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  • 苏晴,程金伟,李盼,李由,魏锐利.甲状腺相关视神经病变的回顾性临床横断面研究[J].第二军医大学学报,2018,39(5):474-479    [点击复制]
  • SU Qing,CHENG Jin-wei,LI Pan,LI You,WEI Rui-li.Retrospective clinical cross-sectional study on dysthyroid optic neuropathy[J].Acad J Sec Mil Med Univ,2018,39(5):474-479   [点击复制]
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甲状腺相关视神经病变的回顾性临床横断面研究
苏晴,程金伟,李盼,李由,魏锐利*
0
(海军军医大学(第二军医大学) 长征医院眼科, 上海 200003
*通信作者)
摘要:
目的 明确甲状腺相关视神经病变(DON)的临床特征,为早期诊断和治疗提供依据。方法 回顾性分析2015年1月至2017年12月我院收治的DON患者98例196只眼首次就诊的临床资料,包括一般资料和甲状腺功能状态、眼科检查、影像学检查等资料。结合相关文献对所有眼进行判断,可判定为确诊、可疑和排除,将确诊或可疑DON眼纳入研究。结果 98例DON患者中男性59例、女性39例(男女比例为1.51∶1),年龄为34~74(52.51±10.25)岁,均有(被动)吸烟史,96例有甲状腺功能亢进症。确诊DON患者为80例、可疑为18例,确诊122只眼、可疑56只眼、排除18只眼。98例患者的临床活动度评分为(4.44±1.53)分,其中30例≤3分。178只确诊和可疑DON眼中最佳矫正视力≤0.6者有142只,色觉减退130只,视盘水肿38只,视盘苍白56只,视盘正常84只; 18只非DON眼中17只视盘正常。眼球突出度≤21 mm的确诊DON眼有38只。影像学检查显示80例确诊DON的患者均有眶尖拥挤综合征,其中双侧67例(83.75%)、单侧13例(16.25%)。结论 中老年、男性、吸烟史和甲状腺功能亢进是DON的危险因素。眶尖拥挤综合征是DON最主要的病理基础。视力损害、色觉减退和视盘水肿或苍白是DON最具特征性的临床征象。
关键词:  甲状腺相关眼病  甲状腺功能障碍性视神经病变  临床特征  横断面研究
DOI:10.16781/j.0258-879x.2018.05.0474
投稿时间:2018-03-19修订日期:2018-04-29
基金项目:国家自然科学基金(81770959).
Retrospective clinical cross-sectional study on dysthyroid optic neuropathy
SU Qing,CHENG Jin-wei,LI Pan,LI You,WEI Rui-li*
(Department of Ophthalmology, Changzheng Hospital, Navy Medical University (Second Military Medical University), Shanghai 200003, China
*Corresponding author)
Abstract:
Objective To clarify the clinical features of dysthyroid optic neuropathy (DON), so as to provide evidence for early diagnosis and treatment of DON. Methods The general characteristics and data of thyroid function conditions, ophthalmologic and imaging examinations were retrospectively analyzed in 98 patients (196 eyes) with DON diagnosed from Jan. 2015 to Dec. 2017 in our hospital. According to relevant references, the 196 eyes were diagnosed as having definite, equivocal, or no DON. All patients with equivocal or definite DON in at least one eye were recruited. Results Among 98 DON patients, 59 were male and 39 were female, and the ratio of male to female was 1.51:1. The average age of 98 patients was (52.51±10.25) years old, ranging from 34 to 74 years old. All patients had a history of smoking or passive smoking. Ninetysix patients had hyperthyrea. Of 98 patients, 80 had definite DON and 18 equivocal, with 122 eyes being definite, 56 being equivocal and 18 having no DON. The mean clinical activity score was (4.44±1.53) in all patients, of whom 30 cases scored ≤ 3. Of 178 definite and equivocal DON eyes, 142 eyes had best corrected visual acuity ≤ 0.6, 130 had reduced colour vision, 38 had optic disc oedema, 56 had optic disc pallor, and 84 had normal optic disc. Seventeen out of 18 eyes without DON had normal optic disc. The exophthalmos ≤ 21 mm was found in 38 definite DON eyes. Orbital imaging examination showed that all 80 definite DON patients had crowded orbital apex syndrome, with 67 cases (83.75%) having bilateral and 13 (16.25%) having unilateral one. Conclusion Older age, male, smoking and hyperthyrea are risk factors of DON. Crowded orbital apex syndrome is the most important pathological basis of DON. Impaired visual acuity, reduced colour vision and optic disc swelling are the most specific clinical features of DON.
Key words:  thyroid associated ophthalmopathy  dysthyroid optic neuropathy  clinical features  cross-sectional studies