Hiromatsu Y, Tanaka K, Sato M, Kuroki T, Nonaka K, Kojima K, Nishimura H, Nishida H, Kaise N
Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan.
Endocr J. 1993 Feb;40(1):63-72. doi: 10.1507/endocrj.40.63.
To investigate the efficacy of intravenous methylprednisolone pulse therapy on Graves' ophthalmopathy (GO), fifteen patients with severe GO were treated with large dose intravenous methylprednisolone (at a daily dosage of 1 g for 3 successive days). This treatment was repeated 3-5 times for 3-5 weeks. They were monitored before, 2 weeks after and 6 months after therapy by ophthalmological assessment, orbital magnetic resonance imaging (MRI), and by measuring serum antibodies to rat eye muscle (EMAB) in an enzyme linked immunosorbent assay and peripheral blood lymphocyte subsets by flow cytometry. Diplopia and periorbital edema markedly improved after treatment in 9 patients. Mean proptosis values and intraocular pressure measurements significantly decreased after pulse therapy. In 12 patients enlarged eye muscles significantly reduced in size after treatment, as determined by MRI. The overall ophthalmopathy index was improved from 4.8 +/- 2.4 to 2.5 +/- 1.6 at the end of pulse therapy (P < 0.01) and 2.4 +/- 1.5 six months after therapy (P < 0.01). Serum EMAB were detected in 8 out of 10 patients tested and their level significantly decreased after pulse therapy (from 3.3 +/- 1.4 to 2.5 +/- 1.2, P < 0.01). A significant increase in peripheral blood CD4+CD45RA+ cells was observed after pulse therapy. Increased numbers of CD11-CD8+ cells and decreased numbers of CD11+CD8++ cells were found prior to treatment and were normalized after pulse therapy. Our study indicates that methylprednisolone pulse therapy can be considered as a choice for the treatment of GO. The improvement in eye muscle involvement in these patients may be due to the effects of infused methylprednisolone on both humoral and cellular immune functions.
为研究静脉注射甲泼尼龙冲击疗法对Graves眼病（GO）的疗效，对15例重度GO患者采用大剂量静脉注射甲泼尼龙（每日剂量1 g，连续3天）进行治疗。该治疗重复3 - 5次，为期3 - 5周。在治疗前、治疗后2周及6个月时，通过眼科评估、眼眶磁共振成像（MRI）、酶联免疫吸附测定法检测大鼠眼肌抗体（EMAB）以及流式细胞术检测外周血淋巴细胞亚群对患者进行监测。9例患者治疗后复视和眶周水肿明显改善。脉冲治疗后平均突眼值和眼压测量值显著降低。MRI检查显示，12例患者治疗后眼肌肿大明显减轻。脉冲治疗结束时，总体眼病指数从4.8±2.4改善至2.5±1.6（P<0.01），治疗后6个月为2.4±1.5（P<0.01）。10例接受检测的患者中有8例检测到血清EMAB，脉冲治疗后其水平显著降低（从3.3±1.4降至2.5±1.2，P<0.01）。脉冲治疗后外周血CD4 + CD45RA +细胞显著增加。治疗前发现CD11 - CD8 +细胞数量增加，CD11 + CD8 ++细胞数量减少，脉冲治疗后恢复正常。我们的研究表明，甲泼尼龙脉冲疗法可作为GO治疗的一种选择。这些患者眼肌受累情况的改善可能归因于输注的甲泼尼龙对体液免疫和细胞免疫功能的影响。
