甲状腺相关眼病381例临床分析.pdf

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1、·400··论著·甲状腺相关眼病381例临床分析孙华焦秦谭令王曙宁光赵咏桔[摘要】目的探讨甲状腺相关眼病(TAO)病程特点、临床特征及病情的影响因素，为临床早期诊断和预后判断提供依据。方法分析2002年1月一2004年12月诊治的381例TAO患者病史、眼征、实验室及影像学检查结果，并进行随访。结果(1)86.4%的患者伴有甲状腺功能亢进症(甲亢),87.9%的患者眼病与甲亢同时发生或迟于甲亢发生，平均间隔时间为18.8个月。(2)眼睑受累表现中以上眼睑退缩最常见，伴复视症状的有120例(38.7%)，伴眼球活动受限的89例(28.7%),眼球活动受限的方向以上转受限为主(61.8%)。平

2、均突眼度为17.9mmo14.5%的患者合并眼压升高。眼外肌受累以双侧多发为特点，下直肌增粗最常见。(3)随访中，仅19.2%的患者接受激素、放疗或手术治疗。结论TAO的发病多伴甲状腺功能的异常;其临床特征有其自身的特点。早期正确的临床诊断以及对病情的合理分析对病情转归和预后有重要意义。【关键词】格雷夫斯病;临床医学Thyroid-associatedophthalmopathy;aclinicalstudyof381casesSUNHua,JIAOQin,TANLing,WANGShu,NINGGuang，ZHAOYong一ShanghaiClinicalCenterforEndocri

3、neandMetabolicDiseases，DepartmentofEndocrineandMetabolicDiseases,RuijinHospital,ShanghaiJiaotongUniversitySchoolofMedicine,Shanghai200025，ChinaCorrespondingauthor;ZHAOYong一，Email:yongju1220@medmail.corncn[Abstract】ObjectiveTofindtheclueofmakingaccuratediagnosisforthyroid-associatedophthalmopathy(T

4、AO)场analyzing381cases.MethodsWeanalyzed381caseswithTAOdiagnosedinRuijingHospitaltosummarizethecharacteristicsofclinicalsymptomsandsigns,thetypeanddurationofthyroiddisorders,theimagestudyofcomputerizedtomograp场andtoknowtheeffectofsomeinfluencingfactorsonthecourseandseverityofTAO.Results(1)Inthe381c

5、asesofTAO,only86.4%hadhyperthyroidism,asTAOcouldbeassociatedwithhypothyroidismoreuthyroidism.Ophthalmopathyoccurredsimultaneouslywiththedevelopmentofhyperthyroidismorfollowedit18.8monthslaterinthemajorityofthepatients.(2)Uppereyelidretractionwasthecommonestsignofthelids.120casescomplainedofdoublev

6、ision.89hadeyemovementrestriction,especiallytoupperdirection.Meanextentofproptosiswas17.9mm.14.5%hadhighintraocularpressure.Theextraocularmusclesinvolvementwascharacteristicallybilateralandmultiple.Theinferiorrectuswasthemostfrequentlyinvolvedwithenlargement.(3)Only19.2%casesreceivedcorticosteroid

7、s,retrobulbarirradiationorsurgerybecauseoftheseverityofocularsymptomsandsigns.ConclusionsTAOwayoccurwiththedevelopmentofhyperthyroidismsimultaneouslyorfollowitlater.Thediseasehasitsownclinicalcharacteristicsandna