| Objective: To investigate the clinical efficacy and safety of intermittent intravenous corticosteroids in the treatment of thyroid associated ophthalmopathy,and to compare the efficacy of different cumulative doses of corticosteroids,so as to provide basis for clinical treatment.Methods: a total of 30 patients with moderate and severe active thyroid associated ophthalmopathy,including 11 males and 19 females,with an average age of 46.7 ±15.02 years,were selected from the Department of Endocrinology,General Hospital of Tianjin Medical University from January 2016 to December 2019.All patients were treated with intermittent intravenous injection of glucocorticoid:methylprednisolone sodium succinate 250 mg or 500 mg was mixed with 5% glucose and then pumped in 3-6 hours,once every other day,three times as a course of treatment,and the next intravenous injection was performed after 3 weeks.According to the patient’s specific condition,the course of treatment is 3-6 months.According to the cumulative dose of glucocorticoid,the patients were divided into three groups:low,medium and high.The average cumulative dose of glucocorticoids in the three groups was 2.75 ± 1.1g in group A,4.57 ± 0.2g in group B,7.13 ± 1.2g in group C,with significant difference(P < 0.05).10 cases(n = 10)were included in the low dose group,including 4 males and 6 females,with an average age of 45.4 ±14.7 years;10 cases(n = 10)were included in the middle dose group,including 2males and 8 females,with an average age of 44 ± 15.4 years;10 cases(n = 10)were included in the high dose group,including 5 males and 5 females,with an average age of 48.8 ± 16.1 years.A.There was no significant difference in gender,smoking history,age and Tao course between groups B and C(P > 0.05).To explore the efficacy and safety of intermittent intravenous corticosteroid therapy.Result:1.Clinical effect(1)There was significant difference in CAS score before and after treatment(P <0.005).(2)There was no significant difference(P = 0.17)in the degree of proptosis of left eye and significant difference(P = 0.03)in the degree of proptosis of right eye in group a before and after treatment.There was no significant difference in exophthalmos between the left and right eyes before and after treatment in group B(P= 0.069 in the left eye and P = 0.072 in the right eye).The exophthalmos of 20 eyes in group C were improved,and there was a significant difference between the degree of exophthalmos before and after treatment(P < 0.05).(3)There was no significant difference in visual acuity between the left and right eyes in group A(P = 0.8 for the left eye and P = 0.9 for the right eye).There was no significant difference in visual acuity between the left and right eyes in group B(P =1.0 in the left eye and P = 0.5 in the right eye).Compared with before treatment,the visual acuity of the left eye in group C was significantly improved(P = 0.008),but there was no significant difference in the visual acuity of the right eye(P = 0.09).(4)There was no significant difference in intraocular pressure between groups A,B and C(P > 0.05).2.Clinical safety There was no significant difference in body weight between the three groups(P >0.05).There was no significant difference in systolic and diastolic blood pressure between the three groups(P > 0.05).There was no significant difference in ALT and AST between the three groups(P > 0.05).There was no significant difference in fasting blood glucose between the three groups(P = 0.1).There was no significant difference in blood calcium,potassium,sodium,magnesium and phosphorus between the three groups(P > 0.05).Compared with before treatment,there was significant difference in Ig G in group A(P = 0.036),and no significant difference in the rest(P >0.05);there was significant difference in C3 in group B(P = 0.02),and no significant difference in the rest(P > 0.05);there was significant difference in Ig G,Ig A,Ig E in group C(P < 0.05),and no significant difference in the rest(P > 0.05).There was no significant difference in BMD between the three groups(P > 0.05).There was no significant difference in serum osteocalcin,type I collagen carboxyl end fragment and PINP between the three groups(P > 0.05).There was no significant difference in cor,ACTH and 24-hour urine cortisol between the three groups before and after treatment(P > 0.05)Conclusion: the effect of intermittent intravenous corticosteroid therapy on moderate and severe Tao is clear.The higher the cumulative dose,the better the effect.Intermittent intravenous corticosteroid therapy did not affect body weight / blood pressure / fasting blood glucose / liver and kidney function,bone mineral density,bone turnover index and adrenal function,and was independent of cumulative dose,.Intermittent intravenous corticosteroid therapy can inhibit the immune function,especially in the high dose group.It is suggested that the treatment of intermittent venous shock is effective with little side effect. |
PDF Full Text Request