曲安奈德球侧及上穹隆部注射治疗中重度活动期甲状腺相关眼病的效果  

Efficacy of triamcinolone periglobal and upper fornix injection for moderate to severe active thyroid associated ophthalmopathy

作　　者：罗丽华[1] 高立新[1] 王薇[1] 苗慧 马秀梅 李冬梅 Luo Lihua;Gao Lixin;Wang Wei;Miao Hui;Ma Xiumei;Li Dongmei(Department of Ophthalmology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology&Visual Sciences,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京友谊医院眼科,100050 [2]首都医科大学附属北京同仁医院,北京同仁眼科中心,眼科学与视觉科学北京市重点实验室,100730

出　　处：《眼科》2020年第4期260-265,共6页Ophthalmology in China

基　　金：北京市医院管理中心儿科学科协同发展中心专项(XTCX201824);首都卫生发展科研专项项目(CFH2018-2-2053);首都医科大学附属北京友谊医院院启动基金(yyqdkt2018-33)。

摘　　要：目的观察曲安奈德(triamcinolone acetonide,TA)球侧及上穹隆部注射治疗中重度活动期甲状腺相关眼病(thyroid associated ophthalmopathy,TAO)的疗效与并发症。设计回顾性病例系列。研究对象北京友谊医院中重度活动期TAO患者34例(60眼)。方法回顾患者的病历资料。所有患者采用眼球侧注射TA(20~40 mg)。其中上睑退缩≥2 mm者联合上睑穹隆部注射TA(20 mg)。首次治疗后1周复查,此后每月复查,如症状改善,每月重复注射1次。当上睑位置降至正常或与对侧健眼一致,眼睑、结膜充血水肿、复视消退时停药。观察随访至少3个月,平均随访(9.12±5.28)个月。主要指标临床活动性评分(clinical activity score,CAS)、甲状腺眼病生活质量量表(quality of life in thyroid eye disease,TED-QOL)评分,上睑缘距角膜映光点距离(marginal reflex distance,MRD1)、眼球突出度、最佳矫正视力、眼压、B超眼外肌直径。结果治疗前及最后随访时比较,CAS评分分别为(3.79±0.81)、(1.29±0.68)(P=0.000);TED-QOL量表评分分别为(17.85±2.80)、(10.18±3.02)(P=0.000);MRD1分别为(6.29±0.68)、(4.56±0.71)(P=0.000);眼球突出度分别为(18.20±2.77)mm、(17.65±2.90)mm(P=0.000);上、下、内、外直肌直径分别为(2.34±0.67、3.62±1.06、3.06±0.67、2.71±0.79)mm,(2.15±0.50、3.30±0.99、2.81±0.61、2.51±0.61)mm(P均<0.05);最佳矫正视力(LogMAR)分别为(4.99±0.12)、(4.99±0.16)(P=0.289);眼压分别为(16.65±2.91)mmHg、(16.78±4.30)mmHg(P=0.772)。上睑退缩者球侧注射联合上穹隆注射组较单纯球侧注射组的上睑退缩程度治疗前后差异分别为(1.15±0.38)mm、(2.31±0.48)mm(P=0.000);两组眼球突出度前后差异分别为(-0.69±0.75)、(-0.84±1.28)mm(P=0.712);两组治疗前后上、下、内、外直肌直径差分别为(0.22±0.52,0.28±0.49)mm,(0.32±0.56,0.51±0.76)mm、(0.35±0.40,0.34±0.49)mm,(0.23±0.56,0.47±0.84)mm(P均>0.05)。治疗后眼压升高>21 mmHg者9/60眼(15%)。治疗后月经Objective To study the efficacy and complication of triamcinolone(TA)periglobal and upper fornix injection for moderate to severe active thyroid associated ophthalmopathy(TAO).Design Retrospective case series.Participants 34 cases(60 eyes)of patients with moderate to severe TAO.Methods The patient's medical records were reviewed.All patients received a periobital injection of TA(20-40 mg).The patients whose upper eyelid retraction≥2 mm were given 20 mg TA into the fornix of the upper eyelid.Follow-up visit at 1 week after the first treatment,repeat the injection monthly if the symptoms were improved.When the upper eyelid position dropped to normal or consistent with the contralateral eye,the eyelid and conjunctival hyperemia and edema were stopped,the patients were observed and followed up for at least 3 months.The mean follow-up was 9.12±5.28 months.Main Outcome Measures Clinical activity score(CAS),thyroid eye disease quality of life scale(TED-QOL),marginal reflex distance(MRD1),exophthalmos,LogMAR best corrected visual acuity(BCVA),intraocular pressure,B ultrasonic extraocular muscle diameter.Results Before treatment and in the last follow-up,the CAS scores were(3.79±0.81)and(1.29±0.68)respectively(P=0.000).The TED-QOL scale scores were(17.85±2.80)and(10.18±3.02)respectively(P=0.000).The MRD1 was(6.29±0.68)and(4.56±0.71)respectively(P=0.000).The degree of exophthalmos was(18.20±2.77)mm and(17.65±2.90)mm respectively(P=0.000).The diameters of the superior,inferior,internal and external rectus muscles were(2.34±0.67,3.62±1.06,3.06±0.67,2.71±0.79)mm,(2.15±0.50,3.30±0.99,2.81±0.61,2.51±0.61)mm,respectively(all P<0.05).The BCVA(LogMAR)was(4.99±0.12)and(4.99±0.16)(P=0.289)respectively.Intraocular pressure was(16.65±2.91)mmHg and(16.78±4.30)mmHg respectively(P=0.772).The difference in the degree of upper eyelid retraction between periglobal and upper fornix injection and single periglobal injection was(1.15±0.38)mm and(2.31±0.48)mm respectively(P=0.000).The difference before and after treatme

关 键 词：甲状腺相关眼病/治疗 曲安奈德 

分 类 号：R581[医药卫生—内分泌] R771.3[医药卫生—内科学]