甲泼尼龙不同用药方案治疗甲状腺相关眼病的对照研究

甲状腺相关眼病(TAO)是临床常见且治疗棘手的眼病,主要见于Grave病(GD)和桥本甲状腺炎患者。近年来,有关TAO病因和发病机制的研究取得了显著进展,但在治疗方面仍然存在许多困难。糖皮质激素用于TAO的治疗已有近50     

亚临床甲减合并甲状腺相关眼病1例

甲状腺相关眼病（TAO）,是以眼球后及眶周眼组织的浸润性病变为特征的自身免疫性疾病。它可与各种自身免疫性甲状腺病并发,最多见于Graves病,偶见于桥本甲状腺炎。     

广东汉族人群细胞毒性T淋巴细胞相关抗原-4基因多态性与甲状腺相关性眼病的关系

目的探讨细胞毒性T淋巴细胞相关抗原（CTLA）-4基因外显子1的49位点A／G多态性与甲状腺相关性眼病（TAO）之间的关系。方法研究对象包括TAO患者45例、自身免疫性甲状腺疾病（AITD）无眼病患者100例和本院健康体检中心筛选的无亲缘关系的健康体检者100例。应用聚合酶链反应技术（PCR）对所有血液标本进行CTLA-4基因外显予1的49位点A／G酶切住点限制性片段长度多态性（RFLP）研究，分析比较此多态位点的基因型和等位基因频率在不同人群中分布的差异。结果①TAO组GG基因型频率、G等位基因频率均显著高于无眼病组及对照组（P〈0．05或P〈0．01）；无眼病组GG基因型频率、G等位基因频率亦均显著高于对照组（P〈0．01）。TAO组、无眼病组AA基因型频率均显著低于对照组（P〈0．01），但TAO组与无眼病组相比差异无统计学意义（P=0．118）。②按性别分层后，TAO组、无眼病组男性CG基因型频率及G等位基因频率均显著高于对照组（P〈0．05），而TAO组与无眼病组相比差异无统计学意义（P=0．053）。TAO组、无眼病组女性GG基因型频率及G等位基因频率均同样显著高于对照组（P〈0．05），但TAO组与无眼病组相比亦差异无统计学意义（P=0．075）。③TAO组按甲状腺眼病分级分成5＋6级、4级和3级，3组进行比较发现，3组之间GG基因型频率及G等住基因频率相比差异均无统计学意义（P〉0．05）。结论CTLA-4基因可能是广东地区汉族人群中TAO的易感候选基因。     

甲状腺相关性眼病药物治疗现状

早在200多年以前,就已经发现甲状腺相关性眼病(TAO)这种疾病了。一般认为TAO是与Graves病(GD)既有关联又有区别的器官特异性自身免疫性疾病,它可和各种自身免疫性甲状腺疾病伴发。据调查,GD患者中有25～50％伴有不同程度的眼病,桥本氏甲状腺炎(HT)中有2％伴有眼病,而5％TAO病人不伴有明显的甲亢,但这类病人或多或少显示有甲状腺免疫学检查异常。TAO的确切发病机理尚未完全阐明,可能与基因、自身免疫、眶内成纤维细胞活性、环境、吸烟等因素有关,近年来对TAO的临床治疗进行了积极地探讨,以寻找适合TAO患者的最佳治疗方案。     

甲状腺相关眼病患者接受激素治疗后的临床疗效及生活质量评估

目的：评估甲状腺相关眼病（TAO）患者接受糖皮质激素冲击治疗后的临床疗效及生活质量。方法：采用前瞻性研究,纳入47例活动期中重度TAO患者为TAO组及43例正常对照人群为对照组。TAO患者静脉滴注甲基强的松龙共12周：第1周连续3天,剂量500mg/d;第2～6周,每周1次,剂量500mg/次,静脉滴注;第7～12周,每周1次,剂量250mg/次,静脉滴注。甲基强的松龙总剂量5.5g。眼病活动度采用临床活动性评分方法（CAS）,以CAS评分、眼球突出度及睑裂宽度的变化评估临床疗效,用TAO生活质量问卷（TAO-QOL）进行生活质量评估。结果：TAO患者视功能及社会心理评分显著低于对照组（P〈0.01）;接受糖皮质激素治疗后,TAO患者CAS评分、眼球突出度及睑裂宽度均明显低于治疗前（P〈0.01、P〈0.01、P〈0.05）;与治疗前比较,治疗后TAO患者的视功能及社会心理评分均有显著升高（P〈0.01）。结论：TAO严重降低了患者的生活质量;糖皮质激素冲击治疗TAO不仅临床疗效显著,而且可改善患者的生活质量。     

