Graves眼病部分免疫抑制剂疗效探讨

目的　对比几种免疫抑制剂对Graves眼病的疗效 ,旨在寻求免疫治疗的有效手段。方法　Graves眼病 75例 ,A组 31例 ,采用泼尼松 (16例 ,其中完成 13例 )或雷公藤多甙 (TW ,15例 )治疗 ;B组 2 3例 ,采用环孢素A(CsA ,11例 )或霉酚酸酯 (MMF ,12例 )治疗 ,疗程 12周 ;对照组 2 1例 ,仅给抗甲状腺药治疗并调节甲状腺功能。疗效判断采用改进的Given Wilson积分指数系统 ,积分下降或上升≥ 3分为好转或恶化 ,<3分为无变化。结果　 12周末 ,泼尼松组 13例中 7例好转 ,6例无效 ;TW组15例中 10例好转 ,5例无变化 ;CsA组 11例中 5例好转 ,6例无效 ;MMF组 12例中 11例好转 ,1例无变化 ;对照组 2 1例中 4例好转 ,5例恶化 ,12例无效。MMF好转率高于CsA(P <0 0 5 ) ;TW与泼尼松比较差异无显著性 (P >0 0 5 )。各治疗组 12周末眼病分值均有下降 (P <0 0 1) ,下降幅度大小依次为MMF、TW、泼尼松和CsA组。结论　MMF用于治疗Graves眼病疗效优于CsA ,且较低剂量应用副作用不多 ;较小剂量的TW治疗Graves眼病疗效与泼尼松相仿 ,但可能副作用较少。

Immunosuppressive therapies in patients with Graves' ophthalmopathy

OBJECTIVE: To compare the efficacy and tolerability of 4 immunosuppressants in treating Graves' ophthalmopathy (GO). METHODS: Seventy-five untreated GO patients were enrolled in this study. The diagnosis of GO was based on the presence of the typical clinical features and exclusion of possible cranial/orbital diseases. In group A, 31 patients were randomly assigned to receive either prednisone (n = 16, treatment completed in 13 cases with doses of 40 mg, 20 mg and 10 mg per day for 4 weeks) or tripterygium wilfordii multiglycoside (TW, n = 15, 30 - 60 mg per day); in group B, 23 adults were randomized to receive cyclosporin A (CsA, n = 11, 5 - 6 mg per kilogram of body weight per day) or mycophenolate mofetil (MMF, n = 12, 16 - 18 mg per kilogram of body weight per day) therapy. The remaining 21 patients (control group) were given only anti-thyroid drugs and levo-thyroxine. The disease severity and therapeutic response were quantitatively assessed according to the Ophthalmopathy Index Scoring System from Given-Wilson (1989) with sensible modification. Improvement or progression of ophthalmopathy was defined if the difference, either increase or decrease, of the score, reached 3 or more in the ophthalmopathy index. If this did not occur, a lack of response was indicated. RESULTS: After 12 weeks, 7 of the 13 treated with prednisone improved and the remaining 6 lacked response. In the TW group, 10 of the 15 responded to the therapy; 5 had no change. There was no significant difference in clinical response between the above 2 groups (P > 0.05). Five CsA-treated and 11 MMF-treated patients responded to the therapy (45% vs 92%; P < 0.05). It seems that MMF is more effective than CsA in the treatment of GO, although a significant decrease (P < 0.01) in the mean score of the CsA group has also been shown at the end of the course. Four of the controls improved, 5 (24%) showed worsening of ophthalmopathy, and the remaining 12 (57%) had no significant change. In the prednisone group, 3 gained body weight by more than 5%, and 2 developed impaired glucose tolerance. These two and one of the three weight gaining patients ceased the therapy. CONCLUSIONS: New immunosuppressant MMF may be more effective than CsA in the treatment of Graves' ophthalmopathy. TW may be equally effective as and perhaps better tolerable than prednisone in the immunotherapy of Graves' ophthalmopathy.