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利妥昔单抗眼眶注射联合甲泼尼龙静脉滴注对Graves眼病的疗效及免疫系统的影响

Efficacy of rituximab orbital injection combined with intravenous drip of methylprednisolone in treating Graves' ophthalmopathy and its influence on immune system

    摘要
  • 摘要:
    目的 探讨利妥昔单抗(RTX)眼眶注射联合甲泼尼龙静脉滴注对甲状腺眼病(Graves眼病)的治疗效果。
    方法 将2021年7月—2023年1月资阳市人民医院收治的102例Graves眼病患者随机分为联合组(n=34)、甲泼尼龙组(n=34)和RTX组(n=34)。甲泼尼龙组给予糖皮质激素(甲泼尼龙)单药, RTX组给予RTX单药，联合组给予RTX联合甲泼尼龙。比较3组总有效率、眼征状况、甲状腺体积、甲状腺免疫抗体抗甲状腺球蛋白抗体(TGAb)、抗促甲状腺素受体抗体(TRAb)、抗甲状腺过氧化物酶抗体(TPOAb)水平、临床活动度量表(CAS)评分、外周血免疫球蛋白免疫球蛋白G4(IgG4)、IgG4/IgG水平及不良反应。
    结果 联合组总有效率为97.06%(33/34), 高于甲泼尼龙组的79.41%(27/34)和RTX组的76.47%(26/34), 差异有统计学意义(P < 0.05)。治疗4、8周后，联合组眼球突出度、球尖距、眼内压、球后软组织体积均低于甲泼尼龙组、RTX组，差异有统计学意义(P < 0.05); 联合组甲状腺体积、CAS评分均低于甲泼尼龙组、RTX组，差异有统计学意义(P < 0.05); 联合组TGAb、TRAb、TPOAb均低于甲泼尼龙组、RTX组，差异有统计学意义(P < 0.05); 联合组IgG4、IgG4/IgG均低于甲泼尼龙组、RTX组，差异有统计学意义(P < 0.05)。3组不良反应发生比较，差异无统计学意义(P>0.05)。
    结论 Graves眼病患者接受RTX眼眶注射联合甲泼尼龙静脉滴注可获得更好的疗效，有利于改善眼征状况，调节TGAb、TRAb、TPOAb及免疫球蛋白。

     

    Abstract:
    Objective To explore the efficacy of rituximab (RTX) orbital injection combined with intravenous drip of methylprednisolone in treating Graves' ophthalmopathy.
    Methods A total of 102 patients with Graves' ophthalmopathy in the Ziyang City People's Hospital from July 2021 to January 2023 were randomly divided into combination group (n=34), methylprednisolone group (n=34), and RTX group (n=34). The methylprednisolone group was given glucocorticoids (methylprednisolone) monotherapy, the RTX group was given RTX monotherapy, and the combination group was given RTX combined with methylprednisolone. The total effective rate, ophthalmic manifestations, thyroid volume, thyroid immune antibodies thyroid globulin antibody (TGAb), thyrotropin receptor antibody (TRAb) and thyroid peroxidase antibody (TPOAb) levels, the Clinical Activity Scale (CAS), levels of immunoglobulins in peripheral blood immunoglobulin G4 (IgG4) and IgG4/IgG, and adverse reactions were compared among the three groups.
    Results The total effective rate was 97.06%(33/34) in the combination group, which was significantly higher than 79.41%(27/34) in the methylprednisolone group and 76.47%(26/34) in the RTX group (P < 0.05). After 4 and 8 weeks of treatment, the exophthalmos degree, interocular distance, intraocular pressure, and retrobulbar soft tissue volume in the combination group were significantly lower than those in the methylprednisolone group and the RTX group (P < 0.05); the thyroid volume and the CAS score in the combination group were significantly lower than those in the methylprednisolone group and the RTX group (P < 0.05); the TGAb, TRAb and TPOAb levels in the combination group were significantly lower than those in the methylprednisolone group and the RTX group (P < 0.05); the IgG4 and IgG4/IgG in the combination group were significantly lower than those in the methylprednisolone group and the RTX group (P < 0.05). There was no significant difference in the incidence of adverse
    Conclusions For patients with Graves' ophthalmopathy, therapeutic effect of RTX orbital injection combined with intravenous drip of methylprednisolone is better, which is beneficial for improving ophthalmic manifestations and regulating levels of TGAb, TRAb, TPOAb and immunoglobulins.

     

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