甲状腺相关性眼病患者的护理

甲状腺相关眼病（TAO）是一种易于侵犯眼外肌的自身免疫性眼眶疾病，是临床护理的难点之一，患者多为中年人。临床上以内分泌性眼球突出、眶内性病变，暴露性角膜炎及视冲经损伤尤为多见。由于TAO病程长、恢复慢、长期药物治疗不良反应大，患者生活和工作压力大，致使其生活质量下降。要提高患者的生活质量及改善其外在形象，增强其自信心．则加强护理就显得十分苇要。现将12例TAO患者的护理体会报道如下。     

泼尼松在甲状腺相关性眼病治疗的临床观察及护理

目的观察泼尼松在甲状腺相关性眼病（TAO）的治疗及护理效果与安全性。方法通过对60例临床活动期的TAO患者与58例非临床活动期的TAO患者口服泼尼松治疗护理后，各临床症状改善情况的对比及41例临床活动期的TAO眼球突出患者治疗前后对比。结果经过泼尼松治疗护理临床活动期的TAO患者有效率为91．7％，非临床活动期的TAO患者有效率为51．7％，眼球突出疗效明显。结论经过精心的治疗及护理，用泼尼松对TAO临床活动期治疗疗效显著、安全可靠。     

甲状腺相关性眼病患者泪液分泌的初步研究

甲状腺相关性眼病（thyroid—associated ophthalmopathy,TAO）是一种免疫性疾病。患者常有流泪或干涩症状。为探讨TAO患者泪液分泌功能,为诊断和治疗TAO患者的眼表并发症提供理论依据,我们研究了TAO患者的泪液分泌状况,现报告如下。     

云克联合甲基强的松龙治疗甲状腺相关性眼病的疗效观察

目的探讨云克联合甲基强的松龙对甲状腺相关性眼病（TAO）的疗效。方法选择2008年2月至2011年5月在我院治疗的TAO患者共79只眼。随机分为云克治疗组（36例）,对照组（41例）。对照组采用甲基强的松龙治疗,治疗组在此基础上加用云克治疗。观察眼球突出度、临床活动性积分、眼球运动、复视情况,并进行详细记录。结果云克治疗组在改善眼球突出度及临床活动性积分方面总有效率疗效分别为86．9％和76．3％明显优于对照组。并在改善眼球运动及复视情况方面疗效优于对照组。结论云克联合甲基强的松龙治疗甲状腺相关性眼病安全、有效,优于单纯甲基强的松龙冲击治疗。     

甲状腺相关眼病的临床疗效分析

目的观察几种治疗方法对甲状腺相关眼病（TAO）患者的临床疗效。方法对98例（161只眼）TAO患者的临床资料进行回顾性分析。结果TAO患者多发生于40岁以上的中年人（70．5％）,性别无明显差异;以眼球突出、眼睑退缩和复视为主要就诊原因,70％以上的患者有眼征和眼外肌受累;98例患者中,甲状腺功能正常者53例,甲状腺功能异常者（甲状腺功能亢进39例、甲状腺功能低下6例）45例。其中60例应用糖皮质激素冲击治疗,病情明显改善;31例行手术治疗后病情得到控制,4例放射治疗后病情稳定,手术及放射治疗的同时应用糖皮质激素治疗;3例行糖皮质激素、放射及手术3种方法联合治疗后病情平稳。结论甲状腺相关眼病应用糖皮质激素冲击治疗是关键,病变严重者辅助以放射治疗或眼眶手术治疗,可收到满意的效果。     

