甲状腺相关眼病患者眼表损害与相关因素分析

Ocular Surface Damage and Correlative Factors in Thyroid Associated Ophthalmopathy

【目的】评估甲状腺相关眼病(TAO)患者的眼表临床症状、泪膜功能与印迹细胞学改变,并分析其相关因素。【方法】选取39例(78眼)TAO患者与30例(60眼)正常人,记录眼表症状评分、泪膜破裂时间、角膜荧光素染色、基础泪液分泌试验,结膜印迹细胞学光镜检查分级,TAO患者记录疾病病程、临床活动性评分,计算眼表损害分值,测量眼球突出度、睑裂高度、上睑迟落、眼睑闭合不全程度。【结果】35例TAO患者出现眼表损害相关症状,病例组较正常对照组眼表症状评分增高(TAO:3.0±1.8,对照组:0.2±0.4,P<0.01),泪膜破裂时间(s)缩短(TAO:5.7±2.8,对照组:11.8±2.9,P<0.01),角膜荧光素染色评分增高(TAO:1.9±1.6,对照组:0.4±0.5,P<0.01),基础泪液分泌(mm/5min)减少(TAO:6±3,对照组:14.1±2.8,P<0.01)。结膜印迹细胞学检查:病例组中28眼(35.9%)为0级,26眼(33.3%)为1级,18眼(23.1%)为2级,6眼(7.69%)为3级;对照组22眼(73.3%)为0级,6眼(20.0%)为1级,2眼(6.67%)为2级(P<0.01)。TAO患者眼表损害分值与泪液基础分泌量呈负相关(r=-0.29,P=0.04),与临床活动性评分、眼球突出度、睑裂高度呈正相关(r1=0.67,P1<0.01;r2=0.41,P1<0.01;r3=0.35,P3=0.02)。多重线性回归分析示临床活动性评分、眼球突出度与睑裂高度是TAO患者眼表损害的危险因素(Rad2=0.928,P<0.01)。【结论】TAO患者眼表损害不但与眼球暴露因素增多、基础泪液分泌减少有关,炎症本身也参与了TAO的眼表损害。TAO临床活动性、睑裂高度和眼球突出度是导致TAO患者眼表损害的危险因素。

【Objective】 To evaluate the clinical symptoms,tear film functions,ocular surface damage,and relative factors in patients with thyroid associated ophthalmopathy （TAO）. 【Methods】 A total of 39 patients （78 eyes） with TAO and 30 controls （60 eyes） underwent a full eye examination including an evaluation of symptoms,tear film break-up time （BUT）,fluorescein staining,Schirmer I test,and impression cytology. The disease duration and Clinical Activity Score （CAS） of patients with TAO were recorded,and the patients were examined for ocular surface damage scores,proptosis,palpebral fissure width,lig lag,and lagophthalmos. 【Results】 Thirty-five patients with TAO had symptoms that attributed to the ocular surface. Dry eye symptom scores were higher （TAO：3.0 ± 1.8,control：0.2 ± 0.4,P 0.01）,BUT （s） were shorter （TAO：5.7 ± 2.8,control：11.8 ± 2.9,P 0.01）,fluorescein staining scores were higher （TAO：1.9 ± 1.6,control：0.4 ± 0.5,P 0.01）,Schirmer I test （mm / 5 min） were lower （TAO：6 ± 3,control：14.1 ± 2.8,P 0.01） in TAO than in control. Impression cytology revealed grade 0 changes in 28 （35.9%） eyes,grade 1 changes in 26 （33.3%） eyes,grade 2 changes in 18 （23.1%） eyes and grade 3 changes in 6 （7.69%） eyes in TAO,whereas grade 0 changes in 22 （73.3%） eyes,grade 1 changes in 6 （20.0%） eyes and grade 2 changes in 2 （6.67%） eyes were seen in control （P 0.01）. Ocular surface damage in TAO correlated significantly with CAS （r = 0.67,P 0.01）,Schirmer I test （r = -0.29,P = 0.04）,proptosis （r = 0.41,P 0.01）,and palpebral fissure width （r = 0.35,P = 0.02）. Multiple regression analysis revealed that CAS,proptosis and palpebral fissure width are risk factors for the ocular surface damage in TAO （Rad2 = 0.928,P 0.01）. 【Conclusions】 The ocular surface damage in patients with TAO is not only correlated with reduced tear production,proptosis,and increased palpebral fissure width,the autoimmune inflammation may be involved in. Clinical activity,proptosis and palpebral fissure width were three significant risk factors for the ocular surface damage in TAO.