Clinical Effect Of High Dose Glucocorticoid Combined With Cyclosporine A In The Treatment Of Graves Ophthalmopathy

Objective: Hyperthyroidism infiltrative exophthalmos is a kind of inner body,immune,genetic factors and external environmental factors,such as eye disease,is a kind of common complications of hyperthyroidism,also known as Graves ophthalmopathy(Graves’ orbitopathy,GO),the incidence of about 25-50%.At present,domestic and foreign studies have reported successively that glucocorticoid(GC)can inhibit the immune reaction of the body,and act an anti-inflammatory part to relieve the state of congestion and edema of the body,which can be applied to clinical GO patients.However,for the efficacy and safety of GC,there are many options in the selection of its dose,the formulation of the course of treatment and the selection of the combination of second-line immunosuppressant.This research aims to survey and contrast the clinical efficacy and the occurrence rate of adverse events of high-dose GC combined with cyclosporine A(Cs A)in patients with moderate and severe GO,for offering first-hand data,clinical trial data and academic basis for subsequent studies on immunosuppressant treatment of GO.Methods: Forty patients with moderate to severe GO who received treatment in the A people’s Hospital of Inner Mongolia Medical University over a period of more than a year were included.They were divided into survey group and contrast group,with 20 samples in each group.There was no significant difference in the basic data between the two groups.Hormone oral group: on the foundation of antithyroidism drug therapy,prednisone(manufacturer,batch number and specification were the same)was taken orally for treatment.The dosage was 30-60 mg once a day in the first week,and the dosage was reduced and maintained in small doses every week until the drug was stopped.The treatment course was 3months.Hormone shock group:on the foundation of antithyroidism drug therapy,intravenous injection of sodium methylprednisolone succinate was used,the predose was 0.5g/w×6w,then0.25g/w×6w.Both groups were given Cs A 50mg/d orally,and stopped after 3 months.Meanwhile,calcium supplements were added.Monitoring of 40 samples during treatment serum thyroid function、TRAb、TPOAb、TGAb,the degree of exophthalmus(by the same person use the same type of heinz exophthalmus meter measurement),observed in patients with ocular symptoms,orbital CT contrast before and after the treatment,clear the extraocular muscle recovery;At the same time,weight,blood glucose,viscera function,serum ions,ion concentration,blood urine and stool routine,and bone mineral density were monitored to observe whether there were symptoms of Cushing-like syndrome,infection,muscle and nerve symptoms,etc.,and the data were recorded and counted.Data were recorded and statistically analyzed using SPSS22.0.Results: After statistical data,it was found that: 1.The decrease degree of CAS score in patients with moderate and severe active GO was more obvious(p < 0.05)with high dose GC intravenous shock combined with oral Cs A.In addition,from the perspective of clinical manifestations,ocular symptoms were relieved faster and more obviously.2.After treatment,the decrease degree of ocular protrusion in the GC intravenous shock group was more evident than that in the GC oral group(P < 0.05).3.After treatment,the orbital CT of GC intravenous shock group showed a higher rate of extraocular muscle hypertrophy returning to normal than that of GC oral group(p < 0.05).4.After treatment,TRAb level in the GC intravenous impulse group decreased to a higher degree than that in the oral GC group,and TPOAb and TGAb decreased significantly,with significance within the same group(p < 0.05).The decrease of TPOAb and TGAB in GC oral group was not significant.5.There was little imparity in the occurrence of side effects between the GC shock group and the oral GC group.Conclusions: For patients with moderate and severe GO,high-dose GC intravenous shock combined with oral Cs A has more significant clinical efficacy,faster and more obvious relief of ocular symptoms,In the GC shock group,the hyperthyroidism related antibody TRAb decreased faster and maintained more stable levels.It is suggested that high-dose hormone intravenous infusion regimen may be beneficial to better regulate thyroid autoimmune dysfunction.But there was little imparity in the occurrence of side effects between the oral GC group and the GC intravenous impact group,which may be on account of the small number of included cases and less follow-up period.and this conclusion needs further study.