甲状腺功能对未并发甲状腺相关眼病患者眼表的影响

Effect of thyroid function on ocular surface in patients with non-concurrent thyroid associated ophthalmopathy

目的观察甲状腺功能水平对未并发甲状腺相关眼病(TAO)患者眼表功能的影响。方法选取2012年1月至2017年1月该院收治的甲状腺功能异常但未并发TAO的患者2 365例纳入研究组,同期健康体检者100例纳入对照组。检测研究对象血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)与促甲状腺激素受体抗体(TRAb)水平,根据测定结果将甲状腺功能异常患者分成甲状腺功能亢进(甲亢)组和甲状腺功能减退(甲减)组、TSH增高组和TSH降低组及TRAb阳性组和TRAb阴性组。对各组受试者甲状腺功能水平、泪液分泌试验(SIT)、泪膜破裂时间(BUT)、眼球突出度、眼表疾病指数(OSDI)评分、角膜荧光染色(FS)及角膜炎症指数评分比较分析。结果与对照组比较,研究组BUT值明显偏低,而FS、OSDI评分与角膜炎症指数评分明显偏高,差异有统计学意义(P<0.05);甲亢组BUT值明显低于甲减组和对照组(P<0.05)。TSH增高组患者FS与OSDI评分明显低于TSH降低组,差异有统计学意义(P<0.05);甲亢组FS明显高于甲减组和对照组(P<0.05),甲亢组和甲减组OSDI评分与角膜炎症指数评分均明显高于对照组(P<0.05)。TRAb阳性组患者FS与OSDI评分明显高于TRAb阴性组,差异有统计学意义(P<0.05)。血清TSH与角膜炎症指数、OSDI评分呈正相关(P<0.05)。结论即使未伴有TAO,甲状腺功能异常患者也可存在眼表功能损伤,甲状腺功能亢进、血清TSH及TRAb水平可能是导致眼表功能损伤主要原因。

Objective To observe the effect of thyroid function on ocular surface function in patients with non-concurrent thyroid associated ophthalmopathy （TAO）. Methods From January 2012 to January 2017, 2 365 patients with abnormal thyroid function but without TAO were enrolled in research group.A total of 100 healthy subjects were selected into control group.Serum free Triiodothyronine （FT 3）,free thyroxine （FT 4）,thyroid-stimulating hormone （TSH）and thyrotropin receptor antibody （TRAb） were detected,and the patients were divided into hyperthyroid group and hypothyroidism group,TSH increased group and TSH reduction group,TRAb positive group and TRAb negative group.Thyroid functional level,basal tear secretion test （SIT）,tear rupture time （BUT）,ocular surface disease index （OSDI） score,corneal fluorescein staining （FS） and corneal inflammation index were compared between the subjects in each group. Results Compared with the control group,the BUT value of the study group was significantly lower,FS,OSDI score,and corneal inflammation index scores were significantly higher （ P 〈0.05）.The BUT value of the hyperthyroidism group was significantly lower than that of the hypothyroidism group and control group （ P 〈 0.05）.The FS and OSDI in patients with elevated TSH were significantly lower than those in patients with lower TSH （ P 〈0.05）.The FS in hyperthyroidism group was significantly higher than that in hypothyroidism group and control group （ P 〈 0.05 ）.The OSDI score and corneal inflammation index score in the hyperthyroidism group and the hypothyroidism group were significantly higher than those in the control group （ P 〈0.05）.The FS and OSDI score in the TRAb-positive group were significantly higher than those in the TRAb-negative group （ P 〈0.05）.Serum TSH positively correlated with corneal inflammation index and OSDI score （ P 〈0.05）. Conclusion Even if TAO don′t associate with thyroid dysfunction,there might be ocular surface injury,hyperthyroidism,serum TSH and TRAb levels might be the main cause of ocular surface damage.