糖皮质激素冲击治疗甲状腺相关性眼病对肾上腺皮质功能的影响.docVIP

糖皮质激素冲击治疗甲状腺相关性眼病对肾上腺皮质功能的影响 目的 评价大剂量糖皮质激素冲击治疗对甲状腺相关性眼病（thyroid-associated ophthalmopathy，TAO）患者肾上腺皮质功能的影响。方法例活动性中、重度TAO患者甲基强的松龙500mg/天静滴3天，间隔4周冲击治疗6疗程患者于间歇期口服强地松10mg/天，于4周内减停。分别于冲击治疗前治疗后及24周进行疗效与不良反应评定，并检测血清皮质醇（F）促肾上腺皮质激素（ACTH）及24小时尿皮质醇水平，分析对肾上腺皮质功能的影响。结果、组疗效（有效率分别为8％、8％，无效或恶化率分别为％、15％，F=0.68；复发率分别为％、％，F=0.）与不良反应发生率（分别为％、％，=0.14）无显著差异。所有患者肾上腺皮质功能治疗前均正常，6次治疗结束后，组例患者肾上腺皮质功能均于4周时恢复正常；组患者在4周结论 大剂量甲基强的松龙间歇冲击治疗甲状腺相关性眼病有效，但对肾上腺皮质功能有明显抑制。在间歇期口服强的松者，疗效与不良反应无显著改善，但肾上腺皮质功能抑制更加明显。 关键词：甲状腺相关性眼病；糖皮质激素；肾上腺皮质功能 Glucocorticoid treatment of thyroid associated ophthalmopathy adrenal Tang Wei, Liang Cui, dinner group, Ye Fei, Tony, Shi Yong Quan, Liu Zhimin Shanghai Changzheng Hospital, Endocrinology, 200003 Objective To evaluate high-dose glucocorticoid treatment of adrenal cortex function in patients with thyroid associated ophthalmopathy (thyroid-associated ophthalmopathy, TAO).Methods 48 patients with active, severe TAO patients using a stratified random method into the intermittent treatment group (24 cases) and maintenance treatment group (24 cases). All patients received at intervals of 4 to give weeks of methylprednisolone 500mg / day intravenous infusion of the treatment, for 3 consecutive days at a time for a course, a total of the impact of treatment of six courses. Intermittent period of the intermittent treatment group without any drug intervention; maintenance of patients treated with oral prednisone treatment in the interim period, the initial dose of 10mg / days, and within four weeks of gradual reduction in stop. Two groups of patients, respectively, before the impact of treatment, and 24 weeks after the end of treatment, every 4 weeks for efficacy and adverse effects assessment, and to detect the level of serum cortisol (F), adrenocorticotropic hormone (ACTH) and 24-hour urinary cortisol to analyze the impact of the adrenal cortex function. Results of intermittent treatment group, to maintain the efficacy of the treatment group (83.3%, 87.5%, invalid or exacerbation