[1]严劼,李妍,胡竹林.不同治疗方法对改善甲状腺相关眼病症状的效果评价[J].眼科新进展,2019,39(8):758-761.[doi:10.13389/j.cnki.rao.2019.0173]
　YAN Jie,LI Yan,HU Zhu-Lin.The observation of different treatments for thyroid-associated ophthalmopathy[J].Recent Advances in Ophthalmology,2019,39(8):758-761.[doi:10.13389/j.cnki.rao.2019.0173]
点击复制

不同治疗方法对改善甲状腺相关眼病症状的效果评价/HTML
分享到：

《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
39卷
期数:
2019年8期
页码:
758-761
栏目:
应用研究
出版日期:
2019-08-05

文章信息/Info

Title:
The observation of different treatments for thyroid-associated ophthalmopathy
作者:
严劼; 李妍; 胡竹林
650021　云南省昆明市，昆明医科大学第四附属医院、昆明医科大学　云南省眼科研究所　云南省眼科疾病预防防治重点实验室　云南省第二人民医院白内障与眼底疾病防治省创新团队　云南省姚克专家工作站
Author(s):
YAN Jie; LI Yan; HU Zhu-Lin
Fourth Affiliated Hospital of Kunming Medical University，Kunming Medical University，Yunnan Eye Institute，Key Laboratory of Yunnan Province for the Prevention and Treatment of Ophthalmology，Provincial Innovation Team for Cataract and Ocular Fundus Disease，Expert Workstation of YAO Ke，Kunming 650021，Yunnan Province，China
关键词:
甲状腺相关眼病; 激素治疗; 眶减压手术; 球旁局部激素注射
Keywords:
thyroid-associated opthalmopathy; glucocorticoid therapy; orbital decompression surgery; periorbital triamcinolone acetonide injection
分类号:
R775
DOI:
10.13389/j.cnki.rao.2019.0173
文献标志码:
A
摘要:
目的　评价手术加全身激素治疗、球旁局部激素注射、全身激素治疗用于不同病情甲状腺相关眼病（thyroid-associated ophthalmopathy,TAO）的疗效。方法　入组36例（72眼）TAO患者，根据病情分为三组并给予相应治疗，手术+全身激素组（手术组）、球旁局部注射激素治疗组（球旁组）和全身激素组（激素组）。比较治疗前及治疗后视力、眼球突出度和临床活动性评分（clinical activity score,CAS)改善情况。结果　手术组、激素组患者治疗前、治疗后视力比较，差异无统计学意义（P＞0.05），治疗后眼球突出度降低、CAS减少，与治疗前比较，差异均有统计学意义（P＜0.05），且眼球突出度降低幅度最大。球旁组治疗后与治疗前比较，视力提高、眼球突出度降低、CAS评分减少，差异均有统计学意义（均为P＜0.05）。眼球突出度降低的有效率分别为手术组100.0%、球旁组65.3%、激素组3.2%，手术组、球旁组有效率均优于激素组（均为P＜0.05）。对改善视力、降低CAS评分的有效率三组间差异无统计学意义（P＞0.05）。结论　对严重的TAO患者施行眶减压手术是降低眼球突出度首选治疗方式。球旁局部激素注射总体效果优于全身激素治疗，但是还需要更多的临床研究来比较球旁局部激素注射治疗、长期激素治疗、短期激素冲击治疗三者间的优劣。
Abstract:
Objective　To estimate the curative effect of orbital decompression surgery plus intravenous glucocorticoids,periorbital injection,intravenous glucocorticoids for thyroid-associated opthalmopathy (TAO) patients with different disease classification.Methods　Totally 36 patients (72 eyes) were enrolled,who were divided into three groups according to their disease classification in order to receive treatments respectively：orbital decompression surgery plus intravenous glucocorticoids (surgery group),periorbital injection (injection group) and intravenous glucocorticoids (glucocorticoids group).Eventually，the initial values of visual acuity,exophthalmos and clinical activity score (CAS) were compared with that of the end of following-up.Results　In surgery group,compared with pre-treatment,the visual acuity in post-treatment was not statistically significant (P＞0.05).After treatment,exophthalmos and CAS decreased in comparison with pre-treatment,which was statistically significant (P＜0.05)，and exophthalmos reduced most.In the injection group,compared with pre-treatment,visual acuity was improved,and exophthalmos and CAS were generally reduced,which were all statistically significant (all P＜0.05).In glucocorticoids group,the difference of visual acuity between pre-treatment and post-treatment was not statistically significant (P＞0.05).After treatment,the reduction of exophthalmos and CAS was statistically significant (P＜0.05).The response rates of reducing exophthalmos in surgery group,injection group and glucocorticoids group were 100.0%,65.3% and 3.2% respectively,and the response rates of surgery group and injection group were better than glucocorticoids group (all P＜0.05).The response rates for improving visual acuity,decreasing CAS between three groups were not statistically significant (P＞0.05).Conclusion　Orbital decompression has the priority for patients with severe TAO in order to reduce exophthalmos.Periorbital injection is generally better than intravenous glucocorticoids,which,however,needs more clinical investigation to compare the differences between periorbital injection,long-term and short-term glucocorticoids pulse treatments.

