内分泌病历讨论突眼-课件.ppt

口服皮质类固醇 根据临床评估逐渐减量，减少2.5-10mg/2-4w，最小量维持数月，治疗需持续3-12月 用药期或停药后反复者需延长维持治疗时间 I131治疗时预防使用，放疗后1-3d 0.3-0.5mg/kg·d 随后减量，2m后停药 Oral corticosteriod According to the clinical assessment: To reduce the dose gradually, about 2.5-10mg/2-4w. The lowest dose must maintain for monthes. The treatment lasts 3-12monthes . In the period of medication or withdrawal,the patients who have a relapse need a longer time of the maintain treatment . A asynergistic effect with orbital radiotherapy by I131 1st-3rd days after radiotherapy : 0.3-0.5mg/kg·d 4th-2 month: reducding the dose over 2 monthes : withdrawal Treatments in Ophthalmonogy 静滴皮质类固醇（有效率提高60%） 甲强龙500-1000mg静滴，隔日一次，连用3次 中重度TAO：甲强龙静滴500mg，1次/w，共6周 后改为250mg，次/w，共6周 重度TAO：15mg/kg 连用2d 隔2w1次 共4次； 后改为7.5mg/kg 连用2d 隔2w1次 共4次 Corticosteriod by iv. drop (the effective rate enhanced over 60 % ) Prednisone :500-1000mg ，iv.drop , QID, 3 times continuously Mild and Severe TAO:1. Prednisone: 500 mg , iv.drop , QW , for 6 weeks →25o mg , iv.drop , QW, for 6 weeks Severe TAO: 1. 15mg/kg ,QD,for 2 days →1time/3weeks， for 4 times →7.5mg/kg, QD,for 2 days → 1time/3weeks， for 4 times Treatments in Ophthalmonogy 皮质类固醇 结膜下或球后注射 疗效弱于全身用药，不推荐使用 Corticosteriod Subconjunctival or retrobulbar injection: A weaker effect than systemic administration, No recomment Treatments in Ophthalmonogy 其他免疫调节剂 环孢素 甲胺喋呤 环磷酰胺 其他（雷公藤等） 辅助用药 The other Immunomodulators Cyclosporine ? Methylamine neopterin Cyclophosphamide The others(Tripterygium,ect.) Treatments in Ophthalmonogy Side effects of Corticosteriod the damage of Multiple systems 垂体肾上腺抑制 HPA sup