中重度与极重度甲状腺相关眼病与甲状腺功能临床分析

Clinical analysis of moderate-to-severe and very severe thyroid associated ophthalmopathy and thyroid function

目的分析中重度与极重度甲状腺相关眼病(TAO)发病一般规律、甲状腺功能状况,为TAO的治疗提供依据。方法对2008年1月至2016年12月诊治的122例TAO患者的临床资料进行回顾性分析。结果 122例TAO平均年龄(48.20±18.54)岁,其中男性19~76岁,平均(49.65±13.19)岁,女性22~74岁,平均(46.66±13.84)岁,差别无统计学意义(t=1.221,P>0.05)。甲状腺功能异常病程介于0~360个月,中位数12个月,眼病病程介于0.5~360个月,中位数7个月。男女两组间甲状腺功能异常病程与眼病病程均无统计学差异(P>0.05)。甲亢102例(83.6%),甲减13例(10.7%),甲状腺功能正常者7例(5.7%),平均CAS评分差别无统计学意义(P>0.05)。甲状腺功能异常治疗情况:抗甲状腺药物治疗85例,经治疗后甲状腺功能稳定38例,眼病加重13例;甲状腺手术治疗11例,治疗后甲状腺功能稳定1例,眼病加重4例;I131治疗14例,治疗后甲状腺功能稳定1例,眼病加重10例。结论中重度与极重度TAO患者大多伴有甲状腺功能异常,甲状腺功能异常会增加TAO发展和恶化的危险程度。

Objective To analyze the characteristics and thyroid function status of moderate-to-severe and very severe thyroid associated ophthalmopathy（ TAO）,and to provide basis for the treatment. Methods Clinical data of 122 patients with TAO were collected from January 2008 to December 2016 in our hospital and were analyzed retrospectively. Results In the 122 case of TAO,average age was 48. 20 ± 14. 58 and there was no difference between men（49. 65 ± 13. 19）and women（46. 66 ± 13. 84）. The course of abnormal thyroid function varied from 0 to 360 months and the median was 12 months. TAO occurred in 0. 5 to 360 months,and the median was 7 months. There was no difference between male and female patients. Hyperthyroidism was present in 102 case（83. 6%）,and hypothyroidism was present in 13 case（10. 7%）,and euthyroidism in 7 case（5. 7%）,and there was no difference in CAS score between these groups. 85 patients were treated with oral anti-hyperthyroid medications. Thyroid dysfunction had been controlled in 38 of them and 13 patients had exacerbated TAO. 11 patients were treated with thyroidectomy. Thyroid dysfunction was controlled in 1 of them,and 4 patients had exacerbated TAO. 14 patients were treated with I131. Thyroid dysfunction was controlled in 1 of them,and 10 patients had exacerbated TAO. Conclusions Most of the moderate-to-severe and very severe TAO are accompanied by abnormal thyroid function. Thyroid dysfunction increases the risk of exacerbation and development of TAO.