参考文献/References:

［1］　BARTALENA L，FATOURECHI V.Extrathyroidal manifestations of Graves’ disease：a 2014 update［J］.Endocrinol Invest，2014，37(8)：691-700.
［2］　BANH R S.Current insights into the pathogenesis of Graves’ ophthalmopathy［J］.Horm Metab Res，2015，47(10)：773-778.
［3］　DOUGLAS R S，GUPTA S.The pathophysiology of thyroid eye disease：implications for immunotherapy［J］.Curr Opin Ophthalmol，2011，22(5)：385-390.
［4］　STRIANESE D.Update on Graves disease：advances in treatment of mild，moderate and severe thyroid eye disease［J］.Curr Opin Ophthalmol，2017，28(5)：505-513.
［5］　FICHTER N，GUTHOFF R F，SCHITTKOWSKI M P.Orbital decompression in thyroid eye disease［J］.ISRN Ophthalmol，2012，2012：739236.
［6］　ESTCOURT S，HICKKEY J，PERROS P，DAYAN C，VAIDYA B.The patient experience of services for thyroid eye disease in the United Kingdom：results of a nationwide survey［J］.Eur J Endocrinol，2009，161(3)：483-487.
［7］　BARTALENA L，BALDESCHI L，DICKINSON A，ECKSTEIN A，KENDALL-TAYLOR P，MARCOCCI C,et al.Consensus statement of the European Group on Graves’ orbitopathy (EUGOGO) on management of GO［J］.Thyroid，2008，18(3)：333-346.
［8］　WIERSINGA W M.Advances in treatment of active，moderate-to-severe Graves’ ophthalmopathy［J］.Lancet Diabetes Endocrinol，2017，5(2)：134-142.
［9］　RUCHALA M，SAWKICKA-GUTAJ N.Advances in the pharmacological treatment of Graves’ orbitopathy［J］.Expert Rev Clin Pharmacol，2016，9(2)：981-989.
［10］　LIM S L，LIM A K，MUMTAZ M，HUSSEIN E，WAN B W，KHIR A S.Prevalence，risk factors，and clinical features of thyroid-associated ophthalmopathy in multiethnic Malaysian patients with Graves’ disease［J］.Thyroid，2008，18(12)：1297-1301.
［11］　PRUMMEL M F，WIERSINGA W M.Smoking and risk of Graves’ disease［J］.JAMA，1993，269(4)：479-482.
［12］　GRAHAM S M，BROWN C L，CARTER K D，SONG A，NERAD J A，Medial and lateral orbital wall surgery for balanced decompression in thyroid eye disease［J］.Laryngoscope，2010，113(7)：1206-1209.
［13］　CUBUK M O，KONUK O，UNAL M.Orbital decompression surgery for the treatment of Graves’ ophthalmopathy：comparison of different techniques and long-term results［J］.Int J Ophthalmol，2018，11(8)：1363-1370.
［14］　WAKELKAMP I M，BALDESCHI L，SAEED P，MOURITS M P，PRUMMEL M F，WIERSINGA W M.Surgical or medical decompression as a first-line treatment of optic neuropathy in Graves’ ophthalmopathy? A randomized controlled trial［J］.Clin Endocrinol (Oxf)，2010，63(3)：323-328.
［15］　HAMED-AZZAM S，MUKARI A，FELDMAN I，SALIBA W，JABALY-HABIB H，BRISCOE D.Fornix triamcinolone injection for thyroid orbitopathy［J］.Graefes Arch Clin Exp Ophthalmol，2015，253 (5)：1-6.
［16］　ZANG S，PONTO K A，KAHALY G J.Clinical review：Intravenous glucocorticoids for Graves’ orbitopathy：efficacy and morbidity［J］.J Clin Endocrinol Metab，2011，96(2)：320-332.
［17］　KAHALY G J，BANG H，BERG W，DITTMAR M.Alpha-fodrin as a putative autoantigen in Graves’ ophthalmopathy［J］.Clin Exp Immunol，2005，140(1)：166-172.
［18］　MODJTAHEDI S P，MODJTAHEDI B S，MANSURY A M，SELVA D，DOUGLAS R S，GOLDBERSG R A，et al.Pharmacological treatments for thyroid eye disease［J］.Drugs，2006，66(13)：1685-1700.
［19］　BORDABERRY M，MARQUES D L，PEREIRA-LIMA J C，MARCON I M，SCHMID H.Repeated peribulbar injections of triamcinolone acetonide：a successful and safe treatment for moderate to severe Graves’ ophthalmopathy［J］.Acta Ophthalmol，2009，87(1)：58-64.
［20］　JURJA S.Graves ophthalmopathy--terapeutical alternatives［J］.Rom J Ophthalmol，2015，59(2)：103-106.

