放疗治疗甲亢性突眼病的疗效观察及其与甲状腺刺激性抗体的关系

Effect of orbital radiotherapy for Graves ophthalmopathy and its relationship to thyroid-stimulating antibody

目的评价眼球后眶内软组织外照射对甲亢性突眼的疗效以及患者血清中甲状腺刺激抗体(TSAb)与放疗疗效的关系。方法用酶联免疫吸附法(ELISA法)测定入选甲亢性突眼患者血清中TSAb水平,并以此作为分组依据将患者分为3组,用60Goγ射线对不同TSAb水平的各组甲亢性突眼患者眼球后眶内软组织进行照射;观察突眼度、眼部症状和体征改善情况,评价其疗效并分析患者血清TSAb水平与突眼减轻程度的相关性。结果放疗后患者眼球突出度较放疗前明显减轻,左眼(19.37±1.69)mm比(21.76±1.73)mm,右眼(19.03±1.86)mm比(21.34±1.79)mm,P均<0.01;放疗后6个月时效果更明显,左眼(18.01±1.83)mm比(21.76±1.73)mm,右眼(17.36±1.91)mm比(21.34±1.79)mm,P均<0.01,眼部症状明显缓解,总有效率为81.2%。血清TSAb水平与眼球突出度改善程度呈负相关。结论眼球后眶内软组织放疗能有效治疗浸润性突眼、明显改善眼部症状,TSAb水平与突眼的放疗效果呈负相关性,并可能成为预测放疗疗效的检测指标。

Objective To evaluate the effect of orbital radiotherapy on Graves ophthalmopathy and its relations with the serum level of thyroid-stimulating antibodies(TSAb). Methods TSAb serum level of patients was detected by enzyme-labeled imnunosorbent assay(ELISA) method and patients are divided into three groups according to their serum level of TSAb. Orbital radiotherapy with 60Coγ-radiation was used to treat the three groups of Graves ophthalmopathy patients. Curative effect was appraised and the correlation of the curative effect and serum level of TSAb was analyzed. Results exophthalmos were decreased in 29 left eyes and 28 right eyes after orbital radiotherapy(left eyes: 19.37± 1.69 vs 21.76± 1.73,right eyes: 19.03± 1.86 vs 21.34± 1.79,P< 0.01),especially at 6 months after orbital radiotherapy(left eyes: 18.01± 1.83 vs 21.76± 1.73, right eyes: 17.36± 1.91 vs 21.34± 1.79,P< 0.01). Eye symptoms were improved significantly .The overall effective rate was 81.2%. There is an inverse correlation between the serum level of TSAb and regression degree of exophthalmos. Conclusion Orbital radiotherapy was an effective way to cure and prevent the progression of Graves ophthalmopathy. The effect of orbital radiotherapy may be related to the serum level of TSAb.