhuǎn),差異具有統(tǒng)計學(xué)差異(p0.05);右眼壓[p0.01;16(14.5-17)vs18(17-19)mmhg],左眼壓為[p0.01;16(14-18.5)vs18(17-21.5)mmhg],左眼視力[p0.01;0.80(0.55-1.00)vs1.00(0.85-1.00)],右眼視力改變也有統(tǒng)計學(xué)差異[p0.01;1.00(1.00-1.00)vs0.80(0.45-0.90)]。2、cas評分的改善程度與tao的病程呈正相關(guān)(r=0.840,p=0.000),而與gd的病程、bmi指數(shù)以及年齡無關(guān);3、治療后恢復(fù)情況所占在人數(shù)以及百分比:其中cas評分降低了1~2分的有4人,占了23.53%,cas評分降低了3~4分的有12人,占了70.59%,,cas評分降低了5分以及以上的有1人,占了5.88%。4、治療前后對比,患者血壓、bmi、肝功能、皮質(zhì)醇(8點、16點、24點)、血糖、離子代謝、pth的變化未見統(tǒng)計學(xué)差異。5、激素沖擊引起不同副作用的人數(shù)以及所在百分?jǐn)?shù):結(jié)合患者實驗室檢查以及相關(guān)體征,經(jīng)過治療后,有1人出現(xiàn)骨量減低,占總?cè)藬?shù)5.88%,有2人出現(xiàn)了泌尿系統(tǒng)感染,占總?cè)藬?shù)11.76%,有2人出現(xiàn)了消化道的癥狀,占總?cè)藬?shù)11.76%,有2人出現(xiàn)了輕微庫欣貌,占總?cè)藬?shù)11.76%,有4人出現(xiàn)了新發(fā)的糖代謝異常,占總?cè)藬?shù)的23.53%,其余呼吸道感染、新發(fā)糖尿病、肌痛以及肌無力、低鉀血癥以及抑郁癥等副作用未有發(fā)生。結(jié)論:大劑量糖皮質(zhì)激素沖擊治療甲狀腺相關(guān)性眼病的有效性和安全性優(yōu)于治療前,尤其是在緩解眼部軟組織炎癥方面,對于提高視敏度、減少眼壓、減低突眼度等方面均有較明顯的作用。
[Abstract]:Objective: Thyroid associated ophthalmopathy (TAO) is the most common extrathyroidal complication of autoimmune diseases. The incidence of Graves'disease (GD) is as high as 25%[1]. Early diagnosis of TAO can effectively treat the disease. Intravenous therapy with high dose of glucocorticoid is active. The first-line treatment of TAO in the first six weeks, 500 mg methylprednisolone a week, 250 mg methylprednisolone a week for the second six weeks, a total of 12 weeks, the cumulative dose of 4.5 mg [3]. 1. From January 2013 to January 2017, 17 patients who met TAO criteria and excluded criteria were selected as the case group. Their names, age, sex, height, weight, abdominal circumference, cigarette smoking, past major medical history, TAO history and family history were collected. 2. Ophthalmological examinations were performed before and after the shock to identify the patients. The changes of ocular function, including exophthalmos, binocular vision, intraocular pressure, and CAS score before and after impact were compared to observe the effectiveness of treatment. 3. The changes of blood routine, urine routine, electrolyte, liver function, OGTT test, cortisol rhythm and bone mass were detected before and after impact therapy. Patients with acid reflux, heartburn, belching, hiccup, abdominal distention, abdominal pain and other symptoms of gastrointestinal ulcer; patients with cough and sputum and other respiratory infection symptoms; have frequent urination, urgency, and so on; symptoms of urinary tract infection; through the comparison of the above to assess the safety of treatment. 4, all data using SPSS 17.0 statistical software for statistical points. Data conforming to normal distribution were analyzed by mean (-) + standard deviation (x (-) + s) and t test respectively. Data not conforming to normal distribution were analyzed by M (q25-q75). Comparison between groups was performed by Mann-Whitney rank sum test. Pearson correlation analysis was used to analyze the correlation. P0.05 was statistically significant. Left exophthalmos were [p0.01; 16 (15-17) vs 18 (16.5-19.5) mm], right exophthalmos were [p0.01; 16 (14-18) vs 17 (16-20) mm], CAS was [p0.01; 8 (7.5-9) vs 5 (4-6)], and intraocular pressure was significantly reduced, visual acuity was also significantly improved, the difference was statistically poor. Right eye pressure [p0.01; 16 (14.5-17) vs 18 (17-19) mmhg], left eye pressure [p0.01; 16 (14-18.5-17) vs 18 (17-21.5) mmhg], left eye vision [p0.01; 0.01; 0.80 (0.55-0.55-1.00) vs 1.00 (0.85-1.00)], right eye vision changes were also statistically significant [p0.01; 1.00 (1.00 (1.00 (1.00 (1.00-00-1.00-1.00-1.00-1.00) vs 0.80 (17-20.80-80-80 (45)], left eye vision [p0.0.01; 0.80 (0.90, 0.90]the improvement of CAS score was positively correlated with the course of Tao (r = 0.840, P = 0.000), but not with the course of gd, BMI index and age; 3, the number and percentage of recovery after treatment: CAS score decreased by 1-2 points in 4 people, accounting for 23.53%, CAS score decreased by 3-4 points in 12 people, accounting for 70.59%, CAS score decreased by 5 points and more than 1 person, accounting for 5.88%. Blood pressure, bmi, liver function, cortisol (8:00, 16:00, 24:00), blood glucose, ion metabolism, PTH changes were not statistically significant. 5, hormone shock caused different side effects of the number and the percentage: combined with the patient's laboratory tests and related signs, after treatment, one person showed bone loss, accounting for 5.88% of the total, 2 people had urinary tract. Systemic infections accounted for 11.76% of the total population, 2 of whom had gastrointestinal symptoms, accounting for 11.76% of the total population, 2 had a slight Cushing appearance, accounting for 11.76% of the total population, 4 had new glucose metabolism abnormalities, accounting for 23.53% of the total population, the rest of respiratory tract infections, new diabetes, myalgia and myasthenia, hypokalemia and depression and other side effects. Conclusion: The efficacy and safety of high dose glucocorticoid pulse therapy for thyroid associated ophthalmopathy are better than those before treatment. Especially in alleviating ocular soft tissue inflammation, it can improve visual acuity, reduce intraocular pressure and reduce exophthalmos.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R581;R771.3
