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目的：探讨激素冲击治疗联合放疗用于中重度Graves眼病的临床疗效。方法：将2014 年2 月~2015 年6 月之间我院收治的 109例中重度Graves眼病患者随机分为A 组（n=37）、B 组（n=35）、C 组（n=37）。A 组患者单纯采用抗甲状腺药物治疗，B 组患者则在A组的基础上进行激素冲击治疗，C 组患者则采用B组基础上联合球后放疗方案治疗，所有患者治疗后保持随访至少6个月，对比三组疗效，记录三组患者治疗前、治疗6 个月时的临床活动评分（CAS）及眼球突出度，及随访期间不良反应情况。结果：三组有效率比较，C 组>B 组>A 组，差异有统计学意义（P<0.05）。治疗后三组CAS 评分均显著优于治疗前（P＜0.05），且C 组显著低于A、B 组（P＜0.05），A、B 组间比较无显著差异（P＞0.05）。治疗后B、C 组眼球突出度显著低于治疗前（P＜0.05），且C 组显著低于A、B 组（P＜0.05）。A、B、C 三组不良反应发生率分别为0、14.29%、5.41%，A、C 组比较无显著差异（P＞0.05），B 组不良反应发生率明显高于A、C组（P＜0.05）。结论：激素冲击联合放疗治疗中重度Graves眼病具有显著的疗效，能够有效降低患者的CAS 评分及眼球突出度，效果明显优于单纯抗甲状腺治疗或激素冲击治疗，且安全性较好，值得在临床上推广和应用。

英文摘要:

Objective:To investigate the clinical effect of hormone pulse combined with radiotherapy in the treatment of moderate and severe Graves ophthalmopathy.Methods:A total of 109 patients with moderate and severe Graves ophthalmopathy treatment in our hospital from February 2014 ~2015 June were randomly divided into groupA (n=37), groupB (n=35), group C (n=37). The group A received anti-thyroid drug treatment alone, and group B was added hormone pulse treatment on the basis of group A, while the group C was added radiotherapy on the basis of group B, all patients followed up for at least six months after treatment, cmpared to the effect among three groups, as well as the clinical activity scores(CAS)and degree of exophthalmos before and 6 months after treatment, and the adverse reactions during follow-up.Results:The rank of effective rate in three groups was group C > group B > group A, the difference was statistically significant(P<0.05). The CAS scores in three groups after treatment were lower than before treatment(P＜0.05), and the group C was significantly lower than A and groupB (P<0.05),contrast no significant difference between group A and group B(P>0.05). The degree of exophthalmos in group B and group C after treatment were significantly lower than before treatment (P＜0.05), and group C were significantly lower than A and group B (P <0.05). The incidence of adverse reactions in group A, B, C were 0, 14.29%, 5.41% respectively, which showed that group B were significantly higher than group A and groupC (P<0.05), but group A and group C had no significant difference (P>0.05).Conclusion:The effect is significant of hormone pulse combined with radiotherapy in the treatment of moderate and severe Graves ophthalmopathy, which can effectively reduce the CAS scores and exophthalmos of patients, better than simple anti-thyroid drug and hormone pulse therapy, with higher security, it is worth of promotion and application in clinic.

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