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目的探讨大剂量泼尼松方案与环磷酰胺长春新碱泼尼松(COP)方案治疗甲状腺相关眼病(TAO)的临床疗效。方法选择2000年8月至2003年7月在北京协和医院眼科确诊的27例甲状腺相关眼病患者,参考患者病情严重程度及对化疗药物的依从性将其分为两组,泼尼松组13例,COP组14例,两组患者的性别构成、年龄比较差异均无统计学意义(P>0.05)。分别比较两组患者组内和组间治疗前后临床活动度积分(CAS)、病情严重程度、眼外肌厚度及24h尿中糖胺聚糖(GAG),分析临床疗效。结果COP组治疗前后CAS积分分别为6.5±1.6和1.9±1.3;泼尼松组为4.4±1.8和1.6±1.1,治疗前CAS积分COP组显著高于泼尼松组(P<0.001),两组治疗前后组内分别比较差异均有统计学意义(P<0.01)。COP组治疗前后眼外肌的厚度分别为(6.8±1.7)mm和(5.3±1.1)mm;泼尼松组为(6.5±1.5)mm和(5.8±1.1)mm;两组治疗前后组内分别比较差异均有统计学意义(P<0.01)。COP组与泼尼松组治疗后眼外肌厚度分别减少(22.4±4.4)%和(13.3±4.6)%,组间比较差异有统计学意义(P<0.01)。两组治疗后病情显著缓解。治疗前后的24h尿GAG水平:COP组(7例)分别为(40.6±10.1)mg/24h和(15.7±5.1)mg/24h,泼尼松组(5例)分别为(33.6±6.6)mg/24h和(16.7±2.5)mg/24h,均降至正常;组内分别比较差异均有统计学意义(P<0.01)。结论大剂量泼尼松方案和COP方案均是治疗TAO的有效方案,统计学分析结果显示COP方案较泼尼松方案更有效,提示COP方案可能适合治疗活动度高、病情严重的TAO患者。
Objective To investigate the clinical effects of high-dose prednisone and cyclophosphamide-vincristine (COP) on thyroid-associated ophthalmopathy (TAO). Methods From August 2000 to July 2003 in Peking Union Medical College ophthalmology diagnosed 27 cases of thyroid associated ophthalmopathy patients with reference to the severity of the disease and the compliance of chemotherapy drugs will be divided into two groups, prednisone group of 13 patients , COP group of 14 patients, the two groups of gender composition, age, no significant difference (P> 0.05). The clinical activity score (CAS), severity of disease, extraocular muscle thickness and 24h urinary glycosaminoglycan (GAG) were compared between the two groups before and after treatment, and the clinical efficacy was analyzed. Results Before and after treatment, the COP scores in COP group were 6.5 ± 1.6 and 1.9 ± 1.3, respectively, and those in prednisone group were 4.4 ± 1.8 and 1.6 ± 1.1. The score of COP in COP group before treatment was significantly higher than that in prednisone group (P <0.001) Group before and after treatment, respectively, the difference was statistically significant (P <0.01). The thickness of the extraocular muscles in the COP group were (6.8 ± 1.7) mm and (5.3 ± 1.1) mm respectively before and after treatment; those in the prednisone group were (6.5 ± 1.5) mm and (5.8 ± 1.1) mm respectively; Respectively, the difference was statistically significant (P <0.01). The thickness of extraocular muscles in COP and prednisone groups decreased by (22.4 ± 4.4)% and (13.3 ± 4.6)%, respectively, with statistically significant differences (P <0.01). Two groups of patients after treatment significantly alleviated. The urinary GAG levels of 24h before and after treatment were (40.6 ± 10.1) mg / 24h and (15.7 ± 5.1) mg / 24h in COP group (7 cases) and 33.6 ± 6.6 mg / 24h and (16.7 ± 2.5) mg / 24h respectively, all decreased to normal; there were significant differences among the groups (P <0.01). Conclusions Both high-dose prednisone and COP regimen are effective treatments for TAO. Statistic analysis shows that COP regimen is more effective than prednisone regimen, suggesting that COP regimen may be suitable for the treatment of TAO patients with high activity and serious disease.