Observation Efficacy Of Yunke Plus Glucocorticosteroid In Graves' Ophthalmopathy

Objective:Graves' ophthalmopathy is an autoimmune orbital inflammatory disease and is the most common extrathyroid manifestation of Graves' disease.At present,different treatment schemes are mainly selected according to the clinical characteristics of patients,disease classification and thyroid function.This study will explore the efficacy and safety of Yunke combined with hormone therapy for Graves' ophthalmopathy.Methods:121 patients with mild and moderate to severe GO admitted from October2017 to October 2018 in our endocrinology department were selected as research objects and divided into two groups according to the severity of the disease: A(mild)and B(moderate to severe).Mild GO patients were randomly divided into 2 groups(A1 group and A2 group).Moderate and severe GO patients were randomly divided into 2 groups(B1 group and B2 group).A1 group was treated with antithyroid drugs.Group A2(observer)received Yunke therapy on the basis of Group A1.Group B1 received Yunke therapy on the basis of Group A1,while Group B2 received Yunke+hormone therapy on the basis of Group A1.Result:1.comparison between two subgroups after mild GO treatment: the right exophthalmos,CAS and bilateral intraocular pressure in group A1 decreased compared with those before treatment,but only the right exophthalmos was different from those before treatment(p < 0.05).In group A2,the right intraocular pressure,left intraocular pressure,right exophthalmos,left exophthalmos and CAS decreased after treatment compared with before treatment,and the difference was statistically significant(P < 0.05).After treatment,the right intraocular pressure,left intraocular pressure,right exophthalmos,left exophthalmos and CAS in group A2 were significantly lower than those in group A1,with statistically significant difference(p <0.05).After treatment,the total effective rates of A1 group and A2 group were44.8% and 79.3% respectively.The difference was statistically significant(c2=7.323,p < 0.05)2.comparison between two subgroups after moderate and severe GO treatment:right intraocular pressure,left intraocular pressure,right exophthalmos,left exophthalmos,CAS decreased after treatment compared with before treatment,and there were differences in right intraocular pressure,binocular exophthalmos,CAS before and after treatment(p < 0.05).The right intraocular pressure,left intraocular pressure,right exophthalmos,left exophthalmos and CAS in group B2 decreasedsignificantly after treatment compared with before treatment(p < 0.05).After treatment,the right intraocular pressure,left intraocular pressure,right exophthalmos,left exophthalmos and CAS in group B2 were significantly lower than those in group B1,with statistically significant difference(p < 0.05).After treatment,the total effective rates of group B1 and group B2 were 59.4% and 87.1% respectively.The difference was statistically significant(c2=6.14,p < 0.05).3.Analysis of related factors of recovery after treatment showed a very significant correlation between the improvement degree of CAS and the course of disease(P<0.01),with a correlation coefficient of 0.351,showing a positive correlation.There was no significant correlation between CAS improvement and age and BMI(P>0.05).4.Safety analysis of treatment No serious adverse reactions occurred in the two groups of patients during treatment.Combined with laboratory examination and relevant signs of patients,after treatment,2(all female)in group B2 developed urinary tract infection,accounting for 6% of the total number,1 developed digestive tract symptoms,accounting for 3% of the total number,but no peptic ulcer occurred.There were 2 cases of new impaired glucose tolerance,accounting for 6% of the total number,1 case of insomnia,accounting for 3% of the total number,and the rest of respiratory tract infection,new diabetes,myasthenia,hypokalemia,hypocalcemia and other side effects did not occur.No adverse reactions occurred in the other groups.Conclusion: In this study,patients with mild GO,especially those in active phase,may consider Yunke therapy.Yunke+hormone therapy for patients with moderate to severe GO has better safety and effectiveness,especially in improving ocular inflammation and reducing exophthalmos.