目的：探讨替妥尤单抗联合糖皮质激素冲击治疗甲状腺相关眼病(TAO)的临床疗效，及其对患者甲状腺功能、炎症因子水平及不良反应的影响。

方法：选取本院眼科收治的活动期TAO患者，随机分为激素组和联合组。激素组采用糖皮质激素冲击治疗，联合组在激素组基础上联合替妥尤单抗静脉输注。比较两组临床疗效、治疗前后CAS、OSDI、M-C-TAO-QOL评分、眼征指标(眼裂宽度、眼球突出度)、炎症因子(TNF-α、CRP、IL-17)水平、甲状腺功能(TSH、FT3、FT4)及不良反应发生情况。

结果：纳入TAO患者96例192眼，激素组和联合组各48例96眼，联合组男17例，女31例，平均年龄51.85±3.53岁； 激素组男14例，女34例，平均年龄51.26±3.84岁。联合组总起效率(94%)高于激素组(79%)(P<0.05)。治疗后，联合组CAS评分、OSDI评分、眼裂宽度、眼球突出度、TNF-α、CRP、IL-17水平均低于激素组，M-C-TAO-QOL评分高于激素组(P<0.05)。两组治疗后甲状腺功能指标、不良反应发生率比较无差异(P>0.05)。

结论：替妥尤单抗联合糖皮质激素冲击治疗TAO疗效显著，能更有效控制眼部炎症、改善眼征及患者生活质量，且对甲状腺功能无明显不良影响，安全性可控。

METHODS: Active TAO patients admitted to the Ophthalmology Department were enrolled and randomly divide into the steroid group and the combined group. Then the steroid group was treated with glucocorticoid pulse therapy, while the combined group was combined with intravenous infusion of teprotumumab on the basis of the steroid group. The clinical therapeutic effect, the CAS, OSDI, M-C-TAO-QOL scores, ocular sign indicators(fissure width, proptosis), levels of inflammatory factors(TNF-α, CRP, IL-17), thyroid function(TSH, FT3, FT4)before and after treatment, and occurrence of adverse reactions were compared between two groups.

RESULTS:Totally 96 TAO patients(192 eyes)were included, with 48 cases(96 eyes)in each group. In the combined group, there were 17 males and 31 females, with an average age of 51.85±3.53 y; in the steroid group, there were 14 males and 34 females, with an average age of 51.26±3.84 y. The total effective rate of the combined group(94%)was higher than that of the steroid group(79%)(P<0.05). After treatment, the CAS score, OSDI score, fissure width, proptosis, levels of TNF-α, CRP, and IL-17 in the combined group were all lower than those in the steroid group, and the M-C-TAO-QOL score was higher than that in the steroid group(P<0.05). However, there was no difference in thyroid function indicators and adverse reactions between two groups after treatment(P>0.05).

CONCLUSION: The combination of teprotumumab and glucocorticoid pulse therapy for TAO has a prominent therapeutic effect. Meantime, it can more effectively control ocular inflammation, improve ocular signs and quality of life of patients, and has no obvious adverse effect on thyroid function, with controllable safety.