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目的 评价99Tc 亚甲基二膦酸盐 (99Tc MDP ,“云克”)与免疫抑制疗法治疗Graves’眼病(GO)的疗效。方法 42例中～重度GO患者 ,随机分为试验组与对照组 ,试验组采用静脉推注“云克” ,对照组采用免疫抑制治疗。治疗前及治疗后 4个月由同一眼科医生检查患者眼部情况 ,同时测定患者甲状腺激素水平及TSH (TRAb)受体抗体、甲状腺球蛋白抗体 (TGA)和甲状腺微粒体抗体(MCA)水平。治疗 4个月后 ,采用NOSPECS分类标准及眼病指数判断疗效。采用SPSS 7 5统计软件进行统计分析。结果 免疫抑制治疗组 6 7% (14/ 2 1例 )的患者有效 ,而“云克”治疗组 6 2 % (13/ 2 1例 )的患者有效。两组治疗前后总的眼病指数差异无显著性 (t=0 5 6 4,P >0 5 0 )。两组间总的治疗效果差异无显著性 (χ2 =0 0 2 ,P >0 5 0 ) ,但免疫抑制治疗组软组织炎症改善较“云克”治疗组快。两组疗效与TRAb、TGA、MCA及治疗前GO活性程度有相关关系。“云克”治疗组未发生副作用 ,免疫抑制治疗组有明显副作用。结论 “云克”是治疗GO的一种具有潜力的药物 ,对于内科治疗与131I治疗甲亢后的GO患者均有效。
Objective To evaluate the efficacy of 99Tc methylene diphosphonate (99Tc MDP) and immunosuppressive therapy in the treatment of Graves’ ophthalmopathy (GO). Methods Forty-two patients with moderate to severe GO were randomly divided into test group and control group. The experimental group received intravenous injection of “Yunke” and the control group received immunosuppressive therapy. The same ophthalmologist examined the ophthalmological condition of the patients before treatment and 4 months after treatment. Thyroid hormone level, TSH (TRAb) receptor antibody, thyroglobulin antibody (TGA) and thyroid microsomal antibody (MCA) levels were also measured. After 4 months of treatment, using NOSPECS classification criteria and eye index to determine the efficacy. SPSS 7 5 statistical software for statistical analysis. Results Sixty-seven percent (14 of 21) patients in the immunosuppressive group were effective, while 62,2% (13/2) of the patients in the “Yunke” group were effective. There was no significant difference between the two groups before and after treatment (t = 0546, P> 0.05). There was no significant difference in the overall treatment effect between the two groups (χ2 = 0.002, P> 0.05), but the improvement in soft tissue inflammation was more rapid in the immunosuppressive group than in the “Yunke” group. The efficacy of the two groups was related to the levels of TRAb, TGA, MCA and pretreatment GO activity. There were no side effects in the “Yunke” treatment group, and obvious side effects in the immunosuppressive treatment group. Conclusion Yunke is a promising drug for the treatment of GO and is effective for patients with GO after medical therapy and 131I treatment of hyperthyroidism.