目的：探究糖皮质激素、环磷酰胺、奥曲肽三种药物治疗Graves眼病(GO)的临床疗效。

方法：回顾性研究。选取2018-06/2019-10我院收治的GO患者102例152眼，按治疗方式分为糖皮质激素组(33例51眼)、环磷酰胺组(38例59眼)与奥曲肽组(31例42眼)，总疗程12wk。比较三组患者治疗效果，治疗前后眼球突出度、复视、眼内压、视力变化情况，并进行甲状腺相关眼部活动度评分(CAS)； 经眼部超声检查眼轴、球横径、球尖距、球后软组织周长、面积及体积的变化； 测定治疗前后促甲状腺激素受体抗体(TRAb)、甲状腺过氧化物酶抗体(TPOAb)及甲状腺体积的变化； 统计不良反应发生情况。

结果：糖皮质激素组、环磷酰胺组患者疗效均优于奥曲肽组(P<0.05)，但糖皮质激素组与环磷酰胺组疗效无差异(P>0.05)。治疗12wk，三组患者眼球突出度、CAS评分均降低(P<0.05)，视力及自觉复视情况均改善，球尖距、球后软组织周长、面积及体积、TRAb、TPOAb、甲状腺体积均降低(P<0.05)，且糖皮质激素组、环磷酰胺组患者眼球突出度、CAS评分、球尖距、球后软组织周长、面积及体积、TRAb、TPOAb、甲状腺体积均低于奥曲肽组(P<0.05)，但糖皮质激素组、环磷酰胺组组间以上参数比较均无差异(P>0.05)。治疗期间，糖皮质激素组体质量增加及总不良反应发生率均高于环磷酰胺组与奥曲肽组(P<0.0167)，但环磷酰胺组、奥曲肽组组间不良反应发生率无差异(P>0.0167)。

结论：糖皮质激素、环磷酰胺治疗GO整体疗效优于奥曲肽，对眼征及甲状腺相关病变改善优于奥曲肽，但环磷酰胺治疗不良反应较糖皮质激素低，安全性更高，可作为GO治疗的首选。

METHODS: A retrospective study was conducted. Totally 102 patients(152 eyes)with GO admitted to the hospital between June 2018 and October 2019 were divided into glucocorticoid group(33 cases, 51 eyes), cyclophosphamide group(38 cases, 59 eyes), and octreotide group(31 cases, 42 eyes)according to the treatment method. All groups received 12wk of treatment. The treatment results were comparatively analyzed. Changes in proptosis degree, diplopia, intraocular pressure and visual acuity before and after treatment were measured. Clinical activity scoring(CAS)of thyroid associated eye movements was performed. Changes in ocular axes, eyeball transverse diameter, ocular apex distance, retrobulbar perimeter, area and volume were measured by eye ultrasound. Changes in thyrotropin receptor antibody(TRAb), thyroid peroxidase antibody(TPOAb)and thyroid volume before and after treatment were determined. The incidence of adverse reactions was counted.

RESULTS: Compared with octreotide group, grades of curative effect of glucocorticoid group and cyclophosphamide group were better(P<0.05), but there was no statistically significant difference between glucocorticoid group and cyclophosphamide group(P>0.05). After 12wk of treatment, the proptosis degree and CAS scores of the three groups were decreased(P<0.05), visual acuity and conscious diplopia were improved, ocular apex distance, retrobulbar perimeter, area and volume, TRAb, TPOAb and thyroid volume were decreased(P<0.05). The proptosis degree, CAS scores, ocular apex distance, retrobulbar perimeter, area and volume, TRAb, TPOAb and thyroid volume of glucocorticoid group and cyclophosphamide group were smaller than those of octreotide group(P<0.05), without statistically significant differences between glucocorticoid group and cyclophosphamide group(P>0.05). During treatment, the incidences of weight gain and the total incidence of adverse reactions were higher in glucocorticoid group than in cyclophosphamide group and octreotide group(P<0.0167), but there were no statistically significant differences between cyclophosphamide group and octreotide group(P>0.0167).

CONCLUSION:Glucocorticoids and cyclophosphamide are better than octreotide in the treatment of GO, which can better improve ocular signs and thyroid-related lesions. Additionally, the incidence of adverse reactions caused by cyclophosphamide is lower than glucocorticoids, and its safety is higher. Therefore, cyclophosphamide is the first choice for treating GO.