吸烟与格雷夫斯眼病的治疗结果

Cigarette smoking and treatment outcomes in Graves ophthalmopathy.

作者信息

Bartalena L, Marcocci C, Tanda M L, Manetti L, Dell'Unto E, Bartolomei M P, Nardi M, Martino E, Pinchera A

机构信息

University of Pisa, Italy.

出版信息

Ann Intern Med. 1998 Oct 15;129(8):632-5. doi: 10.7326/0003-4819-129-8-199810150-00010.

DOI:10.7326/0003-4819-129-8-199810150-00010

PMID:9786811

Abstract

BACKGROUND

It is unclear whether smoking affects the course of Graves ophthalmopathy and therapeutic outcomes.

OBJECTIVE

To observe smoking behavior in a randomized study of the effect of radioiodine therapy on ophthalmopathy and in a case series of patients with Graves ophthalmopathy receiving orbital radiation therapy and glucocorticoids.

DESIGN

Randomized, single-blind study of smoking and mild ophthalmopathy after radioiodine therapy (study 1) and a retrospective cohort study of the association between smoking and response of severe ophthalmopathy to treatment (study 2).

SETTING

University medical center.

PATIENTS

300 patients with mild ophthalmopathy (study 1) and 150 patients with severe ophthalmopathy (study 2).

INTERVENTION

In study 1, patients received radioiodine alone or radioiodine and a 3-month course of oral prednisone (initial dosage, 0.4 to 0.5 mg/kg of body weight per day). In study 2, patients received high-dose oral prednisone for 6 months (initial dosage, 80 to 100 mg/d) and underwent orbital radiation therapy by linear accelerator (cumulative dose, 20 Gy per eye over 2 weeks).

MEASUREMENTS

Degree of ophthalmopathy was assessed by overall evaluation (inflammatory changes, proptosis, extraocular muscle dysfunction, corneal involvement, and optic neuropathy).

RESULTS

In study 1, ophthalmopathy progressed in 4 of 68 nonsmokers (5.9% [95% CI, 3% to 9%]) and 19 of 82 smokers (23.2% [CI, 13% to 33%]) who received radioiodine alone (P = 0.007). Ophthalmopathy was alleviated in 37 of 58 nonsmokers (63.8% [CI, 51% to 78%]) and 13 of 87 smokers (14.9% [CI, 10% to 26%]) who received radioiodine plus prednisone (P < 0.001). In study 2, 61 of 65 nonsmokers (93.8% [CI, 90% to 98%]) and 58 of 85 smokers (68.2% [CI, 57% to 78%]) responded to treatment (P < 0.001).

CONCLUSIONS

Cigarette smoking increases the risk for progression of ophthalmopathy after radioiodine therapy and decreases the efficacy of orbital radiation therapy and glucocorticoid therapy.

摘要

背景

吸烟是否会影响格雷夫斯眼病的病程及治疗效果尚不清楚。

目的

在一项关于放射性碘治疗对眼病影响的随机研究以及一系列接受眼眶放射治疗和糖皮质激素治疗的格雷夫斯眼病患者中观察吸烟行为。

设计

放射性碘治疗后吸烟与轻度眼病的随机、单盲研究（研究1）以及吸烟与重度眼病治疗反应之间关联的回顾性队列研究（研究2）。

地点

大学医学中心。

患者

300例轻度眼病患者（研究1）和150例重度眼病患者（研究2）。

干预

在研究1中，患者单独接受放射性碘治疗或放射性碘治疗加为期3个月的口服泼尼松疗程（初始剂量，每天0.4至0.5mg/kg体重）。在研究2中，患者接受6个月的高剂量口服泼尼松治疗（初始剂量，80至100mg/d），并通过直线加速器进行眼眶放射治疗（累积剂量，每只眼睛在2周内为20Gy）。

测量

通过全面评估（炎症变化、眼球突出、眼外肌功能障碍、角膜受累和视神经病变）评估眼病程度。

结果

在研究1中，单独接受放射性碘治疗的68名不吸烟者中有4名（5.9%[95%CI，3%至9%]）眼病进展，82名吸烟者中有19名（23.2%[CI，13%至33%]）眼病进展（P = 0.007）。接受放射性碘加泼尼松治疗的58名不吸烟者中有37名（63.8%[CI，51%至78%]）眼病缓解，87名吸烟者中有13名（14.9%[CI，10%至26%]）眼病缓解（P < 0.001）。在研究2中，65名不吸烟者中有61名（93.8%[CI，90%至98%]）对治疗有反应，85名吸烟者中有58名（68.2%[CI，57%至78%]）对治疗有反应（P < 0.001）。