目的:探究对合并糖尿病的Graves眼病进行治疗的方法及临床效果。方法:选取于2016年10月至2022年04月临沂市人民医院收治的130例合并糖尿病的Graves眼病患者,随机分为观察组(甲强龙联合甲氨蝶呤治疗)和对照组(甲强龙治疗)各65人。对比两组治疗情况。结果:相比于对照组(78.46%),观察组治疗总有效率(96.92%)较高(P < 0.05);观察组、对照组治疗后的血糖水平均下降,差异有统计学意义(P < 0.05),但治疗后血糖值组间差异无统计学意义(P > 0.05);观察组临床症状评分低于对照组(P < 0.05);结论:对合并糖尿病的Graves眼病患者运用甲强龙联合甲氨蝶呤治疗,能够提高治疗的疗效,减轻患者临床症状,使其生活质量得到改善。 Objective: To explore the treatment method and clinical effect of Graves eye disease with diabetes mellitus. Methods: A total of 130 patients with Graves’ disease complicated with diabetes who were admitted to Linyi People’s Hospital from October 2016 to April 2022 were randomly divided into observation group (methylprednone plus methotrexate treatment) and control group (methylprednone treatment), 65 in each group. The treatment of the two groups was compared. Results: Compared with the control group (78.46%), the total effective rate of observation group (96.92%) was higher (P < 0.05). The blood glucose level of the observation group and the control group decreased after treatment, and the difference was statistically significant (P < 0.05), but there was no significant difference in blood glucose value between the two groups after treatment (P > 0.05). The clinical symptom score of observation group was lower than that of control group (P < 0.05). Conclusion: The use of methylprednone combined with methotrexate in the treatment of Graves eye disease patients with diabetes can improve the therapeutic effect, relieve the clinical symptoms and improve their quality of life.
目的:探究对合并糖尿病的Graves眼病进行治疗的方法及临床效果。方法:选取于2016年10月至2022年04月临沂市人民医院收治的130例合并糖尿病的Graves眼病患者,随机分为观察组(甲强龙联合甲氨蝶呤治疗)和对照组(甲强龙治疗)各65人。对比两组治疗情况。结果:相比于对照组(78.46%),观察组治疗总有效率(96.92%)较高(P < 0.05);观察组、对照组治疗后的血糖水平均下降,差异有统计学意义(P < 0.05),但治疗后血糖值组间差异无统计学意义(P > 0.05);观察组临床症状评分低于对照组(P < 0.05);结论:对合并糖尿病的Graves眼病患者运用甲强龙联合甲氨蝶呤治疗,能够提高治疗的疗效,减轻患者临床症状,使其生活质量得到改善。
糖尿病,Graves眼病,内分泌疾病,临床效果
Ying Cui1*, Zhenyu Pan2*, Guanqi Gao3#
1School of Clinical Medicine, Weifang Medical University, Weifang Shandong
2Shandong Medical College, Linyi Shandong
3Department of Endocrinology and Metabolic Diseases, Linyi People’s Hospital, Linyi Shandong
Received: Jul. 3rd, 2022; accepted: Jul. 29th, 2022; published: Aug. 5th, 2022
Objective: To explore the treatment method and clinical effect of Graves eye disease with diabetes mellitus. Methods: A total of 130 patients with Graves’ disease complicated with diabetes who were admitted to Linyi People’s Hospital from October 2016 to April 2022 were randomly divided into observation group (methylprednone plus methotrexate treatment) and control group (methylprednone treatment), 65 in each group. The treatment of the two groups was compared. Results: Compared with the control group (78.46%), the total effective rate of observation group (96.92%) was higher (P < 0.05). The blood glucose level of the observation group and the control group decreased after treatment, and the difference was statistically significant (P < 0.05), but there was no significant difference in blood glucose value between the two groups after treatment (P > 0.05). The clinical symptom score of observation group was lower than that of control group (P < 0.05). Conclusion: The use of methylprednone combined with methotrexate in the treatment of Graves eye disease patients with diabetes can improve the therapeutic effect, relieve the clinical symptoms and improve their quality of life.
Keywords:Diabetes, Graves Ophthalmopathy, Endocrine Diseases, Clinical Effect
Copyright © 2022 by author(s) and Hans Publishers Inc.
