超声监测下注射A型肉毒毒素对甲状腺相关眼病限制性斜视的疗效观察  

Effect of botulinum toxin type A injection on restrictive strabismus of thyroid associated ophthalmopathy under ultrasound monitoring

作　　者：徐海燕[1] 李辉[1] 徐冬冬[1] 姜茹欣[1] 陈有信[1] Xu Haiyan;Li Hui;Xu Dongdong;Jiang Ruxin;Chen Youxin(Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院眼科,100730

出　　处：《中华医学超声杂志（电子版）》2018年第11期864-868,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：国家自然科学基金(81271043)

摘　　要：目的探讨在超声监测下注射A型肉毒毒素(BTXA)对甲状腺相关眼病(TAO)限制性斜视患者眼外肌厚度的改变以及改善斜视度的临床疗效观察。方法选取2014年12月至2016年12月在北京协和医院眼科诊治的18例(21只眼)TAO限制性斜视患者,在非肌电图引导下注射BTXA,并应用超声分别在注射前、注射后1周、1个月、3个月进行眼外肌厚度的测量,并观察斜视度的改善情况。结果所有患者眼外肌厚度在注射后均有不同程度下降,注射前后不同时间之间差异有统计学意义(F=26.72,P <0.01)。本研究中11只眼处于活动期,在注射治疗后1周、1个月、3个月的眼外肌厚度均小于注射前,差异有统计学意义(t=5.31、7.24、11.60,P均<0.05),10只眼为静止期,在注射后1周的眼外肌厚度大于注射前(t=-3.02,P <0.05),而注射后1个月、3个月的眼外肌厚度与注射前比较,差异无统计学意义。本研究21只眼中水平斜视7只眼,注射后1个月、3个月的平均斜视度均低于注射前,差异有统计学意义(t=3.60、4.05,P均<0.05);注射后1周的平均斜视度与注射前差异无统计学意义。垂直斜视14只眼,注射后1周、1个月、3个月的斜视度均低于注射前,差异有统计学意义(t=2.39、3.89、4.87,P均<0.05)。2组斜视度均达到有效改善。活动期眼外肌厚度与斜视度无显著相关性(r=0.048,P=0.758),而静止期眼外肌厚度与斜视度有中等程度的相关性(r=0.421,P=0.007)。结论超声为TAO限制性斜视的治疗提供了方便的监测方法。注射BTXA使TAO患者限制性斜视的眼外肌厚度明显下降,斜视度得到有效改善。Objective To investigate the clinical effect of botulinum toxin type A(BTXA)injection on the thickness of the extraocular muscles and the improvement of strabismus in patients with restrictive strabismus of thyroid associated ophthalmopathy(TAO)under ultrasonic monitoring.Methods From December2014to December2016,18patients(21eyes)with TAO restricted strabismus were injected with BTXA under the guidance of non-electromyography.The thickness of extraocular muscles was measured before injection,1week,1month and3months after injection with ultrasound,and the improvement of strabismus degree was observed.Results The thickness of extraocular muscles in all patients decreased after injection.The difference was statistically significant in different time before and after injection(F=26.72,P<0.01).The11eyes in this group were in the active stage.The thickness of the extraocular muscles was less than that before the injection,1week,1month and3months after injection.The difference was statistically significant(t=5.31,7.24,11.60,all P<0.05)and10eyes at inactive stage.The thickness of extraocular muscle at1week after injection was higher than that before injection(t=-3.02,P<0.05).The thickness of extraocular muscles at1and3months after injection was not significantly different from that before injection.The average strabismus degree in1month and3months after injection was lower than that before injection in21eyes,and the difference was statistically significant(t=3.60,4.05,both P<0.05).The mean strabismus at1weeks after injection was not significantly different from that before injection.In the14eyes with vertical strabismus,the degree of strabismus at1week,1month and3months after injection were all lower than those before injection,and the difference was statistically significant(t=2.39,3.89,4.87,all P<0.05).The two groups of strabismus were all improved effectively.There was no significant correlation between the thickness of the extraocular muscles and the strabismus during the active stage(r=0.048,P=0.758),There was a mod

关 键 词：A型肉毒毒素 甲状腺相关眼病 限制性斜视 超声检查 

分 类 号：R445.1[医药卫生—影像医学与核医学] R581[医药卫生—诊断学] R777.41[医药卫生—临床医学]