孙逸仙纪念医院眼科,广东,广州,510120
网络首发:2018-11-20,
纸质出版:2018
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范淑贤, 李梓敬, 张一弛, 等. 甲状腺相关眼病的EUGOGO临床分级特征[J]. 中山大学学报(医学科学版), 2018,39(6).
Clinical Manifestation of EUGOGO Classification in Graves'Orbitopathy[J]. Journal of Sun Yat-sen University (Medical Sciences), 2018, 39(6).
【目的】分析甲状腺相关眼病(GO)以欧洲甲状腺相关眼眶病专家组(EUGOGO)标准分级的临床特 征。【方法】回顾性收集2010年1月-2016年12月于中山大学孙逸仙纪念医院内分泌与眼科明确诊断为GO的 110例病例,记录其病史、眼部检查,分别按照EUGOGO标准、NOSPECS标准进行GO严重程度的分级,按照临床 活动度评分(CAS)进行GO炎症活动度的分级,并对这些指标进行综合性分析。【结果】本研究共收集110例患 者211眼。患者年龄平均47.4(S=12.8)岁,其中具有吸烟史27例。甲状腺疾病病史平均24.7(S=42.5)月。GO病 史平均10.4(S=23.1)月。眼球突出度平均19.1(S=3.1)mm。按照EUGOGO标准:轻度25例(22.7%),中-重度56 例(50.9%),威胁视力病例包括压迫性视神经病变(DON)或角膜破坏29例(26.4%)。临床活动度CAS评分≥3分 者(活动)47例(42.7%),CAS评分<3分者(不活动)63例(57.3%)。而按照NOSPECS分级系统评估, 2级2例 (1.8%), 3级9例(8.2%), 4级69例(62.7%), 5级6例(5.5%), 6级24例(21.8%)。所有病例中,74例(67.3%)接受 全身激素治疗;15例(13.6%)接受眼眶放射治疗; 4例(3.6%)接受手术治疗(眼眶减压术, 3例;斜视手术, 1例)。 【结论】GO患者非活动性病例略多于活动性病例,中-重度病例与威胁视力的病例占多数。目前国内按照EU? GOGO推荐的治疗方法进行治疗的病例较少,对GO临床治疗方案尚不统一,因而需要进一步探索适合我国国情 治疗GO的研究。
【Objective】To study the clinical manifestation of EUGOGO(the European Groupon Graves‘ Orbitopathy)classification in Graves’Orbitopathy(GO) .【Methods】In this retrospective study,the clinical charts of GO patients at SunYat-sen Memorial Hospital between January 2010 and December 2016 were reviewed. 【Results】Data were collected from 211 eyes of 110cases. The meanage of all the cases was 47.4(S=12.8)years,27 cases are smoking. Duration of thyroid disease and GO were24.7(S=42.5)months and 10.4(S=23.1)months,respectively. The mean exophthalmic value of cases was 19.1(S=3.1)mm. In EUGOGO classification, they were distributed at all scopeofseverities from grade mild(25cases,22.7%),moderate-severe(56cases,50.9%)to sight-threatening(29cases,26.4%). Clinically significantactive disease,defined as CAS(Clinical ActivityScore)≥3 was present in 47(42.7%)patients,while others 63 (57.3%)presented in active with CAS<3. In NOSPECS system ,the distribution is mainly concentrated at phase 4(69 cases,62.7%)and phase6(24 cases,21.8%).In this study,74 cases(67.3%)treated with different regimens of systemic glucocorticoid,15 cases(13.6%)treated with orbital radio therapy and 4cases(3.6%)treated with surgeries(3 cases with orbital decompression and 1 case with strabismus surgery) .【Conclusions】Although the majority of patients in the study were inactive with CAS<3,more than half of patients presented relatively high severity as moderate-severeor sight-threatening disease. At present,the therapy according to EUGOGO guidelines is rarely used in China and the management of GO are not uniformin clinical practice. Therefore,it is necessary to explore the evidence-based therapeutic methods suitable for Chinese in the future.
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