Twp Clinical Efficacy Of The Treatment Of Graves' Ophthalmopathy Is Observed

Objective To observe the clinical efficacy and security of the treatment for Graves ophthalmopathy by using Tripterygium Glycosides, and to explore its effect mechanism.Object and methods1 Object 39 cases of Graves Ophthalmopathy ("GO"in follows), course 3 -24 months, age 16-63 years old, were randomly divided into two groups, one group with the Joint Tripterygium Glycosides ("TG"in follows) and low-dose prednisone as experimental group, the control group with simply high-dose prednisone, all with a total course of 16 weeks.2 Disposal method①For the experimental group: taking TG 1mg/d/kg for continue for 16 weeks, prednisone 15mg / day in the same time but for only 11 weeks, decrease prednisone from the 12th week;②For the control group: taking only prednisone 60mg / d continue for 4 weeks, reduce gradually from the 5th week until the end of course;③The two groups took synthetic anti-thyroid drugs for keeping the thyroid function in the normal range. Evaluation index1 Efficacy Evaluation1.1 Clinical manifestations According to the leveling method for scoring activity which was recommended by Mr. Mouritis, the testing objects of GO was divided into 3 levels of mild, moderate and severe, and rating by related proportion. After treatment, to determine the effect by reduction rate: reduction rate≥50% for the markedly,≥20% for effective, <20% invalid.1.2 Measurement of exophthalmos After treatment , decreasing of exophthalmos 2mm as markedly, decreasing of 1mm as effective, no change or increasing is invalid.1.3 Judgement of the integrated efficacy After treatment, judgement of the efficacy by combination clinical manifestation and measurement results of exophthalmos.2 Security Observe the indications of blood pressure, blood glucose, electrolytes, body weight and upper gastrointestinal symptoms before and after treatment, for making safety assessment.3 Determination of T lymphocyte subsets Detection the indicators of CD3,CD4, CD8, CD4/CD8 before and after treatment.Results1 Clinical manifestations The clinical manifestations of two groups are improved after treatment, 27.78% efficient and 72.22% markedly for experimental group; 23.08% effective and markedly 76.92% for control group. And general efficient between the two groups was no significant difference in symptom improvement (P> 0.05).2 Exophthalmos degrees Comparing the exophthalmos before and after treatment for the two groups, the experimental group reached 78.26% of efficient, and 68.75% for control group, there was no significant difference in exophthalmos degree (P> 0.05).3 Determine the integrated efficacy Results showed that sub-clinical reduction rate and the exophthalmos degree reduction rate are consistent, and there was no difference on general efficacy for the two groups after treatment (P> 0.05).4 Security assessment There are 3 patients in experimental group showed gaining weight and hair, 2 patients showed anti-acid with epigastric discomfort, the incidence of side effects is 17.39%; In control group, there are 11 patients showed gaining weight and hair, limb muscle atrophy, 7 patients showed anti-acid with abdominal pain, 2 patients showed elevating blood glucose, the incidence of side effects was 81.25%, the incidence of side effects were significant differences (P <0.01). 5 Determination of T lymphocyte subsets Immunological indicators were compared before and after treatment, CD4 decreased, CD8 increased, CD4/CD8 decreased, with statistical significance (P <0.05); and compare these parameters between the two groups was no significant difference in change (P> 0.05).Conclusions1 TG with low-dose of prednisone to treat Graves ophthalmopathy shows better effect for short-term;2 Comparing with the impact therapy of high-dose prednisone to cure GO for short-term clinical, the efficacy of TG with low-dose of prednisone is consistent;3 Comparing the two methods of Treatment of GO, the side effects of low-dose prednisone is minor, obviously safety is better than high-dose prednisone group;4 Further confirmed the occurrence of GO is root from autoimmune disorders;5 The occurrence of GO may be related to decrease in the number of TS cells, low-cut function, can not effectively suppress Th cells;6 The effect mechanism of Tripterygium Glycosides with low-dose prednisone treatment of GO is probably the mechanism of immunosuppression.