甲状腺相关眼病403例临床分析

Clinical analysis of 403 cases of thyroid associated ophthalmopathy

目的总结甲状腺相关眼病（TAO）的临床特征以及眼部病变发生发展的影响因素。方法回顾性系列病例研究。收集四川大学华西医院眼科2009年11月至2012年6月诊治的403例甲状腺相关眼病患者的临床资料，包括眼部检查、影像学检查及甲状腺功能测定情况等。计量资料采用t检验，计数资料采用X2检验，对影响因素采用多因素logistic回归分析。结果TAO多发于40岁以上人群，性别之间差异无统计学意义（X2=0．133，P=0．670），以双眼患病多见。本组中甲状腺功能异常303例，甲状腺机能亢进289例。甲状腺机能亢进患者行I_131治疗62例，之后51例（82．26％）发生甲状腺功能减退，其中64．71％患者出现眼征或症状加重。甲状腺功能异常患者TAO严重程度2级以上（67．66％）以及CAS评分（即临床活动性评分标准）4分以上者（40．29％）均较甲状腺功能正常组严重度2级以上（37．00％）及活动度4分以上者（21．32％）高。33．75％患者以眼睑水肿为就诊原因；78．41％患者出现眼睑肿胀，75．93％上睑挛缩及83．37％上睑迟落，10．42％患者睑裂闭合不全，49．38％眼球运动受限，9．43％角膜受累；CT显示直肌受累频率依次为下内上外直肌。在83例吸烟者（男女比例为27：1）中有56例（67．47％）TAO严重度在4级以上。结论对于甲状腺功能异常的患者，TAO的严重程度与甲状腺的功能控制状况有关，I_131治疗甲状腺功能亢进后出现甲状腺功能减退与眼病的加重有关，吸烟与眼病严重度有一定关系。

Objective To monitor and summarize the clinical manifestation of thyroid associated ophthalmopathy （TAO） and to analyze the thyroid function and any other factors that may have effects on the progression of TAO. Methods Retrospectively, 403 TAO cases （676 eyes） were collected from November 2009 to June 2012 and their clinical manifestations were summarized and analyzed （quantitative and qualitative data were analyzed by using chi-square test and t-test, respectively; the relationship between various factors and TAO was analyzed with logistic regression ）. Results TAO occurred mostly in individuals over 40 years with no gender preference（ X2 = 0. 133, P = 0. 715 ）and characteristically bilateral. In our study, abnormal thyroid function was present in 303 cases, in which hyperthyroidism was found in 289 cases. In 62 hyperthyroidism patients accepting I_131 treatment, 51 cases （82.26%） developed hypothyroidism and 64. 71% of them developed TAO or showed progression of TAO. TAO with over 2 grade in severity （67.66%） and 4 grade in CAS （40. 29% ） occurred more frequently in patients with abnormal thyroid function than those with euthyroidism （37.00% vs. 21.32% ）. Edema of eyelids was the major manifestation and main reason for ophthalmic examination. Eye lids retraction and lagging eyelids were present in 75.93% and 83.37% cases, respectively. Involvement of extraocular muscle presented in 49.38% cases. Lagophthalmos and damage of the cornea appeared in 10. 42% and 9.43% cases, respectively. CT examination showed that the most common involvement of extraoeular muscles was inferior rectus; medial and superior rectus were the second and the third involved muscles, respectively. Lateral rectus was seldom involved. The VI and V grade of TAO occurred in 67.47% of 56 cases with smoking habit. Conclusions Thyroid function has a certain relationship to the severity of TAO. Hypothyroidism after the I_131 mav be related to the Drom＇ession of TAO. Smoking mav also correlated with the severitv of TAO.