A型肉毒毒素在甲状腺相关眼病治疗中的应用  

Clinical application of botulinum toxin type A in the treatment of thyroid-associated ophthalmopathy

作　　者：崔好好 邵庆[1] Hao-Hao Cui;Qing Shao(Department of Ophthalmology,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,Jiangsu Province,China)

机构地区：[1]南京医科大学第一附属医院眼科,中国江苏省南京市210029

出　　处：《国际眼科杂志》2023年第7期1120-1125,共6页International Eye Science

基　　金：国家自然科学基金项目(No.81672673)。

摘　　要：甲状腺相关眼病(TAO)是一种累及多种眼眶组织的自身免疫性炎症性疾病,临床表现多样,严重影响患者的生活质量。TAO的治疗主要包括稳定甲状腺功能、抗炎、免疫调节等内科治疗以及缓解眼部症状的手术治疗。A型肉毒毒素通过阻断神经肌肉接头处的神经冲动传导起到麻痹肌肉的作用,对于TAO患者因眼外肌受累出现的限制性斜视以及因提上睑肌和Müller肌受累出现的上睑退缩具有一定的治疗价值,特别是当患者存在手术禁忌证、缺乏手术时机及手术意愿时。本文就A型肉毒毒素在TAO治疗中的应用作一综述,着重总结A型肉毒毒素治疗TAO限制性斜视和上睑退缩的作用机制、剂量、有效性及可能的并发症,并探讨A型肉毒毒素对于TAO患者出现的眼外肌压迫所致眼压升高、眉间皱纹、干眼等潜在的治疗价值,以期为临床干预提供参考。Thyroid-associated ophthalmopathy (TAO) is an autoimmune inflammatory disease involving multiple orbital tissues with a variety of clinical manifestations,which has serious effects on the life quality of patients.Interventions of TAO mainly include medical treatment to stabilize thyroid function,reduce inflammation and regulate immune function,as well as surgical treatment to relieve ocular symptoms.Botulinum toxin type A can paralyze muscles by blocking nerve impulse conduction at the neuromuscular junction,which is of certain therapeutic value for restrictive strabismus due to extraocular muscle involvement and upper eyelid retraction due to involvements of levator palpebrae superioris and Müller’s muscle in TAO patients,especially when they have surgical contraindications,lack surgical opportunity,or refuse surgery.This paper reviews the application of botulinum toxin type A in the treatment of TAO,focusing on its pharmacological mechanism,dosage,effectiveness,and possible complications when treating restrictive strabismus and upper eyelid retraction,and discussing potential therapeutic values of botulinum toxin type A for intraocular pressure elevation,glabellar frown lines and dry eye caused by extraocular muscle compression in TAO patients,in order to provide a reference for clinical intervention.

关 键 词：A型肉毒毒素 甲状腺相关眼病 斜视 上睑退缩 眼外肌 

分 类 号：R581[医药卫生—内分泌] R771.3[医药卫生—内科学]