Department of Endocrinology, Jingzhou Cental Hospital, Jingzhou, China.
Department of Pediatrics, Jingzhou First People's Hospital, Jingzhou, China.
Front Endocrinol (Lausanne). 2023 Mar 21;14:1140196. doi: 10.3389/fendo.2023.1140196. eCollection 2023.
To analyze the efficacy of mycophenolate mofetil (MMF) and glucocorticoid administration in patients with thyroid-associated ophthalmopathy (TAO).
Sixty patients with moderate to severe TAO treated in Jingzhou Central Hospital from January 2022 to June 2022 were selected and enrtolled in this study. The subjects were divided into experimental group (n=30) and control group (n=30) based on the random number table method. Glucocorticoid pulse therapy was provided in the control group, while MMF was given in the experimental group on the basis of Control group. Clinical activity score (CAS), quality of life (QOL), visual acuity, eyelid fissure width, intraocular pressure, and degree of exophthalmos were observed at the time of admission and at the 12 week and 24 post-treatment weeks. We compared the immune function (TRAb, IL-6, and CD4+/CD8+) of the two groups pre-treatment and 24 weeks post-treatment, and evaluated the clinical therapeutic effect.
The clinical effective rates at 12 and 24 weeks in the experimental group were higher (73.3% and 83.3%) than those in the control group (46.7% and 60.0%) (0.05). After 12 weeks of treatment, patients' CAS scores, and bilateral lid fissure width decreased and right eye visual acuity increased in the control group compared with those before treatment ( 0.05); further, after 24 weeks of treatment, patients' QOL scores and bilateral visual acuity increased and CAS scores, bilateral lid fissure width and proptosis decreased compared with those before treatment, and patients' QOL scores, CAS scores and bilateral proptosis improved more than those at 12 weeks of treatment (0.05). Additionally, greater improvements were observed in the patients' QOL and CAS scores, and proptosis after 24-week treatment than after 12-week treatment (<0.05). In the experimental group, the QOL score and binocular visual acuity increased, whereas the CAS score, intraocular pressure, lid width, and proptosis decreased after 12 weeks of treatment as compared to the values of these parameters in the pre-treatment period ( 0.05); after 24 weeks of treatment, greater improvements were established in the ocular-related indexes improved compared to the pre-treatment period and after 12 weeks of treatment ( 0.05). After 12 weeks of treatment, the patients in the experimental group had more considerable improvements in the right visual acuity, right intraocular pressure, and left lid fissure width than the control group ( 0.05); at 24 weeks of treatment, patients in the experimental group had greater improvements in the QOL score, bilateral visual acuity, intraocular pressure, bilateral lid fissure width, and bilateral proptosis than the control group ( 0.05). No significant differences were found in the values of TRAb, IL-6, and CD4+/CD8+ between the two groups before treatment (>0.05); the values of TRAb, IL-6, and CD4+/CD8+ in the experimental group was significantly lower than those before treatment and in the control group after 24weeks of treatment. (>0.05). No statistically significant difference was observed in the incidence of liver damage and menstrual disorders between the two groups during the 24 weeks of treatment (>0.05).
The combination of oral MMF and glucocorticoid shock therapy is an effective drug for the treatment of patients with moderately active TAO.
分析霉酚酸酯（MMF）和糖皮质激素给药在甲状腺相关眼病（TAO）患者中的疗效。
选择 2022 年 1 月至 2022 年 6 月在荆州市中心医院治疗的 60 例中重度 TAO 患者，并将其纳入本研究。根据随机数表法将受试者分为实验组（n=30）和对照组（n=30）。对照组给予糖皮质激素脉冲治疗，实验组在对照组的基础上加用 MMF。观察入院时及治疗后 12 周和 24 周的临床活动评分（CAS）、生活质量（QOL）、视力、睑裂宽度、眼压和眼球突出度。比较两组治疗前和治疗后 24 周的免疫功能（TRAb、IL-6 和 CD4+/CD8+），并评价临床疗效。
实验组在治疗 12 周和 24 周的临床有效率（73.3%和 83.3%）高于对照组（46.7%和 60.0%）（0.05）。与治疗前相比，对照组患者在治疗 12 周后 CAS 评分和双侧睑裂宽度降低，右眼视力提高（ 0.05）；进一步治疗 24 周后，患者的 QOL 评分和双侧视力提高，CAS 评分、双侧睑裂宽度和眼球突出度降低，且 QOL 评分、CAS 评分和双侧眼球突出度较治疗 12 周时改善更明显（0.05）。此外，实验组患者治疗 24 周后 QOL 和 CAS 评分以及眼球突出度的改善程度均优于治疗 12 周时（<0.05）。实验组患者治疗 12 周后 QOL 评分和双眼视力增加，CAS 评分、眼压、睑裂宽度和眼球突出度降低，与治疗前相比（ 0.05）；治疗 24 周后，与治疗前和治疗 12 周后相比，眼相关指标的改善更为明显（ 0.05）。治疗 12 周后，实验组患者右眼视力、右眼眼压和左眼睑裂宽度的改善明显优于对照组（ 0.05）；治疗 24 周后，实验组患者 QOL 评分、双眼视力、眼压、双侧睑裂宽度和双侧眼球突出度的改善明显优于对照组（ 0.05）。两组患者治疗前 TRAb、IL-6 和 CD4+/CD8+值无统计学差异（>0.05）；实验组患者治疗 24 周后 TRAb、IL-6 和 CD4+/CD8+值明显低于治疗前和对照组（>0.05）。两组患者在 24 周治疗期间肝损伤和月经紊乱的发生率均无统计学差异（>0.05）。
口服 MMF 联合糖皮质激素冲击治疗是治疗中重度 TAO 患者的有效药物。
