本文選題：甲狀腺相關(guān)性眼病　切入點(diǎn)：眼眶磁共振　出處：《南方醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：甲狀腺相關(guān)性眼病(Thyroid Associated Ophthalmopathy,TAO)是一種病因復(fù)雜的自身免疫性疾病,基本病變包括脂肪從頭合成(DeNovo Adipogenesis)、透明質(zhì)酸形成、間質(zhì)水腫、眼外肌增大。眼球突出是TAO最常見的癥狀,患者通�？砂殡S眼瞼攣縮、眼瞼腫脹、結(jié)膜發(fā)紅等一系列影響容貌的癥狀。同時(shí),該疾病通常表現(xiàn)為癥狀快速進(jìn)展的活動(dòng)期和癥狀緩慢消退的非活動(dòng)期,在活動(dòng)期進(jìn)行免疫抑制、球后放射等治療效果較好,非活動(dòng)期則效果差。所以,早期識(shí)別激素有效的治療時(shí)機(jī)對(duì)疾病預(yù)后至關(guān)重要。定量測(cè)量TAO患者球后軟組織體積有助于進(jìn)一步理解該病的發(fā)病機(jī)制,也為臨床診治提供更多客觀依據(jù)。研究目的:1.本研究擬應(yīng)用Mimics(Materialise,Louvain,Belgium)軟件建立TAO患者及正常人球后軟組織(球后脂肪及眼外肌)體積的精準(zhǔn)化三維重建測(cè)量技術(shù),并驗(yàn)證該方法的精準(zhǔn)度和可行性。2.利用TAO患者球后脂肪體積指標(biāo)結(jié)合現(xiàn)已公認(rèn)的活動(dòng)期指標(biāo)及臨床相關(guān)指標(biāo),初步探索TAO患者球后脂肪體積測(cè)定的臨床價(jià)值。材料與方法:我們手工利用黃油及雞肉制作模擬球后軟組織的模具,并將模具已知體積和3D重建體積進(jìn)行比較,以驗(yàn)證該方法的精準(zhǔn)度,同時(shí)募集10名TAO患者,分別由3名觀察者三維重建并計(jì)算TAO患者球后軟組織體積,通過比較觀察者內(nèi)誤差和觀察者間誤差以驗(yàn)證該方法的可重復(fù)性。此外,我們收集2016-1月～2016-12月在我院初診的35例TAO患者的臨床資料。測(cè)量1.5T眼眶MRI球后脂肪體積及SIR值分析其與臨床各項(xiàng)指標(biāo)的相關(guān)性,并收集12例健康人,初步比較TAO組及健康組球后脂肪體積的差異。研究結(jié)果:1.兩名觀察者測(cè)量模具所得體積與其真實(shí)體積相比的相對(duì)誤差顯示:球后脂肪組織為-4.60%～-2.78%之間,眼外肌在-4.13%～0.71%之間。球后脂肪測(cè)量觀察者內(nèi)誤差在4%以內(nèi),眼外肌為5.84%。由三名觀察者測(cè)量所得組內(nèi)相關(guān)系數(shù)在0.976～0.996 之間。2.脂肪體積與病程有相關(guān)性(r=0.521,P0.01),病程1年以上為脂肪生成的高峰期;脂肪體積與突眼度存在相關(guān)性(r=0.609,P0.01),突眼度每增加1mm,脂肪體積增加0.82ml;脂肪體積是疾病嚴(yán)重度的獨(dú)立危險(xiǎn)因素;臨床活動(dòng)性評(píng)分(CAS)與SIR值及TRAb存在相關(guān)性(r=0.536,r=0.416,P0.01);TAO組球后脂肪體積顯著高于正常組(P0.01)。結(jié)論:1.在薄層MRI(0.8mm)通過Mimics軟件三維重建眼眶軟組織,并定量測(cè)量球后軟組織體積是一種科學(xué)、精準(zhǔn)、高效的方法。2.TAO病程1年以上可能是球后脂肪組織增多的高峰階段,球后脂肪體積結(jié)合SIR值的測(cè)量有助于最佳激素治療時(shí)機(jī)的探索及預(yù)后分析。
[Abstract]:Thyroid associated ophthalmopathy (Thyroid Associated ophthalmopathy) is an autoimmune disease with complex etiology. Basic diseases include DeNovo Adipogenesism, hyaluronic acid formation, interstitial edema, and extraocular muscle enlargement. Exophthalmos is the most common symptom of TAO. Patients are usually accompanied by eyelid contracture, swelling of the eyelid, redness of the conjunctiva, and a series of symptoms that affect appearance. Immunosuppression in the active phase, Retrobulbar radiation and other treatments are better, but the inactivity phase is poor. So, The timing of early hormone recognition is crucial to the prognosis of the disease. Quantitative measurement of the volume of retrobulbar soft tissue in patients with TAO helps to further understand the pathogenesis of the disease. Objective\\\%\\\ -\\\. The accuracy and feasibility of the method were verified. 2. Using the Retrobulbar Fat Volume Index of TAO patients combined with the accepted active stage index and clinical related indexes, To explore the clinical value of retroglobular fat volume measurement in TAO patients. Materials and methods: we use butter and chicken to make a model of soft tissue behind a ball by hand, and compare the known volume with 3D reconstruction volume. To verify the accuracy of the method, 10 patients with TAO were recruited, and 3 observers were used to reconstruct and calculate the volume of soft tissue at the back of the ball in patients with TAO. The repeatability of the method is verified by comparing the intra-observer error with the inter-observer error. We collected the clinical data of 35 patients with TAO who were first diagnosed in our hospital from June to December, 2016-12. We measured 1.5 T orbital MRI ball fat volume and SIR value to analyze their correlation with clinical indexes, and collected 12 healthy people. The results of the study showed that the relative error between the two observers in measuring the volume of the mould compared with its real volume was -4.60% -2.78%. The extraocular muscle was between -4.13% and 0.71%. The intraobserver error of retrobulbar fat measurement was less than 4%. The extraocular muscle was 5.84. The correlation coefficient was between 0.976 and 0.996 in the group measured by three observers. There was a correlation between the volume of fat and the course of the disease. The peak period of adipogenesis was more than one year. There was a correlation between the volume of fat and the degree of exophthalmos. The volume of fat increased by 0.82ml with the increase of 1 mm in the degree of exophthalmos, and the volume of fat was an independent risk factor for the severity of the disease. The correlation between clinical activity score and SIR value and TRAb is that the volume of retrobulbar fat in group A is significantly higher than that in group A (P 0.01). Conclusion: 1. Three-dimensional reconstruction of orbital soft tissue by Mimics software is a scientific and accurate method. 2. The course of TAO for more than one year may be the peak stage for the increase of retrobulbar adipose tissue. The measurement of retrobulbar fat volume and SIR value may be helpful to explore the best time for hormone therapy and to analyze the prognosis.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R581;R771.3

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