球后放射治疗甲状腺相关眼病122例疗效及影响因素分析  

Orbital radiation in thyroid associated ophthalmopathy—clinical analysis of 122 cases

作　　者：沈洁[1] 范艳飞[2] 戈荧[1] 李际敏[1] 

机构地区：[1]南方医科大学附属南方医院,广州510515 [2]广州军区广州总医院,广州510010

出　　处：《中国实用内科杂志》2010年第8期723-725,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的评价球后放射治疗甲状腺相关眼病(TAO)的疗效及其相关影响因素。方法系统收集南方医科大学附属南方医院1998年1月至2009年4月的122例接受球后放射治疗的TAO患者资料,其中男57例,女65例,年龄22～62岁。治疗采用美国VARIAN2100C型直线加速器,分次照射剂量为200cGy,总剂量2000cGy(10次/2周)。治疗后随访1～12年。结果 (1)球后放射治疗后疗效显著23例,疗效较好57例,疗效一般13例,病情无变化24例,病情进展5例,总有效率为76.23%。软组织受累程度、眼外肌受累程度均较治疗前显著减轻(P<0.01),眼球突眼度治疗后(20.22±2.81)mm较治疗前(21.86±2.59)mm有显著下降(P=0.017);(2)治疗有效和治疗无效两组间临床活动评分(CAS)、吸烟、眼外肌MRI信号强度差异均有统计学意义(P=0.001),年龄、性别、TAO病程差异无统计学意义。结论球后放射治疗可以有效地改善甲状腺相关眼病的症状,CAS、眼外肌MRI信号强度、吸烟等因素影响治疗效果。Objective To study the effect of orbital radiation in thyroid associtated ophthalmopathy and the factors in fluencing prognosis. Methods Retrospective analysis the data of 122 TAO patients whom recceived orbital radiation in Nan Fang hospital during January 1998 to April 2009. All patients were newly diagonosed：duration of TAO less than 2 year,clinical activity score（CAS） ≥3 ,no glucocorticoid treatment or radiotheraphy, no hypertension or diabetes reinopathy, and were performed MRI, assessed the grade of NOSPECS and CAS before orbital radiation. And all patiens received orbital radiation 2000cGy in 2 weeks. The patients were followed-up for 1 year to 12 years and assigned to responsive group or irresponsive group by the major and minor criteria. Analysis of the factors which may be associated with radiotherapy. Results （ 1 ） The therapeutic effects in patients after orbital radiation were ： very good 23cases, good 57 cases, fair 13cases, no change 24cases, worse 5 cases, responsive group included 93 patients, irresponsive group included 29 patients, and total effective rate is 76. 23%. （2）The symptoms of soft issue and extrorbital muscle （EOM） were significant improved -after orbtial radiation （P 〈 0. 001 ）, proptosis was realeased too. （ 3 ） The factors of CAS, MRI-T2 signal intensity of EOM were much higher in responsive group than that in irresponsive group（ P 〈0. 001 ）. But the number of smoking people was more less in effective group than that in ineffective group. The general clinical data, such as age, sex, TAO course have no differences. Conclusion Orbital radiation could effectively improve the symptom of TAO. MRI-T2 SI, CAS and smoking could predict the outcome of orbital radiotherapy for TAO.

关 键 词：甲状腺相关眼病 球后放射治疗 MRI CAS 

分 类 号：R5[医药卫生—内科学]