99Tcm-生长抑素类似物眼眶显像在药物治疗甲状腺眼病疗效观察中的应用价值  

The value of 99Tcm-Octreotide Scintigraphy in the drug treatment of thyroid associated ophthalmopathy

作　　者：孙斌[1] 武珺[2] 李险峰[3] 张朝霞[2] 

机构地区：[1]山西医科大学第三医院眼科,030053 [2]山西医科大学第一医院眼科,030001 [3]山西医科大学第一医院核医学科,030001

出　　处：《中国实用眼科杂志》2010年第10期1086-1091,共6页Chinese Journal of Practical Ophthalmology

基　　金：山西省自然科学基金（2007-011113）

摘　　要：目的 探讨99Tcm-生长抑素类似物眼眶显像在球周注射奥曲肽或曲氨萘德治疗甲状腺相关性眼病（TAO）疗效观察中的应用价值.方法 通过临床活动度评分（CAS）标准和99Tcm-生长抑素类似物眼眶显像确定TAO临床活动性.将处于炎症活动期（CAS≥3分且99Tcm-生长抑素类似物眼眶显像呈阳性）TAO患者（71例）分为两组：奥曲肽治疗组21例,曲氨萘德治疗组50例;并选取正常志愿者（12名）作为对照组.分别在治疗前后,对治疗组和对照组所有受试对象行99Tcm-生长抑素类似物眼眶显像和CAS评分,计算其眼眶生长抑素类似物摄取比值（UR）;对试验组受试对象的眼球突出度、TAO相关眼征（von-Graeve征、Dalrymple征和Eniroth征）、眼压及其它与药物相关的不良反应进行观察记录,对试验数据进行统计学分析.结果 治疗前,治疗组患者UR值显著高于对照组（F=22.517,P＜0.001）,奥曲肽组与曲氨奈德组间差异无统计学意义（P＞0.05）;治疗后,治疗组患者UR值均显著降低（t奥=5.31,P奥＜0.01;t曲=4.34,P曲＜0.01）,接近正常水平（P＞0.05）;与之相似,治疗组患者CAS值也显著低于治疗前（t奥=4.21,P奥＜0.0l;t曲=3.89,P曲＜0.01）.治疗组患者眼球突出症状明显缓解（眼球突出度后退值：奥曲肽组3.48mm,曲氨奈德组2.61mm）.治疗前后,奥曲肽组患者von-Graeve征和Dalrymple征阳性率差异无统计学意义（P＞0.05）,而Eniroth征阳性率显著低于治疗前（P＜0.01）;而曲氨奈德组患者治疗后von-Graeve 征、Dalrymple征和Eniroth征阳性率均显著低于治疗前（χ2von-Graeve=32.19,P＜0.01;χ2Dalrymple=41.36,P＜0.01;χ2Eniroth=26.27,P＜0.01）.治疗组患者治疗前后眼压值无显著改变（P＞0.05）,但曲氨奈德组不良反应发生率显著高于奥曲肽组（χ2=5.396,P＜0.05）.结论 99Tcm-生长抑素类似物眼眶显像对确定TAO临床活动性具有重要的意义,显像阳性的患者活动性高,�Objective To investigate the efficacy of 99Tcm-Octreotide Scintigraph in directing the treatment of thyroid associated ophthalmopathy （TAO） with periocular injection of Octreotide or Triamcinolone Acetonide. Methods Of 71 patients with active TAO （clinical activity score （CAS） ≥3 and positive 99Tcm-Octreotide Scintigraph） were divided into two groups treated with Octreotide （Octreotide Group, 21 cases） or Triamcinolone Acetonide （Triamcinolone Acetonide Group, 50 cases）, respectively. And 12 normal volunteers were enrolled as the control. CAS score, 99Tcm-Octreotide Scintigraph and uptake ratio （UR） were detected before and after the treatment. Exophthalmometry measurements, intraocular pressure and TAO related ocular signs, including von-Graeve＇s sign, Dalrymple＇s sign and Eniroth＇s sign were recorded during the treatment. The incidence of adverse reactions was also evaluated. Results Before treatment, the patients UR levels were significantly higher than the control （F =22.517, P 〈0.001） and no difference was found between Octreotide Group and Triamcinolone Acetonide Group （P 〉0.05）. After treatment, the UR levels in patients were decreased significantly （toT=5.31, P 〈0.01; tTA=4.34, P 〈0.01）, and approximate to the normal （P 〉0.05）. Accordingly, the patients CAS scores were obviously declined after treatment （toT=4.21, P 〈0.01; tTA=3.89, P 〈0.01）. In addition, exophthalmia was obviously alleviated after treatment （Octreotide Group： 3.48 mm; Triamcinolone Acetonide Group： 2.61mm）. As to the TAO related ocular signs, only the occurrence of Eniroth＇s sign showed a substantial decline in Octreotide Group （χ2=11.958, P 〈0.01）. While, all signs fiequency, including von-Graeve＇s, Dalrymple＇s and Eniroth＇s signs were significantly declined in Triamcinolone Acetonide Group （X 2： 32.19, 41.36 and 26.27, P 〈0.01）. The intraocular pressure showed no obvious change in both treated groups. But higher fiequency of adverse reactio

关 键 词：甲状腺相关性眼病 受体 生长抑素类似物 锝 奥曲肽 眼眶显像 

分 类 号：R735.7[医药卫生—肿瘤]