本文編號：2233803
[Abstract]:Objective: Thyroid associated ophthalmopathy (TAO) is the most common extrathyroidal complication of autoimmune diseases. The incidence of Graves'disease (GD) is as high as 25%[1]. Early diagnosis of TAO can effectively treat the disease. Intravenous therapy with high dose of glucocorticoid is active. The first-line treatment of TAO in the first six weeks, 500 mg methylprednisolone a week, 250 mg methylprednisolone a week for the second six weeks, a total of 12 weeks, the cumulative dose of 4.5 mg [3]. 1. From January 2013 to January 2017, 17 patients who met TAO criteria and excluded criteria were selected as the case group. Their names, age, sex, height, weight, abdominal circumference, cigarette smoking, past major medical history, TAO history and family history were collected. 2. Ophthalmological examinations were performed before and after the shock to identify the patients. The changes of ocular function, including exophthalmos, binocular vision, intraocular pressure, and CAS score before and after impact were compared to observe the effectiveness of treatment. 3. The changes of blood routine, urine routine, electrolyte, liver function, OGTT test, cortisol rhythm and bone mass were detected before and after impact therapy. Patients with acid reflux, heartburn, belching, hiccup, abdominal distention, abdominal pain and other symptoms of gastrointestinal ulcer; patients with cough and sputum and other respiratory infection symptoms; have frequent urination, urgency, and so on; symptoms of urinary tract infection; through the comparison of the above to assess the safety of treatment. 4, all data using SPSS 17.0 statistical software for statistical points. Data conforming to normal distribution were analyzed by mean (-) + standard deviation (x (-) + s) and t test respectively. Data not conforming to normal distribution were analyzed by M (q25-q75). Comparison between groups was performed by Mann-Whitney rank sum test. Pearson correlation analysis was used to analyze the correlation. P0.05 was statistically significant. Left exophthalmos were [p0.01; 16 (15-17) vs 18 (16.5-19.5) mm], right exophthalmos were [p0.01; 16 (14-18) vs 17 (16-20) mm], CAS was [p0.01; 8 (7.5-9) vs 5 (4-6)], and intraocular pressure was significantly reduced, visual acuity was also significantly improved, the difference was statistically poor. Right eye pressure [p0.01; 16 (14.5-17) vs 18 (17-19) mmhg], left eye pressure [p0.01; 16 (14-18.5-17) vs 18 (17-21.5) mmhg], left eye vision [p0.01; 0.01; 0.80 (0.55-0.55-1.00) vs 1.00 (0.85-1.00)], right eye vision changes were also statistically significant [p0.01; 1.00 (1.00 (1.00 (1.00 (1.00-00-1.00-1.00-1.00-1.00) vs 0.80 (17-20.80-80-80 (45)], left eye vision [p0.0.01; 0.80 (0.90, 0.90]the improvement of CAS score was positively correlated with the course of Tao (r = 0.840, P = 0.000), but not with the course of gd, BMI index and age; 3, the number and percentage of recovery after treatment: CAS score decreased by 1-2 points in 4 people, accounting for 23.53%, CAS score decreased by 3-4 points in 12 people, accounting for 70.59%, CAS score decreased by 5 points and more than 1 person, accounting for 5.88%. Blood pressure, bmi, liver function, cortisol (8:00, 16:00, 24:00), blood glucose, ion metabolism, PTH changes were not statistically significant. 5, hormone shock caused different side effects of the number and the percentage: combined with the patient's laboratory tests and related signs, after treatment, one person showed bone loss, accounting for 5.88% of the total, 2 people had urinary tract. Systemic infections accounted for 11.76% of the total population, 2 of whom had gastrointestinal symptoms, accounting for 11.76% of the total population, 2 had a slight Cushing appearance, accounting for 11.76% of the total population, 4 had new glucose metabolism abnormalities, accounting for 23.53% of the total population, the rest of respiratory tract infections, new diabetes, myalgia and myasthenia, hypokalemia and depression and other side effects. Conclusion: The efficacy and safety of high dose glucocorticoid pulse therapy for thyroid associated ophthalmopathy are better than those before treatment. Especially in alleviating ocular soft tissue inflammation, it can improve visual acuity, reduce intraocular pressure and reduce exophthalmos.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R581;R771.3
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