Pharmacotherapy of dry eye

INTRODUCTION: based on data from the largest studies of dry eye to date - the Women's Health Study (WHS) and the Physicians' Health Study (PHS) - and other studies, it has been estimated that about 3.23 million women and 1.68 million men, for a total of 4.91 million Americans aged ≥ 50 years, have dry eye. Tens of millions more have less severe symptoms and probably a more episodic manifestation of the disease that is notable only during contact with some adverse contributing factor(s), such as low humidity or contact lens wear. Dry eye disease is a common yet frequently under-recognized public health problem whose etiology and management challenge clinicians and researchers involved in this field. AREAS COVERED: advances in the understanding of the disease have been made over the past 10 years in areas of epidemiology, pathogenesis, clinical manifestation, and possible therapy. Historical aspects and recent information in relation to the use of artificial tear substitutes and anti-inflammatory agents in dry eye disease, including topical cyclosporin and corticosteroids, autologous serum, tetracyclines and systemic immunosuppressants, are covered in this review. The reader will gain insight into the recent views on the pharmacological menu of treatments for dry eyes following the recommendations of the 2007 International Dry Eye Workshop. EXPERT OPINION: dry eye is a visually disabling disease, the treatment of which needs tailoring according to the type and severity of dry eye disease.     

Topical 0.05% cyclosporin in the treatment of dry eye

Dry eye disease is a common and often underdiagnosed condition that affects > 10% of the adult population, > 65 years of age in the US. This condition has been classified into two separate, but overlapping, categories--aqueous deficiency and evaporative loss. Diagnosis is confused by the lack of a single diagnostic test. Fluorescein break-up time is one of the best screening tests and is augmented by Lissamine green supravital staining. New concepts of pathogenesis have shown that dry eye disease appears to be caused by inflammation mediated by T-cell lymphocytes. This finding led to the study and FDA-approval of topical 0.05% cyclosporin A (Restasis) for the treatment of dry eye disease. 0.05% Cyclosporin A offers the first therapeutic treatment for patients with moderate-to-severe dry eye disease due to aqueous deficiency.     

Topical 0.05% cyclosporin in the treatment of dry eye

Dry eye disease is a common and often underdiagnosed condition that affects > 10% of the adult population, > 65 years of age in the US. This condition has been classified into two separate, but overlapping, categories – aqueous deficiency and evaporative loss. Diagnosis is confused by the lack of a single diagnostic test. Fluorescein break-up time is one of the best screening tests and is augmented by Lissamine green supravital staining. New concepts of pathogenesis have shown that dry eye disease appears to be caused by inflammation mediated by T-cell lymphocytes. This finding led to the study and FDA-approval of topical 0.05% cyclosporin A (Restasis^?) for the treatment of dry eye disease. 0.05% Cyclosporin A offers the first therapeutic treatment for patients with moderate-to-severe dry eye disease due to aqueous deficiency.     

Pharmacotherapy of dry eye

Introduction: Based on data from the largest studies of dry eye to date – the Women's Health Study (WHS) and the Physicians' Health Study (PHS) – and other studies, it has been estimated that about 3.23 million women and 1.68 million men, for a total of 4.91 million Americans aged ≥ 50 years, have dry eye. Tens of millions more have less severe symptoms and probably a more episodic manifestation of the disease that is notable only during contact with some adverse contributing factor(s), such as low humidity or contact lens wear. Dry eye disease is a common yet frequently under-recognized public health problem whose etiology and management challenge clinicians and researchers involved in this field.

Areas covered: Advances in the understanding of the disease have been made over the past 10 years in areas of epidemiology, pathogenesis, clinical manifestation, and possible therapy. Historical aspects and recent information in relation to the use of artificial tear substitutes and anti-inflammatory agents in dry eye disease, including topical cyclosporin and corticosteroids, autologous serum, tetracyclines and systemic immunosuppressants, are covered in this review. The reader will gain insight into the recent views on the pharmacological menu of treatments for dry eyes following the recommendations of the 2007 International Dry Eye Workshop.

Expert opinion: Dry eye is a visually disabling disease, the treatment of which needs tailoring according to the type and severity of dry eye disease.     

