朱红云 张福仙 马蓉 崔涛 何慧梅 鞠海兵

[摘要] 目的 探讨甲泼尼龙冲击联合曲安奈德球后注射治疗甲状腺相关眼病的临床效果。 方法 选取2010年1月～2013年12月本院的38例中重度甲状腺相关眼病患者作为研究对象，给予甲泼尼龙500 mg静脉滴注，隔日1次，连续3次联合1次曲安奈德球后注射作为1个疗程，每月1个疗程，连续3个疗程后评价眼部自觉症状、体征、临床活动性评分（CAS）、软组织炎症（NOSPECS）评分和不良反应发生率。 结果 甲泼尼龙冲击联合曲安奈德球后注射3个疗程后眼部畏光、流泪、眼胀、眼痛、复视等症状明显改善或消除。治疗10 d后、3个月后的CAS评分和NOSPECS评分显著低于治疗前，差异有统计学意义（P<0.05）。治疗3个月后的突眼度、眼裂宽度显著小于治疗前，差异有统计学意义（P<0.05）。 结论 甲泼尼龙冲击联合曲安奈德球后注射治疗甲状腺相关眼病疗效确切，安全可靠，不良反应轻。

[关键词] 甲泼尼龙；曲安奈德；球后注射；甲状腺相关眼病

[中图分类号] R581.1 [文献标识码] A [文章编号] 1674-4721（2016）02（b）-0152-03

Clinical effect of methylprednisolone combined with triamcinolone acetonide retrobulbar injection in the treatment of thyroid-associated ophthalmopathy

ZHU Hong-yun1 ZHANG Fu-xian2 MA Rong2 CUI Tao2 HE Hui-mei2 JU Hai-bing2▲

1.Clinical College，Chengdu Military Area Command Kunming General Hospital of Kunming Medical University，Kunming 650032，China；2.Department of Endocrinology，Chengdu Military Area Command Kunming General Hospital，Kunming 650032，China

[Abstract] Objective To explore the clinical effect of methylprednisolone combined with triamcinolone acetonide retrobulbar injection in the treatment of thyroid-associated ophthalmopathy. Methods 38 cases of moderate-severe thyroid-associated ophthalmopathy from January 2010 to December 2013 in our hospital were selected as the research group，all patients were given intravenous methylprednisolone 500 mg，once every other day，and sustained 3 times combined with 1 time of triamcinolone acetonide retrobulbar injection as 1 course.One month for one course.After sustained 3 courses，eye symptoms，signs，clinical activity score （CAS），NOSPECS score and the incidence rate of adverse effect was evaluated respectively. Results After using methylprednisolone combined with triamcinolone acetonide retrobulbar injection for 3 courses，the symptoms liked photophobia eye，lacrimation，eye distension，ophthalmalgia and diplopia obvious improved and eliminated.The CAS score and the NOSPECS score after treatment for 10 days and 3 months was lower than that before treatment，with significant difference （P<0.05）.The degree of exophthalmos，eye fissure width after treatment for 3 months was less than that before treatment，with significant difference （P<0.05）. Conclusion Methylprednisolone combined with triamcinolone acetonide retrobulbar injection in the treatment of thyroid-associated ophthalmopathy has exact effect，safe and with little adverse effect.

[Key words] Methylprednisolone；Triamcinolone acetonide；Retrobulbar injection；Thyroid-associated ophthalmopathy

甲状腺相关性眼病（thyroid associated ophthalmopathy，TAO）是一种常见的眼眶病，也是甲状腺疾病患者最常见的一种甲状腺腺外表现，又称Graves眼病、恶性突眼、浸润性突眼、甲亢突眼、内分泌突眼等，属于器官特异性自身免疫性疾病[1]，可引起眼部干涩不适、眶周肿胀、眼睑退缩、上睑迟落、眼球突出、眼外肌功能障碍、复视和视力下降等多种临床表现[2-3]。在国内外成人组眼眶疾病中，TAO约占20%，Graves病患者中25%～50%伴有TAO，因而TAO成为主要致盲原因之一[4-5]。采用免疫抑制剂治疗TAO是内科治疗的主要手段，糖皮质激素是临床上常用的免疫抑制剂，主要抑制炎症反应和免疫反应，是目前中重度活动期TAO治疗的首选制剂，应用糖皮质激素治疗TAO的途径有局部球后注射、静脉用药和口服用药[6]。……