最大化眼眶减压术治疗重度甲状腺相关眼病视神经病变的疗效及影响因素  

Therapeutic outcomes and influence factors of maximal orbital decompression in the treatment of severe dysthyroid optic neuropathy

作　　者：王毅[1] 李月月[1] 杨娜[2] 马瑞[1] 肖利华[1] Wang Yi Li Yueyue Yang Na Ma Rui Xiao Lihua(Institute of orbital diseases, the General Hospital of the Armed Police Force, Beijing 100039, China)

机构地区：[1]武警总医院眼眶病研究所,北京100039 [2]武警总医院南楼二科,北京100039

出　　处：《中华眼科杂志》2017年第6期416-423,共8页Chinese Journal of Ophthalmology

摘　　要：目的评估最大化眼眶减压术治疗重度甲状腺相关眼病视神经病变（DON）的效果及其影响因素。方法回顾性系列病例研究。收集2009年11月至2016年9月在武警总医院眼眶病研究所诊治的21例（30只眼）重度DON患者。人组标准：最佳矫正视力≤0．1；CT检查可见眼外肌增粗和眶尖拥挤征；色觉减弱。排除标准：最佳矫正视力好于0．1的DON或其他影响视功能的疾病。所有患者接受三壁最大化眼眶减压术治疗。记录并分析治疗结果，包括手术前、后视力，年龄，CAS，甲状腺功能状态和病程。手术前、后视力的比较采用Wilcoxon等级检验，视力改变与年龄（〈50岁和≥50岁）、甲状腺功能状态（甲状腺功能亢进和甲状腺功能低下）、病程（〈3个月和≥3个月）、CAS（〈3分和≥3分）、术前视力（〈0．01和≥0．01）等因素的关系采用Mann—WhitneyU检验和Spearman秩相关分析，并进行Logistic回归分析。结果21例（30只眼）患者中男性11例，女性10例；年龄33．0～71．0岁，平均52．9岁。13例为Graves甲状腺机能亢进患者，8例为各种原因导致的甲状腺机能减退患者。DON病程1．0-12．0个月，中位数4．5个月。术后28只眼（93％）的视力得到改善（z=-4．62，P=0．000）。术前视力与术后视力存在正相关性（r=0．38，P〈0．05）。术前视力≥0．01患者与〈0．01者比较，前者的术后视力（0．10）好于后者（0．50）（z=-2．09，P=0．037）。病程与术后视力的改善程度存在负相关性（r=-0．44，P〈0．05）。年龄、甲状腺机能状态及CAS对术后视力（z=-1．83—0．97，P〉0．05）和术后视力的改善程度（z=1．80--0．82，P〉0．05）均没有统计学意义的影响。结论最大化减压术治疗重度DON安全且有效，术前视力和病程是手术效果的重要影响因素。尽早诊断和治疗可能有助于改善DON的预后，但需进一步增大Objective To evaluate the effectiveness of maximal orbital decompression in treatment for severe dysthyroid optic neuropathy （DON） of thyroid associated ophthalmopathy （TAO） and predictive factors of this therapy. Methods The group consisted of 21 patients （30 eyes） with DON. The diagnosis was based on the following criteria： Deterioration of best corrected visual acuity （VA≤0.1）, enlargement of extraocular muscles and sign of apical crowding in CT imaging, loss of colour vision. Exclusion criteria： VA of DON〉0.1 or other diseases with visual function damage. Maximal 3-wall orbital decompression was undergone. Clinical outcomes were recorded and assessed including pre- and postoperative VA, age, clinical activity score （CAS）, thyroid hormonal status and duration of DON. The pre- and postoperative VA were compared by Wlicoxon signed rank analysis. The relationships between the change of VA and age（〈50 years vs 1〉50 years）, thyroid hormonal status（hyperthyroidism vs hypothyroidism）, CAS（〈3 vs ≥3）, duration （〈3 months vs ≥3 months）, pre-VA（〈0.01 vs ≥0.01） were made statistically by Mann-Whitney U-test, rank correlation analysis,and Logistic regression analysis. Results Thirty eyes of 21 patients （11 male, 10 female） were included in this study. Hyperthyroidism was recorded in 13 cases, the other 8 cases with hypothyroidism. The average age at the time of diagnosis was 52.9 years （range, 33.0-71.0 years）. The median of the duration of DON was 4.5 months （range, 1.0-12.0 months）. Twenty-eight eyes （28/30, 93%） showed improvement of visual acuity after surgery （Z=-4.62, P=0.000）. There was positive correlation between pre- and postoperative VA（r=0.38, P〈0.05 ）. Patients with VA of 0.01 or better had better postoperative VA than those with poorer VA （0.10 vs 0.50, Z=-2.09, P=0.037）. There was negative correlation between the duration and degree of improvement of postoperative VA （r=-0.44, P〈0.05）. Other factors such as ag

关 键 词：GRAVES眼病 视神经疾病 眼眶 减压术 外科 治疗结果 

分 类 号：R581[医药卫生—内分泌] R779.6[医药卫生—内科学]