调强放射治疗技术对Graves眼病突眼症临床治疗效果观察  

Observation on the clinical therapeutic effect of intensity modulated radiation therapy for Graves'ophthalmopathy exophthalmos

作　　者：王博[1] 崔月龙 王利强[1] 杨丽敏[1] 王强[1] 翁少琦 WANG Bo;CUI Yue-long;WANG Li-qiang;YANG Li-min;WANG Qiang;WONG Shao-qi(Department of Radiotherapy,Anyang District Hospital of Puyang,Anyang,Henan 455000,China;Operating Room,Anyang District Hospital of Puyang,Anyang,Henan 455000,China)

机构地区：[1]濮阳市安阳地区医院放疗科,河南安阳455000 [2]濮阳市安阳地区医院手术室,河南安阳455000

出　　处：《医药论坛杂志》2024年第11期1224-1228,F0003,共6页Journal of Medical Forum

摘　　要：目的探讨调强放射治疗(intensity modulated rradiation therapy,IMRT)技术对Graves眼病突眼症患者放疗后治疗效果和对促甲状腺激素受体抗体(thyrotropin receptor antibody,TRAb)、CD3、CD3^(+)CD4^(+)、CD3^(+)CD8^(+)、CD4^(+)/CD8^(+)比值变化的影响分析。方法选择濮阳市安阳地区医院2021年1月至2023年1月收治的23例Graves眼病突眼症患者为研究对象,采用IMRT技术进行眼球框后病变组织放射治疗,2Gy/次,5次/周,共10次,总剂量20Gy;放疗前、放疗第10次、放疗后3个月分别进行突眼度测量、甲状腺相关眼病症状评估及比较分析,放疗前、放疗第10次时、放疗后3个月时分别血液中TRAb含量测定,CD3、CD3^(+)CD4^(+)、CD3^(+)CD8^(+)淋巴细胞计数和CD4^(+)/CD8^(+)比值测定及比较分析。结果放疗第10次时、放疗后3个月时Graves眼病突眼症患者突眼度显著低于放疗前(P<0.05),放疗后3个月时突眼度显著低于放疗第10次时(P<0.05);甲状腺相关眼病症状:眼睑肿胀、畏光流泪、眼睑不能闭合、眼痛、眼球运动障碍、视力下降、复视,放疗第10次结束时、放疗后3个月时,症状好转改善率显著高于放疗前(P<0.05),放疗后3个月时,症状好转改善率高于放疗第10次结束时(P<0.05);放疗前TRAb含量、CD3^(+)CD4^(+)计数、CD4^(+)/CD8^(+)比值,均显著高于放疗第10次时和放疗后3个月时(P<0.05),放疗第10次时显著高于放疗后3个月时(P<0.05);放疗前CD3^(+)CD8^(+)计数显著低于放疗第10次时和放疗后3个月时,放疗第10次时显著低于放疗后3个月时(P<0.05)。结论IMRT技术对Graves眼病突眼症患者突眼度、甲状腺相关眼病症状疗效显著,是患者选择治疗的较好方法;TRAb含量、CD3^(+)CD4^(+)计数、CD3^(+)CD8^(+)计数、CD4^(+)/CD8^(+)比值可作为Graves眼病突眼症患者放疗前后病情评估及疗效判断指标。Objective To investigate the effect of intensity modulated radiotherapy(IMRT)on the treatment of patients with Graves ophthalmopathy(GO)exophthalmos and analyze the influence on the changes of thyrotropin receptor antibody(TRAb),CD3,CD3^(+)CD4^(+),CD3^(+)CD8^(+),CD4^(+)/CD8^(+)ratio before and after the radiotherapy.Methods A total of 23 patients with GO exophthalmos were admitted to Anyang District Hospital of Puyang City from January 2021 to January 2023,and were selected as the study objects.Treatment for the pathological tissue behind the eyeball frame was carried out by using IMRT with 2 Gy/time,5 times/week,10 times in total,and a total dose of 20 Gy.The exophthalmos degrees of patients with GO were measured,and the symptoms of GO were evaluated,which were compared before radiotherapy,the 10th time of radiotherapy,and 3 months after radiotherapy respectively.The contents of TRAb,CD3,CD3^(+)CD4^(+),CD3^(+)CD8^(+),and ratio of CD4^(+)/CD8^(+)were measured as well,which were compared before radiotherapy,the 10th time of radiotherapy,and 3 months after radiotherapy respectively.Results The exophthalmos degree of patients with GO in the 10th time of radiotherapy and 3 months after radiotherapy were significantly lower than that of before radiotherapy(P<0.05),and the exophthalmos degree in 3 months after radiotherapy was significantly lower than that of the 10th time of radiotherapy(P<0.05);Significant improvement rate of symptoms of GO(eyelid swelling,photophobia and tears,eyelid unclosed,eye pain,eye movement disorder,vision loss,diplopia)in the 10th time of radiotherapy and 3 months after radiotherapy were significantly higher than that of before radiotherapy(P<0.05),and the significant improvement rate of symptoms in 3 months after radiotherapy was higher than that of the 10th time of radiotherapy(P<0.05);the contents of TRAb,CD3^(+)CD4^(+),and CD4^(+)/CD8^(+)rate before radiotherapy were significantly higher than those after the 10th time of radiotherapy and 3 months after radiotherapy(P<0.05),the contents o

关 键 词：Graves眼病突眼症 突眼度 调强适形放疗 TRAB T淋巴细胞亚群 

分 类 号：R815[医药卫生—放射医学]