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Graves病也称弥漫性毒性甲状腺肿,是一种伴有甲状腺激素分泌过多的自身免疫性甲状腺疾病,其发病机制尚未完全阐明,目前认为与自身免疫有关 [
选取于2016年10月至2022年04月临沂市人民医院收治的130例合并糖尿病的活动期Graves眼病患者,依据随机数字表法将研究对象分为观察组和对照组各65人。所有患者了解治疗方案并自愿签署知情同意书。
纳入标准:所有患者有糖尿病病史,并确诊为中重度Graves眼病,眼病临床活动性评分(Clinical activity score, CAS) ≥ 3分 [
排除标准:1) 有药物过敏史者;2) 哺乳期或妊娠期女性;3) 感染病史;4) 心肝肾功能受损患者;5) 其他非Graves病甲状腺功能亢进。
糖尿病 [
Graves病 [
CAS评分 [
严重程度分级 [
运用常规抗甲状腺药物治疗所有患者,甲巯咪唑(默克制药有限公司,国药准字:J20171078),每天10 mg,根据甲功结果调整用药;为控制血糖,需要给予胰岛素皮下注射治疗;同时,眼部需要交替使用人工眼液和红霉素眼膏;所有服用甲氨蝶呤的患者每天补充叶酸1 mg [
对照组应用甲泼尼龙(国药集团容生制药有限公司,国药准字:H20040844规格:40 mg/支),0.5 g静脉滴注,隔天1次,使用3天后改为口服30 mg,1周后逐渐减量至每天8 mg,疗程为12周,观察组在对照组的基础上加用甲氨蝶呤,甲氨蝶呤(上海信谊药厂有限公司,国药准字:H31020644规格:2.5 mg/片),剂量为7.5 mg,每周1次治疗。
对比两组治疗效果、血糖水平、临床活动性评分CAS,其中CAS得分越低表示临床症状越轻。
临床症状明显好转为显效,CAS活动性评分下降 ≥ 2分;症状有所改善,CAS活动性评分下降 ≥ 1分时为有效;CAS活动性评分无改善或CAS活动性评分升高 ≥ 1分即病情加重时为无效,以显效和有效为总有效率。
运用SPSS26.0统计学软件,计量资料用( x ¯ ± s )表示,采用t检验;计数资料用百分率表示,采用X2检验,P < 0.05为差异有统计学意义。
1) 130例患者中,观察组男35例、女30例,平均年龄(47.26 ± 8.13)岁;对照组男33例、女32例,平均年龄(46.87 ± 7.19)岁。一般资料无差异,P > 0.05,基线具有可比性。
2) 治疗效果比较:观察组高于对照组(P < 0.05),见表1。
3) 血糖水平对比:观察组、对照组治疗后血糖水平均较治疗前有所改善,差异存在统计学意义(P < 0.05),但治疗后血糖值组间差异无统计学意义(P > 0.05),见表2。
组别 | 例数 | 显效 | 有效 | 无效 | 总有效率 |
---|---|---|---|---|---|
观察组 | 65 | 32 | 31 | 2 | 96.92% (63/65) |
对照组 | 65 | 25 | 26 | 14 | 78.46% (51/65) |
X2 | 12.105 | ||||
P | <0.05 |
表1. 比较治疗总有效率[例(%)]
组别 | 例数 | 餐后2 h血糖 | 空腹血糖 | ||
---|---|---|---|---|---|
治疗前 | 治疗后 | 治疗前 | 治疗后 | ||
观察组 | 65 | 11.36 ± 1.23 | 8.34 ± 1.18 | 9.17 ± 1.27 | 7.02 ± 0.39 |
对照组 | 65 | 11.43 ± 1.11 | 7.16 ± 1.03 | 9.12 ± 1.31 | 6.51 ± 0.27 |
t | 2.025 | 4.524 | 1.036 | 5.624 | |
P | >0.05 | >0.05 | >0.05 | >0.05 |
表2. 对比血糖水平( x ¯ ± s , mmol/L)
4) 临床症状评分对比:观察组症状改善优于对照组(P < 0.05),见表3。
组别 | 例数 | CAS评分( x ¯ ± s ,分) | |
---|---|---|---|
治疗前 | 治疗后 | ||
观察组 | 65 | 6.28 ± 2.14 | 4.4 ± 1.80 |
对照组 | 65 | 6.26 ± 2.12 | 5.25 ± 2.11 |
t | 0.041 | 2.456 | |
P | >0.05 | <0.05 |
表3. 对比临床症状评分( x ¯ ± s ,分)
Graves病是一种原因未明的自身免疫性甲状腺疾病,目前其确切的发病机理还不明确,公认为与细胞免疫、体液免疫有关。Graves眼病也称为甲状腺眼病,是一种与自身免疫性甲状腺疾病相关的眼眶炎症性疾病 [
在促肾上腺皮质激素类药物中,甲强龙作为一种常用药,具有免疫抑制和强大的消炎作用,包括干扰T淋巴细胞和B淋巴细胞功能,阻止中性粒细胞、单核细胞和巨噬细胞在炎症部位的聚集,减少眶内成纤维细胞生成,减轻内分泌眼病的临床症状。研究表明,相对于口服糖皮质激素,静脉注射方式更有效,耐受性更好 [
近年来,其他免疫抑制剂及生物制剂的出现为Graves眼病的治疗提供了又一选择,如甲氨蝶呤,当低剂量使用时,它具有抗炎和免疫调节作用,其通过抑制二氢叶酸还原酶,导致细胞外腺苷释放增多,从而减少炎性细胞因子的产生而影响体液免疫和细胞免疫 [
本文通过探究对合并中重度Graves眼病患者进行内分泌疾病治疗的方法及临床效果,结果显示,观察组治疗总有效率(96.92%)高于对照组(78.46%),(P < 0.05),提示运用甲强龙联合甲氨蝶呤治疗后,临床效果较好;治疗后,与对照组相比,观察组CAS评分均较低(P < 0.05),组内治疗前后比较,差异有统计学意义(P < 0.05),提示两组经治疗后,症状均有所改善,联合治疗疗效更佳,与Strianese,Diego等人的研究结果一致 [
综上所述,对合并糖尿病的中重度Graves眼病患者运用甲强龙联合甲氨蝶呤治疗,是一种有效和安全的治疗方法,能够减轻患者的临床症状,提高治疗疗效,从而加快疾病恢复,临床可推广实施。
崔 颖,潘振宇,高冠起. 合并糖尿病的Graves眼病的治疗及疗效观察Treatment and Curative Effect of Graves Ophthalmopathy Complicated with Diabetes Mellitus[J]. 临床医学进展, 2022, 12(08): 7166-7171. https://doi.org/10.12677/ACM.2022.1281034