疏肝健脾法治疗活动期甲状腺相关眼病的临床观察
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摘要
目的探讨疏肝健脾法治疗活动期甲状腺相关眼病(TAO)的疗效。方法选择符合条件的60例甲状腺相关眼病患者随机分为两组,其中治疗组30例(60只眼)给予口服中药"疏肝健脾方"联合甲强龙冲击治疗,对照组30例(60只眼)给予注射用甲基强的松龙冲击治疗,两组疗程均为12周。观察两组治疗前后CAS评分、眼球突出度变化情况。结果两组临床疗效比较差异无统计学意义(P>0.05),但治疗后两组CAS评分、突眼度均明显降低(P均<0.05),且治疗组各指标改善程度均明显优于对照组(P均<0.05)。结论疏肝健脾法能有效改善TAO患者CAS评分、眼球突出度症状。
OBJECTIVE To investigate the therapeutic effect of soothing liver and invigorating spleen on active thyroid-associated ophthalmopathy(TAO). METHODS Sixty patients with TAO were randomly divided into two groups, the 30 cases(60 eyes) of treatment group were given Chinese Shugan Jianpi formula by combination with pulse methylprednisolone therapy, while the 30 cases(60 eyes) of the control group were treated with pulse methylprednisolone therapy, and the treatment courses of two groups were both 12 weeks. The CAS scores and exophthalmos of the two groups before and after treatment were observed. RESULTS There was no significant difference in clinical efficacy between the two groups(P >0.05), but the scores of CAS and exophthalmos decreased significantly in the two groups after treatment(P<0.05), and the improvement of each index in the treatment group was significantly better than that of the control group(P<0.05). CONCLUSIONS The method of soothing liver and invigorating spleen effectively improved the CAS scores and exophthalmos symptoms in TAO patients.
OBJECTIVE To investigate the therapeutic effect of soothing liver and invigorating spleen on active thyroid-associated ophthalmopathy(TAO). METHODS Sixty patients with TAO were randomly divided into two groups, the 30 cases(60 eyes) of treatment group were given Chinese Shugan Jianpi formula by combination with pulse methylprednisolone therapy, while the 30 cases(60 eyes) of the control group were treated with pulse methylprednisolone therapy, and the treatment courses of two groups were both 12 weeks. The CAS scores and exophthalmos of the two groups before and after treatment were observed. RESULTS There was no significant difference in clinical efficacy between the two groups(P >0.05), but the scores of CAS and exophthalmos decreased significantly in the two groups after treatment(P<0.05), and the improvement of each index in the treatment group was significantly better than that of the control group(P<0.05). CONCLUSIONS The method of soothing liver and invigorating spleen effectively improved the CAS scores and exophthalmos symptoms in TAO patients.
引文
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[26]胡齐鸣,徐蓉娟.治疗Graves眼病经验[J].江西中医药,2003,34(7):7-8.
[2]FANG S,HUANG Y,WANG S,et a1.IL-17A exacerbates fibrosis by promoting the proinflammatory and profibrotic function of orbital fibroblasts in TAO[J].J Cfin Endocrinol Metab,2016,10l(8):2955-2965.
[3]SAHLI E,GUNDUZ K.Thyroid-associated 0phthalmopathy[J].Turk J Ophthalmol,2017,47(2):94-105.
[4]FATOURECHI V.Thyroid dermopathy and acropachy[J].Best Pract Res Clin Endocrinol Metab,2012,26(4):553-565.
[5]ARDLEY M,MCCORQUODALE T,LAAHOOTI H,et a1.Eye findings and immunological markers in probands and their euthyroid relatives from a single family with multiple cases of thyroid autoimmunity[J].Thyroid Res,2012,5(1):4.
[6]程妍,刘煜.甲状腺相关眼病患者泪液细胞因子水平的检测[J].中国实验诊断学,2014,18(4):695-697.
[7]许根贵,吴艺君,盛文,等.甲状腺相关眼病患者视觉质量及影响因素[J]中华眼视光学与视觉科学杂志,2013,15(2):98-103.
[8]VILAR-GONZALEZ S,LAMAS-OLIVEIRA C,FAGUNDEZ-VAR-GAS MA,et a1.Thyroid orbitopathy,an overview with special attention to the role of radiotherapy[J].Endocrinol Nutr,2015,62(4):188-199.
[9]CHOI YJ,LIM HT,LEE SJ,et al.Assessing Graves’ophthalnmopathyspecific quality of life in Korean patients[J].Eye(Lond),2012,26(4):544-551.
[10]PONTO KA,HOMMEL G,PITZ S,et a1.Quality of life in a German graves orbitopathy population[J].Am J Ophthalmol,2011,152(3):483-490.
[11]PARK JJ,SULLIVAN TJ,MORTIMER RH,et a1.Assessing quality of life in Australian patients with Graves’ophthalmopathy[J].Br J Ophthalmol,2003,88(1):75-78.
[12]JENSEN AL,HARDER I.The impact of bodily change on social behaviour in patients with thyroid-associated ophthalmopathy[J].Scand J Caring Sci,2011,25(2):341-349.
[13]KAHALY GJ,HARDT J,PETRAK F,et al.Psychosocial factors in subjects with thyroid-associated ophthalmopathy[J].Thyroid,2002,12(3):237-239.
[14]SON BJ,LEE SY,YOON JS.Evaluation of thyroid eye disease:quality-of-life questionnaire(TED-QOL)in Korean patients[J].Can JOphthalmol,2014,49(2):167-173.
[15]夏瑞南.甲状腺相关眼病临床表现及分级//罗清礼.甲状腺相关眼病[M].北京:人民卫生出版社,2005:192-195.
[16]孙丰源,罗清礼.甲状腺相关眼病//宋国祥.眼眶病学[M].2版.北京:人民卫生出版社,2010:425-429.
[17]何剑峰,吴中耀,杨华胜,等.甲状腺相关眼病合并眼压升高106例l临床分析[J].中国实用眼科杂志,2004,22(3):214-216.
[18]崔浩,刘晶晶.眼球运动与双眼视觉//王光霁.双眼视觉学[M].北京:人民卫生出版社,2004:109.
[19]邓铁涛.中医诊断学[M].上海:上海科学技术出版社,2003:127-128.
[20]Hiromatsu Y,Eguchi H,Tani J,et al.Graves’ophthalmopathy:epidemiology and natural history[J].Intern Med,2014,53(5):353-360.
[21]Bahn RS.Graves’ophthalmopathy[J].N Engl J Med,2010,362(8):726-738.
[22]LYER S,BAHN R.Immunopathogenesis of Graves’ophthalmopathy:the role of the TSH receptor[J].Best Pract Res Clin Endocrinol Metab.2012.26(3):281-289.
[23]傅凤侠,朱社教.甲状腺机能亢进症从肝论治[J].陕西中医,1996,17(2):95.
[24]曹国蓉.甲状腺机能亢进症的辨证论治[J].新中医,1996,28(9):5.
[25]刘清平.廖世煌辨治甲状腺机能亢进突眼症经验[J].浙江中医杂志,200l,36(l):4-5.
[26]胡齐鸣,徐蓉娟.治疗Graves眼病经验[J].江西中医药,2003,34(7):7-8.