甲状腺相关性眼病57例临床分析

发布时间：2018-05-11 01:37

本文选题：甲状腺相关性眼病 + 相关因素　；参考：《浙江大学》2017年硕士论文

【摘要】：目的:甲状腺相关性眼病是一种与多种甲状腺疾病相关的自身免疫性疾病,在成人眼眶疾病中发病率最高,目前人类生活节奏的加快,生活环境的改变及生活压力的增加,导致自身免疫系统紊乱,该病有日益增多的趋势,同时,TAO影响患者外貌与视力,给患者的生活及心理带来极大困扰。其发病机制尚不完全清楚,临床治疗手段多样,但无十分确切有效的治疗方案。本临床观察探讨临床发病特点、甲状腺功能及相关抗体的异常情况以及发病的严重程度;探讨甲状腺相关眼病患者发病性别、年龄、病程、吸烟等与疾病发生发展的关系;以及不同治疗方法对患者远期临床疗效的评估。方法:回顾性研究浙一医院内分泌科2009年8月至2014年9月的57例住院病例。对临床发病特点、甲状腺功能、甲状腺抗体阳性率、EUGOGO严重程度进行统计;按不同性别、年龄、病程、是否吸烟分组进行CAS评分、NOSPECS等级、OI值的数据比较;同时,对可回访的44例经不同治疗方案治疗后的病例,分别分成5组,糖皮质激素+放疗组、糖皮质激素组、ATDs组、131I组、无治疗组,通过评估其治疗前后突眼度改变、治疗前后据症状体征判断,进行临床疗效的评估。结果:57例TAO患者,甲亢患者占96.49%,亚临床甲亢及甲减各占1.75%;甲亢患者中,早于甲亢诊断发病的占10.91%,同时发病的占40%,晚于甲亢诊断发病占49.09%;单眼发病占5.26%,双眼发病占94.73%;临床表现以眼睑回缩、软组织受累、突眼发生率最高,分别为96.49%、80.70%、77.19%;住院病例EUGOGO严重度评估,重度、中度、轻度患者分别占22.81%,22.81%,54.58%。其中男女比例为1.19:1,与其他流行病学不符,可能与样本量较小有关。经统计学分析,年龄与TAO患者的CAS积分、NOSPECS等级、OI值呈正相关(P0.05或P0.01);性别与CAS评分、NOSPECS等级、OI值无相关性(P0.05);病程与TAO患者的CAS积分、NOSPECS等级、OI值呈负相关性(P0.01);吸烟与CAS积分、01值呈正相关(P0.05)。糖皮质激素+球后放疗的有效率为100%,糖皮质激素治疗的有效率为50%,ATDs治疗的有效率为41.18%,131I治疗的有效率为75%,无治疗的有效率为25%,糖皮质激素+球后放疗的疗效较为理想。结论:本次临床观察发现,57例患者均有不同程度的甲状腺功能异常,以双眼发病为主,临床表现以眼睑回缩、软组织受累、突眼为主,EUGOGO严重度评估以轻度患者居多。年龄与TAO患者的临床活动度、临床严重程度呈正相关(P0.05或P0.01);病程与TAO患者的临床活动度、临床严重程度呈负相关(P0.01);吸烟与临床活动度、临床严重程度呈正相关(P0.05)。性别与临床活动度、临床严重程度无明显关系(P0.05)。临床疗效以糖皮质激素联合球后放疗的有效率最为显著,皮质激素联合球后放疗方案可作为临床治疗中重度TAO的首选。
[Abstract]:Objective: thyroid related ophthalmopathy is an autoimmune disease associated with a variety of thyroid diseases. The incidence of the disease is the highest in adult orbital diseases. At present, the pace of human life is quicker, the living environment changes and the pressure of life is increasing, resulting in the disorder of the autoimmune system. The disease has an increasing trend. At the same time, TAO affects the patients. Appearance and vision have brought great distress to the patient's life and psychology. Its pathogenesis is not completely clear, the clinical treatment is varied, but there is no very exact and effective treatment. This clinical observation explores the clinical characteristics, abnormal conditions of thyroid function and related antibodies, and the severity of the disease; to explore thyroid related eyes. The relationship between the sex, age, course of disease, smoking and the development of disease, and the assessment of the long-term clinical efficacy of different treatments. Methods: a retrospective study of 57 hospitalized cases from August 2009 to September 2014 in the Department of Endocrinology, Zhejiang one hospital. The clinical characteristics, thyroid function, positive rate of thyroid antibody, EUGOGO The severity was statistically analyzed; CAS scores, NOSPECS grades, and OI values were compared according to the sex, age, course of illness, and whether the smoking group was divided into 5 groups: glucocorticoid + radiotherapy group, glucocorticoid group, group ATDs, 131I group, and no treatment group. In 57 TAO patients, hyperthyroidism accounted for 96.49%, subclinical hyperthyroidism and hypothyroidism accounted for 1.75%, 10.91% in hyperthyroidism, 40% in hyperthyroidism and 49.09% in hyperthyroidism, 49.09% in hyperthyroidism and 5.26% in monocular disease. The incidence of binocular disease accounted for 94.73%, the clinical manifestations of the eyelid retraction, soft tissue involvement, the highest incidence of exophthalmos, 96.49%, 80.70%, 77.19%, EUGOGO severity assessment in hospitalized cases, severe, moderate, and mild patients accounted for 22.81%, 22.81%, and 54.58%., respectively, 1.19:1, and other epidemiology, may be related to the smaller sample size. Statistical analysis showed that age was positively correlated with CAS score, NOSPECS grade and OI value in TAO patients (P0.05 or P0.01); sex and CAS score, NOSPECS grade, OI value had no correlation (P0.05); the course of disease was negatively correlated with TAO patients' CAS points, grades and values; the 01 values were positively correlated. The effective rate was 100%, the effective rate of glucocorticoid treatment was 50%, the effective rate of ATDs treatment was 41.18%, the effective rate of 131I treatment was 75%, the effective rate of no treatment was 25%, the curative effect of glucocorticoid + Post ball radiotherapy was ideal. Conclusion: This clinical observation found that 57 patients had different degrees of thyroid dysfunction with both binocular hair. The main clinical manifestations were eyelid retraction, soft tissue involvement, and exophthalmos, EUGOGO severity assessment was mostly in mild patients. Age was positively correlated with clinical activity of TAO patients and clinical severity (P0.05 or P0.01); the course of disease was negatively correlated with the clinical activity of TAO patients and clinical severity (P0.01); smoking and clinical activity, clinical There is a positive correlation between severity and severity (P0.05). There is no significant relationship between sex and clinical activity and clinical severity (P0.05). The efficacy of corticosteroid combined with post ball radiotherapy is the most significant. Corticosteroid combined with post ball radiotherapy may be the first choice for clinical treatment of moderate and severe TAO.

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R581;R771.3

【参考文献】