吸烟对甲状腺相关眼病患者术后疗效的影响

Effect of smoking on curative results after surgery in the patients with thyroid eye disease

目的：探讨不同吸烟状态对甲状腺相关眼病患者斜视手术后疗效的影响。方法对2000年1月至2009年12月在我院眼科住院的甲状腺相关眼病患者进行随访，比较不同吸烟状态患者的基本资料、临床数据及术后二次手术情况。结果在208名接受斜视手术的甲状腺相关眼病患者中，55人为不吸烟者，40人为被动吸烟者，21人为曾吸烟者，81人为吸烟者。264名吸烟患者中81人接受了斜视手术，而338名不吸烟患者中仅55人接受了斜视手术（P＝0．038）。曾吸烟患者对比不吸烟患者，其风险比为1．121；被动吸烟患者对比不吸烟患者，其风险比为1．595，差异均没有统计学意义。性别及甲状腺功能状态对斜视的影响不具统计学差异。把术后2年后是否再次接受手术作为标准，用受试者工作曲线确定吸烟指数的最佳截点。结果显示吸烟是甲状腺相关眼病的危险因素，受试者工作曲线下面积为0．929（ P＝0．028）。吸烟指数190年支的敏感度和特异度总和最高（分别为0．886和0．833）。按照190年支，把吸烟患者分成2组。≥190年支组的两年生存率为17．8％，而＜190年支组的两年生存率高达82．9％，两者差异具有统计学意义（P＜0．01）。手术3年后是否再次接受手术作为标准绘制受试者工作曲线，显示被动吸烟并不是甲状腺相关眼病的危险因素，曲线下面积为0．679（P＞0．05，95％可信区间0．512～0.846）。结论吸烟增加甲状腺相关眼病患者接受斜视手术的几率，同时会增加二次手术的概率。

Objective To investigate the effect of different modes of smoking on curative results of strabismus surgery in the patients with thyroid eye disease.Methods Medical followed-ups were made on the patients with thyroid eye disease hospitalized in the Ophthalmology Department of the hospital from January, 2000 to December 2009.Basic information, clinical data and secondary surgical conditions were compared between the patients with different smoking modes.Results Of the 208 thyroid eye disease patients who received strabismus surgery, 55 were nonsmokers, 40 were passive smokers, 21 were use-to-be smokers and 81 were smokers.Of the 264 patients who smoked, 81 received strabismus surgery.However, of the 338 non-smokers, only 55 received strabismus surgery （ P=0.038） .The risk ratio of the use-to-be smokers versus non-smokers was 1.121, while the risk ratio of the passive smokers versus non-smokers was 1.595, and statistical significance could be seen, when comparisons were made between them.There was no statistical significance in the effect of gender and thyroid function on strabismus.With re-surgery after 2 years as the evaluation criteria and the working curve of the subjects as the optimal check-point, results indicated that smoking was the risk factor associated with thyroid eye disease.The area under the curve of the subjects was 0.929（P =0.028）.As a total, the sensitivity and specificity of those who smoked 190 cigarettes a year were the highest （0.886 and 0.833）.In accordance with 190 cigarettes a year as dividing criteria, the smokers were divided into 2 groups.The 2-year survival rate of those patients who smoked 190 cigarettes a year was only 17.8%, while that of the patients who smoked less than 190 cigarettes a year was as high as 82.9%, and statistical significance could be noted when＆nbsp;comparisons were made between them（P 〈0.01）.With re-surgery after 3 years as the evaluation criteria and the standard working curve of the subjects, it was indicated that passive-smoking was a risk factor of thyroid eye disease.The area under the curve was 0.679 （95%confidence interval =0.512-0.846）（P〉0.05）.Conclusion Smoking increased the probability of strabismus surgery in those with thyroid eye disease, at the same time, the probability of secondary surgery would also be increased.