相似文献/References:

[1]杨文娟 班胜刚 何剑峰.甲状腺相关眼病患者外周血单个核细胞中微小 RNA-146a的异常表达及意义[J].眼科新进展,2012,32(5):000.
[2]王方 朱豫 栗夏莲 明亮.甲状腺相关眼病患者血清中白细胞介素-15和白细胞介素-21的含量及临床意义[J].眼科新进展,2013,33(6):000.
[3]刘芳 朱豫 韩宝红.血清 sICAM-1及透明质酸与糖皮质激素治疗TAO敏感性关系的研究[J].眼科新进展,2012,32(2):000.
[4]刘振华 朱豫.甲状腺相关眼病患者血清可溶性细胞间黏附分子-1和可溶性血管细胞黏附分子-1的检测及临床意义[J].眼科新进展,2013,33(4):000.
[5]唐建,罗清礼. 瘦素基因在甲状腺相关眼病眶脂肪及体外分化眶脂肪细胞中的表达[J].眼科新进展,2014,34(9):801.[doi:10.13389/j.cnki.rao.2014.0222]
[6]金珂,朱豫. 甲状腺相关眼病患者干眼症患病率及特征分析[J].眼科新进展,2015,35(5):473.[doi:10.13389/j.cnki.rao.2015.0129]
　JIN Ke,ZHU Yu. Analysis of prevalence and characteristic of dry eye in patients with thyroid associated ophthalmopathy[J].Recent Advances in Ophthalmology,2015,35(8):473.[doi:10.13389/j.cnki.rao.2015.0129]
[7]欧阳明,刘桂琴,樊宁,等.小蘖碱对甲状腺相关眼病眼眶前脂肪细胞分化的影响[J].眼科新进展,2016,36(1):012.[doi:10.13389/j.cnki.rao.2016.0004]
　OU-YANG Ming,LIU Gui-Qin,FAN Ning,et al.Effects of berberine on differerntiation of orbital preadipocytes of TAO patients in vitro[J].Recent Advances in Ophthalmology,2016,36(8):012.[doi:10.13389/j.cnki.rao.2016.0004]
[8]何小寒,刘桂琴,蒋丽琼,等.甲状腺相关眼病患者和正常人眼眶脂肪组织中脂肪特异性磷脂酶A2的表达[J].眼科新进展,2016,36(9):841.[doi:10.13389/j.cnki.rao.2016.0225]
　HE Xiao-Han,LIU Gui-Qin,JIANG Li-Qiong,et al.Expression of AdPLA in orbital adipose tissue of normal and patients with thyroid associated ophthalmopathy[J].Recent Advances in Ophthalmology,2016,36(8):841.[doi:10.13389/j.cnki.rao.2016.0225]
[9]刘桂琴,欧阳明,王云,等.AdPLA 基因在Ⅲ级静止期甲状腺相关眼病眼眶脂肪内高表达研究[J].眼科新进展,2017,37(4):354.[doi:10.13389/j.cnki.rao.2017.0090]
　LIU Gui-Qin,OU-YANG Ming,WANG Yun,et al.Higher expression of AdPLA in orbital adipose tissue of patients with thyroid associated ophthalmopathy of Ⅲ level and stationary phase[J].Recent Advances in Ophthalmology,2017,37(8):354.[doi:10.13389/j.cnki.rao.2017.0090]
[10]马超,刘薇,李凯军,等.甲状腺相关眼病免疫相关发病机制的研究现状与进展[J].眼科新进展,2019,39(8):790.[doi:10.13389/j.cnki.rao.2019.0180]
　MA Chao,LIU Wei,LI Kai-Jun,et al.Current status and progress of immune related pathogenesis in thyroid associated ophthalmopathy[J].Recent Advances in Ophthalmology,2019,39(8):790.[doi:10.13389/j.cnki.rao.2019.0180]

备注/Memo

备注/Memo:
云南省眼科研究所、云南省眼科疾病研究重点实验室项目（编号：2017DG008）；院士和领军人才培养项目（编号：2017HC010）；院士专家工作站项目（编号：2017IC064）；云南省卫生科技计划项目（编号：2016NS182）
更新日期/Last Update: 2019-07-31