血栓闭塞性脉管炎动物模型研究进展

目的对血栓闭塞性脉管炎(thromboangiitis obliterans TAO)动物模型制备方法进行综述,以寻找更加适合临床实际的造模方法。方法对近20年国内外TAO造模方法相关文献进行整理、分析、归纳。结果在已有TAO造模方法中,大鼠是首选造模动物,烟草致敏、寒冻、注射TAO免疫复合物等造摸方法虽然成模率都较好,也各有优缺点;以股动脉注射月桂酸改进模型与临床病理变化更相吻合,也被广泛应用于药理学活性发现和药效评价中。结论针对TAO发病机制的造模方法目前鲜有报道。因此,在深入探讨TAO发病机制基础上的造模方法学研究与模型制备,是创新药物发现与新药药效评价的前提。     

干眼病的眼表炎症机制研究进展

干眼病是常见的眼病之一,为多因素引起的泪液紊乱和眼表功能障碍。炎症反应环路在干眼病发病机制中起重要作用;多种免疫细胞和炎症因子参与干眼病的发病和进展过程;泪腺功能单位既是炎症的触发部位,又是炎症因子的效应器官。本文从眼部炎症改变、泪液中的炎症因子以及介导炎症反应的细胞等方面综述干眼病的眼表炎症机制研究进展。     

清热药治疗糖尿病并发症的研究进展

糖尿病患者机体在持续的高血糖状态影响下,常常发生多种糖尿病并发症,包括糖尿病肾病、糖尿病脑病、糖尿病心脏病、糖尿病眼病等,这些并发症已经成为糖尿病患者致死、致残的主要原因,中医药在治疗糖尿病并发症中发挥着重要的作用。中医药理论认为,热毒是糖尿病并发症发生的重要因素之一,主要是因糖尿病后期,脏腑功能低下,致气机及脏腑疏泄功能失调,引起浊瘀痰湿内蕴,日久而化热毒。针对此病机,中医在治疗糖尿病并发症时,多采取清热解毒的治疗方式,广泛应用清热类中药,因此,围绕近年来清热中药在治疗糖尿病并发症中的临床应用及基础研究作一综述。     

甲状腺相关性眼病患者血清IL-6和IL-15水平及其与病情活动度的相关性研究

目的 观察甲状腺相关性眼病(thyroid associated ophthalmopathy,TAO)患者血清白介素-6(interleukin-6,IL-6)和IL-15水平变化及其与病情活动度的相关性.方法 通过对2013年10月-2015年10月诊断为TAO的56例患者进行回顾性分析,并依照临床TAO临床活动评分标准,将TAO组的患者分为活动期组和非活动期组;同时选取50例健康人为健康组.并分析各组血清IL-6和IL-15水平变化,探讨其与病情活动度的相关性.结果 TAO组血清IL-6和IL-15水平明显高于健康组(P ＜0.001).活动期组血清IL-6和IL-15水平明显高于非活动期组(P＜0.001).IL-6和IL-15与病情活动度均有相关性(r=0.712和0.503,P均＜0.001).结论 TAO患者血清中IL-6和IL-15水平变化与TAO的发生、发展相关,可作为临床诊断和评估TAO病情严重度的重要指标.     

原发性干燥综合征33例临床分析

目的探讨原发性干燥综合征(pSS)患者发病特点及预后。方法选择2008年9月至2011年9月门诊及住院的原发性干燥综合征患者33例的病历资料进行回顾性分析。结果原发性干燥综合征住院人数呈上升趋势,发病高峰年龄为31～54岁;男女性别比为1∶27.3;首诊症状中最多见的是口干、眼干和关节痛:抗SSA、SSB抗体的阳性率分别为89.4%和47.6%:唇腺病理检查者12例,3～4级占50.6%。并发症中最多见的为肾小管酸中毒(19.6%)。结论 pSS近年来就诊人数呈上升趋势;唇腺病理和抗SSA、SSB抗体对pSS的诊断有重要意义;pSS尚不能根治,并发症的处理仍是本病治疗的关键。