作者：李琳玲,王芳,张勇,孙荣
作者单位：（442000）中国湖北省十堰市，郧阳医学院附属十堰市太和医院1眼科;2内分泌科
【摘要】目的:探讨球后注射曲安奈德联合眶部放射治疗中度甲状腺相关性眼病的疗效。
方法:本院治疗的中度甲状腺相关性眼病患者32例60眼，随机分为联合治疗组和对照组：联合治疗组给予球后注射曲安奈德10mg联合眶部放射；对照组给予球后注射曲安奈德10mg。分别测量两组患者治疗前后的眼球突出度及睑裂宽度，观察眼球运动及自觉症状，根据Donaldson等的分级评分系统评估治疗效果，并行眼眶CT检查眼外肌和眶周组织水肿改善情况。
结果:联合治疗组治疗前后眼球突出度、睑裂宽度及眼病分值差异有显著性（P<0.05），对照组治疗前后眼球突出度差异有显著性（P<0.05），但睑裂宽度及眼病分值差异无显著性（P>0.05），联合治疗组眼球突出度、睑裂宽度及眼病分值的降低值较对照组明显，两者差异有显著性(P<0.05)。两组患者复视及眼球运动都有改善，CT检查眼外肌和眶周组织水肿都有所改善，但联合治疗组改善率为81%，治疗组改善率为71%。
结论:球后注射曲安奈德联合眶部放射是治疗中度甲状腺相关性眼病的一种有效方法，治疗效果优于单用球后注射曲安奈德。
【关键词】 甲状腺相关性眼病；球后注射；曲安奈德；眶部放射
Observation of curative effect of Triamcinolone acetomide retrobular injection combined with orbital radiation on TAO
LinLing Li, Fang Wang, Yong Zhang, Rong Sun
1 Department of Ophthalmology, 2 Department of Endocrinology, Taihe Hospital, Yunyang Medical College, Shiyan 442000, Hubei Province, China
Correspondence to: LinLing Li. Department of Ophthalmology, Taihe Hospital, Yunyang Medical College, Shiyan 442000, Hubei Province, China. [email protected]
AbstractAIM: To explore the curative effect of Triamcinolone acetomide (TA) retrobular injection combined with orbital radiation on moderate thyroidassociated ophthalmopathy (TAO). METHODS: Thirtytwo cases (60 eyes) with TAO admitted in our department were randomly selected. According to different methods of therapy, all were randomly divided into two groups: combined therapy group and control group: for combined therapy group, 10mg TA retrobular injection and orbital radiation were executed; for control group, 10mg TA was injected retrobularly only. Then the degree of exophthalmus and width of palpebral fissure in two groups were measured and their symptoms and ocular signs were observed before and after treatment. The therapeutic effect was evaluated based on Donaldson's grade scoring system. Extraocular muscles and periorbital tissues were inspected by CT. RESULTS: In combined therapy group, there was a significant difference in the degree of exophthalmus and width of palpebral and ophthalmocace values before and after treatment (P<0.05). In control group, there was a significant difference in the degree of exophthalmus before and after treatment (P<0.05), but distinct difference in width of palpebral and ophthalmocace values was not found. In addition, the degree of exophthalmus and width of palpebral fissure and ophthalmocace valves in combined therapy group decreased more prominently than those in control group (P<0.05). Diplopia and ocular movement were improved in both groups. CT test also confirmed the improvement of extraocular muscles and periorbital tissues edema, but the improvement rate was 81% in combined therapy group which was 71% in control group. CONCLUSION: Combined application of retrobular injection of TA and orbital radiation was an effective approach for the treatment of moderate TAO. Its therapeutic efficacy was better than administration of TA alone.
KEYWORDS: thyroidassociated ophthalmopathy; retrobular injection; Triamcinolone acetomide; orbital radiation
0引言
甲状腺相关性眼病（thyroidassociated ophthalmopathy, TAO），是眼眶最常见的疾病之一，部分与甲状腺疾病相关，属于自身免疫性疾病。部分TAO有自愈倾向，尽管大多数TAO球后组织都有特征性的改变，但临床上只有30％～50％的患者出现明显眼部症状，3％～5％的患者视力累及[1]。TAO具体的发病机制尚未明确。典型的临床症状为：畏光、流泪、异物感及复视，体征:眼睑退缩、上睑退落、眼球突出及眼外肌肥大。因其发病机制不明，目前我们还不知道患者的眼病是朝着自愈的方向发展或最终演变成严重眼病，治疗方法的选择较困难[2]。在2001/2006年，我们采用了球后注射曲安奈德联合眶部放射治疗中度TAO，取得了满意的效果，现报告如下。
1对象和方法
1.1对象
按照Wilmar等使用的简单分级标准：软组织明显受累，眼突度至少超过正常上限4mm，眼外肌运动受限，通常有间歇性或恒定性复视症状，为中度TAO[1]。严格筛选在我院住院治疗的中度TAO患者32例60眼，随机分为联合治疗组和对照组，联合治疗组患者15例30眼，其中男9例、女21例；年龄18～51（31.2±0.9）岁；均有甲状腺功能异常，对照组患者16例30眼，其中男13例、女17例；年龄16～53（30.8±1.4）岁；均有甲状腺功能异常。
1.2方法 联合治疗组除曲安奈德10mg球后注射外,同时联合应用眶部放射治疗一疗程；对照组仅曲安奈德球后注射治疗一疗程，球后注射方法：用20g/L利多卡因加曲安奈德注射液10mg行患眼球后注射，1次/wk，5wk为一疗程。眶部放射治疗于本院肿瘤科进行,采用PHILIPSL 7514直线加速器，采用6MVX线20Gy，1次/d，10次为一疗程，照射野大小一般为4cm×5cm，患者取仰卧位或侧卧位，头部固定，照射野限定在球后，避开晶状体、泪腺及蝶鞍。
统计学处理：两组治疗前后眼球突出度、睑裂宽度及眼病分值，用±s表示，采用配对t检验；应用SPSS 11.0软件包进行分析，P<0.05有统计学意义。
2结果
2.1眼球突出度
联合治疗组和对照组治疗前后眼球突出度的比较，差异有显著性(P<0.05)。但联合治疗组眼球突出度的降低值较对照组明显，两者比较差异有显著性(P<0.05，表1）。
2.2睑裂宽度
联合治疗组治疗前后睑裂宽度比较，差异有显著性(P<0.05),对照组治疗前后睑裂宽度比较，差异无显著性(P>0.05)。联合治疗组睑裂宽度的降低值较对照组明显，两者比较差异有显著性(P<0.05，表1）。表1两组治疗前后眼球突出度及睑裂宽度的变化（略）
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