Protective effects of standard dose prednisone combined with glutamine on Graves ophthalmopathy after 131I treatment / 重庆医学

ABSTRACT

Objective To investigate the protective effect of standard dose prednisone(starting dose about 0.4 mg/kg bw) combined with glutamine(2 g/d) for Graves' ophthalmopathy(GO) after 131I treatment.Methods The prospective randomized controlled trial was performed and included 116 consecutive patients with mild-to-moderate GO or no active GO after 131I treatment,but with high risk factors.The experimental group(59 cases) started to take oral prednisone(0.44 ± 0.13)mg/kg at 2 d atter theatment,meanwhile replenishing glutamine,and prednisone was gradually decreased by 5mg per 2 weeks and stopped until 2 months;the control group(57 cases) received the initial dose prednisone(0.43± 0.14)mg/kg without replenishing glutamine,and the rest was same as the experimental group.The GO change and prednisone adverse reactions in 2,4,6 months after treatment were evalua ted in the two groups.Results The baseline characteristics had no significant difference between the two groups.In comparison of the experimental group and control group after 6-month treatment,the CAS score was (2.8 ± 0.8 vs.3.5 ± 0.9),exophthalmos degree was (19.6±8.1)mm vs.(21.7±3.0)mm,eyelid width was (11.3±2.9)mm vs.(13.8±3.1)mm,the improvement degree in the experimental group except for degree was superior to the control group (P＜0.01).No new onset GO or deterioation oc curred in the two groups;the experimental group had 42 cases(71.2 ％) of GO improvement and 17 cases(28.8 ％) of stability,while the control group had 39 cases(68.4％) of GO improvement and 18 cases(31.6％) of stability,and the curative effects had no sttis-tical difference between the two groups(P＞0.05).The side effects in the control group were more than those in the experimental group(63.1％ vs.30.5％,P＜0.05).the body mass increase was more obvious [(3.8±1.8) kg vs.(1.4±1.2)kg,P＜0.01],and SBP and DBP in the two groups were slightly increased[(10±4)mm Hg vs.(9±5)mm Hg P＞0.05].Conclusion Using the initial dose of oral prednisone(about 0.4 mg/kg) for 2 months and simultaneously replenishing glutamine (2 g/d)can effectively improve mild-moderate GO,and effectively reduce the adverse reactions of GC.However it is needed to extend the follow-up time to assess whether it can truly prevent the deterioration of GO,and to conduct a further study for the role of glutamine.