ABSTRACT
Thyroid-associated ophthalmopathy (TAO) is an inflammatory eye disease associated with thyroid autoimmune disorder.The traditional treatments have yielded limited efficacy but with some side effects.Recently,researches have shown that some new immunosupressants may be used for the treatment of TAO with significantly improved symptoms,and reduction in clinical activity score.
ABSTRACT
Objective: To study the association between the outcomes of intravenous pulse-therapy with immunosuppressants and the changes of peripheral blood T cell subgroup in patients with Graves' ophthalmopathy (GO). Methods: Fifty-eight patients with GO were randomized into 2 groups (n=29). All patients received antithyroid drugs orally and (or) Levothyroxine; they also received intravenous meprednisone (0.5 g) and cyclophosphamide (0.2 g) once a day for 3 days. After an interval of 4 days the administration of meprednisone and cyclophosphamide was repeated. All patients received a total of 3-6 times of treatment. Patients in group A were given prednisone and cyclophosphamide orally after immunosuppressants. Patients in group B were injected with Dexamethasone into thyroid after immunosuppressants. Results: Two patients withdrew from group A and one from group B. The therapeutic effect in group B was significantly better than that in group A (P<0.05). Compared with before treatment, the degrees of exophthalmos and exophthalmos activity were significantly lowered after treatment (P<0.05); the thyrotropin receptor antibodies (TRAb), thyroid peroxidase (TPOAb), peripheral blood NK cells, CD3+ T lymphocytes, and CD8+ T lymphocytes were significantly reduced after treatment (P<0.05); the ratio of CD4+/CD8+ was increased after the treatment (P<0.05). The degrees of exophthalmos, exophthalmos activity and levels of CD3+ T lymphocytes decreased more significantly in group B than in group A (P<0.05). The ratio of CD4+/CD8+ increased more significantly in group B than in group A(P<0.05). Before treatment the counts of CD4+ T lymphocytes were markedly different between the effective, moderately effective, and the ineffective group (P<0.05). Significant differences in TRAb, TPOAb, CD3+, CD8+ cells were found among the 3 groups after treatment. (P<0.05). CD4+ T lymphocytes and CD4+/CD8+ ratio were significantly higher after treatment compared with those before treatment (P<0.05). Significant differences in TRAb, CD4+, CD8+ T lymphocytes, CD4+/CD8+ ratio were found among 3 groups (P<0.05). Conclusion: Combination of meprednison and cyclophosphamide can relieve the abnormality of peripheral blood T cells in GO and has obvious therapeutic effect. Additional intrathyroid injection of dexamethasone may achieve even better outcome. The reduction of CD4+ T lymphocytes in peripheral blood of GO patients may indicate poor prognsis.
ABSTRACT
The purpose of this study was comparing the effectiveness in the topical applications of cyclosporine with that of steroid, the conventional and standard drug in the treatment of oral lichen planus. 21 patients with oral lichen planus were treated with cyclosporine (n=11) or steroid (n=10) by random allocations. They were recalled 2 weeks, 4 weeks, and 8 weeks after initial treatments. In each recall, the lesion size, clinical symptoms like pain or burning sensation, and side effects were evaluated. The differences of these measurements were compared and the effects of each drug were checked. In reticulation types, steroid showed higher effectivity than cyclosporine and this difference was significant statistically. But in erythema type lesions, either drug showed no significant recovery, statistically. However, the effect of cyclosporine was thought to be more effective. The pain of the lesions was significantly decreased by cyclosporine but not by steroid. The decrease of burning sensation was more dependant upon steroid than cyclosporine, but no statistical relationship could be found. There were no clinical side effects. There was limitation to draw in conclusion due to small pool of this study group. But with the results, this suggestion could be proposed that either drug might be superior to another in effectivity in a specific lesion type or patient symptom, so selection and usage of one drug in a specific case could be better than universal application of one drug in all cases.