2170例眼外肌受累甲状腺相关眼病的临床分析

Clinical Analysis of 2170 Cases of Thyroid-Associated Ophthalmopathy Involving Extraocular Muscles

目的探讨眼外肌受累甲状腺相关眼病(TAO)的临床特征。方法收集2009年9月–2020年1月在四川大学华西医院眼眶病专科门诊就诊,经CT和/或MRI证实眼外肌受累的2170例TAO患者的病例资料,回顾性分析其一般情况、病史、临床表现及影像学特征。结果2170例TAO患者中,男性932例,女性1238例;年龄6~85岁,平均(46.95±13.06)岁。甲状腺功能亢进1684例(77.60%);甲状腺癌13例(0.59%);甲状腺功能减退80例(3.69%);甲状腺功能正常393例(18.11%)。眼球突出(55.25%)和复视(33.09%)是主要的就诊原因,眼球运动受限(83.46%)是最常见的体征。122例患者无眼睑征,仅眼外肌受累,平均年龄为(53.24±13.07)岁。2170例TAO患者共有3799只眼眼外肌受累,单眼541例,双眼1629例;单条眼肌受累1204眼(31.69%),多条眼肌受累2595眼(68.31%)。眼外肌受累频率由高到低依次为下、上、内、外直肌。行MRI增强扫描的1014例患者中,71.99%显示为活动期;临床活动性评分(CAS)为非活动期的775例患者,有69.03%在MRI上显示为活动期。结论眼外肌受累TAO患者有其特异的临床表现,CT、MRI均能用于眼外肌受累的辅助诊断。MRI可以评估眼外肌的病变阶段,而且比CAS更敏感。

Objective To explore the clinical features of thyroid-associated ophthalmopathy(TAO)with extraocular muscle involvement.Methods The data of 2170 TAO patients who were seen at the Orbital Disease Clinic,West China Hospital,Sichuan University from September,2009 to January,2020 were collected retrospectively.The extraocular muscle involvement of these patients was confirmed by CT or MRI.Their general condition,medical history,clinical manifestations and imaging features were analyzed retrospectively.Results Among the 2170 TAO patients,932 were male and 1238 were female.The mean(±SD)age of all the patients was(46.95±13.06)years,ranging between 6 and 85.1684 patients(77.60%)suffered from hyperthyroidism,13 patients(0.59%)had thyroid cancer,80 patients(3.69%)had hypothyroidism,and 393 patients(18.11%)had normal thyroid function.Proptosis(55.25%)and diplopia(33.09%)were the main reasons for their visits to the clinic,and restricted eye movements(83.46%)was the most common sign.122 patients with a mean age of(53.24±13.07)years did not show any eyelid sign and had only extraocular muscle involvement.The 2170 TAO patients had a total of 3799 eyes of extrocular muscle involvement,with 541 patients experiencing monocular involvement and 1629 patients,binocular involvement;1204 eyes(31.69%)had a single extrocular muscle involved and 2595 eyes(68.31%)had multiple extrocular muscles involved.Inferior rectus was the most commonly involved muscle,followed by superior rectus,medial rectus,and lateral rectus in descending order of involvement frequency.Of the 1014 patients who underwent enhanced MRI,71.99%were shown to be in the active phase.69.03%of the 775 patients identified as being in inactive phase according to their clinical activity score(CAS)were shown to be in the active phase according to their MRI results.Conclusion TAO patients with extraocular muscle involvement have their own specific clinical manifestations.CT and MRI can both be used to assist in the diagnosis of extraocular muscle involvement.MRI can be used to assess the pathological stage of extraocular muscles and is more sensitive than CAS.