甲状腺相关眼病381例临床分析

Thyroid-associated ophthalmopathy: a clinical study of 381 cases

目的探讨甲状腺相关眼病(TAO)病程特点、临床特征及病情的影响因素,为临床早期诊断和预后判断提供依据。方法分析2002年1月-2004年12月诊治的381例TAO患者病史、眼征、实验室及影像学检查结果,并进行随访。结果(1)86.4%的患者伴有甲状腺功能亢进症(甲亢),87.9%的患者眼病与甲亢同时发生或迟于甲亢发生,平均间隔时间为18.8个月。(2)眼睑受累表现中以上眼睑退缩最常见,伴复视症状的有120例(38.7%),伴眼球活动受限的89例(28.7%),眼球活动受限的方向以上转受限为主(61.8%)。平均突眼度为17.9mm。14.5%的患者合并眼压升高。眼外肌受累以双侧多发为特点,下直肌增粗最常见。(3)随访中,仅19.2%的患者接受激素、放疗或手术治疗。结论TAO的发病多伴甲状腺功能的异常;其临床特征有其自身的特点。早期正确的临床诊断以及对病情的合理分析对病情转归和预后有重要意义。

Objective To find the clue of making accurate diagnosis for thyroid-associated ophthalmopathy （TAO） by analyzing 381 cases. Methods We analyzed 381 cases with TAO diagnosed in Ruijing Hospital to summarize the characteristics of clinical symptoms and signs, the type and duration of thyroid disorders, the image study of computerized tomography and to know the effect of some influencing factors on the course and severity of TAO. Results （ 1 ） In the 381 cases of TAO, only 86. 4% had hyperthyroidism, as TAO could be associated with hypothyroidism or euthyroidism. Ophthalmopathy occurred simultaneously with the development of hyperthyroidism or followed it 18.8 months later in the majority of the patients. （2） Upper eyelid retraction was the commonest sign of the lids. 120 cases complained of double vision. 89 had eye movement restriction, especially to upper direction. Mean extent of proptosis was 17. 9 mm. 14. 5% had high intraocular pressure. The extraocular muscles involvement was characteristically bilateral and multiple. The inferior rectus was the most frequently involved with enlargement. （3） Only 19. 2% cases received corticosteroids, retrobulbar irradiation or surgery because of the severity of ocular symptoms and signs. Conclusions TAO way occur with the development of hyperthyroidism simultaneously or follow it later. The disease has its own clinical characteristics and natural course. Making accurate diagnosis earlier is essential for instituting treatment and predicting prognosis.