本文選題：甲狀腺相關(guān)性眼病 + 相關(guān)因素�。� 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:甲狀腺相關(guān)性眼病是一種與多種甲狀腺疾病相關(guān)的自身免疫性疾病,在成人眼眶疾病中發(fā)病率最高,目前人類生活節(jié)奏的加快,生活環(huán)境的改變及生活壓力的增加,導(dǎo)致自身免疫系統(tǒng)紊亂,該病有日益增多的趨勢,同時,TAO影響患者外貌與視力,給患者的生活及心理帶來極大困擾。其發(fā)病機制尚不完全清楚,臨床治療手段多樣,但無十分確切有效的治療方案。本臨床觀察探討臨床發(fā)病特點、甲狀腺功能及相關(guān)抗體的異常情況以及發(fā)病的嚴重程度;探討甲狀腺相關(guān)眼病患者發(fā)病性別、年齡、病程、吸煙等與疾病發(fā)生發(fā)展的關(guān)系;以及不同治療方法對患者遠期臨床療效的評估。方法:回顧性研究浙一醫(yī)院內(nèi)分泌科2009年8月至2014年9月的57例住院病例。對臨床發(fā)病特點、甲狀腺功能、甲狀腺抗體陽性率、EUGOGO嚴重程度進行統(tǒng)計;按不同性別、年齡、病程、是否吸煙分組進行CAS評分、NOSPECS等級、OI值的數(shù)據(jù)比較;同時,對可回訪的44例經(jīng)不同治療方案治療后的病例,分別分成5組,糖皮質(zhì)激素+放療組、糖皮質(zhì)激素組、ATDs組、131I組、無治療組,通過評估其治療前后突眼度改變、治療前后據(jù)癥狀體征判斷,進行臨床療效的評估。結(jié)果:57例TAO患者,甲亢患者占96.49%,亞臨床甲亢及甲減各占1.75%;甲亢患者中,早于甲亢診斷發(fā)病的占10.91%,同時發(fā)病的占40%,晚于甲亢診斷發(fā)病占49.09%;單眼發(fā)病占5.26%,雙眼發(fā)病占94.73%;臨床表現(xiàn)以眼瞼回縮、軟組織受累、突眼發(fā)生率最高,分別為96.49%、80.70%、77.19%;住院病例EUGOGO嚴重度評估,重度、中度、輕度患者分別占22.81%,22.81%,54.58%。其中男女比例為1.19:1,與其他流行病學(xué)不符,可能與樣本量較小有關(guān)。經(jīng)統(tǒng)計學(xué)分析,年齡與TAO患者的CAS積分、NOSPECS等級、OI值呈正相關(guān)(P0.05或P0.01);性別與CAS評分、NOSPECS等級、OI值無相關(guān)性(P0.05);病程與TAO患者的CAS積分、NOSPECS等級、OI值呈負相關(guān)性(P0.01);吸煙與CAS積分、01值呈正相關(guān)(P0.05)。糖皮質(zhì)激素+球后放療的有效率為100%,糖皮質(zhì)激素治療的有效率為50%,ATDs治療的有效率為41.18%,131I治療的有效率為75%,無治療的有效率為25%,糖皮質(zhì)激素+球后放療的療效較為理想。結(jié)論:本次臨床觀察發(fā)現(xiàn),57例患者均有不同程度的甲狀腺功能異常,以雙眼發(fā)病為主,臨床表現(xiàn)以眼瞼回縮、軟組織受累、突眼為主,EUGOGO嚴重度評估以輕度患者居多。年齡與TAO患者的臨床活動度、臨床嚴重程度呈正相關(guān)(P0.05或P0.01);病程與TAO患者的臨床活動度、臨床嚴重程度呈負相關(guān)(P0.01);吸煙與臨床活動度、臨床嚴重程度呈正相關(guān)(P0.05)。性別與臨床活動度、臨床嚴重程度無明顯關(guān)系(P0.05)。臨床療效以糖皮質(zhì)激素聯(lián)合球后放療的有效率最為顯著,皮質(zhì)激素聯(lián)合球后放療方案可作為臨床治療中重度TAO的首選。
[Abstract]:Objective: thyroid related ophthalmopathy is an autoimmune disease associated with a variety of thyroid diseases. The incidence of the disease is the highest in adult orbital diseases. At present, the pace of human life is quicker, the living environment changes and the pressure of life is increasing, resulting in the disorder of the autoimmune system. The disease has an increasing trend. At the same time, TAO affects the patients. Appearance and vision have brought great distress to the patient's life and psychology. Its pathogenesis is not completely clear, the clinical treatment is varied, but there is no very exact and effective treatment. This clinical observation explores the clinical characteristics, abnormal conditions of thyroid function and related antibodies, and the severity of the disease; to explore thyroid related eyes. The relationship between the sex, age, course of disease, smoking and the development of disease, and the assessment of the long-term clinical efficacy of different treatments. Methods: a retrospective study of 57 hospitalized cases from August 2009 to September 2014 in the Department of Endocrinology, Zhejiang one hospital. The clinical characteristics, thyroid function, positive rate of thyroid antibody, EUGOGO The severity was statistically analyzed; CAS scores, NOSPECS grades, and OI values were compared according to the sex, age, course of illness, and whether the smoking group was divided into 5 groups: glucocorticoid + radiotherapy group, glucocorticoid group, group ATDs, 131I group, and no treatment group. In 57 TAO patients, hyperthyroidism accounted for 96.49%, subclinical hyperthyroidism and hypothyroidism accounted for 1.75%, 10.91% in hyperthyroidism, 40% in hyperthyroidism and 49.09% in hyperthyroidism, 49.09% in hyperthyroidism and 5.26% in monocular disease. The incidence of binocular disease accounted for 94.73%, the clinical manifestations of the eyelid retraction, soft tissue involvement, the highest incidence of exophthalmos, 96.49%, 80.70%, 77.19%, EUGOGO severity assessment in hospitalized cases, severe, moderate, and mild patients accounted for 22.81%, 22.81%, and 54.58%., respectively, 1.19:1, and other epidemiology, may be related to the smaller sample size. Statistical analysis showed that age was positively correlated with CAS score, NOSPECS grade and OI value in TAO patients (P0.05 or P0.01); sex and CAS score, NOSPECS grade, OI value had no correlation (P0.05); the course of disease was negatively correlated with TAO patients' CAS points, grades and values; the 01 values were positively correlated. The effective rate was 100%, the effective rate of glucocorticoid treatment was 50%, the effective rate of ATDs treatment was 41.18%, the effective rate of 131I treatment was 75%, the effective rate of no treatment was 25%, the curative effect of glucocorticoid + Post ball radiotherapy was ideal. Conclusion: This clinical observation found that 57 patients had different degrees of thyroid dysfunction with both binocular hair. The main clinical manifestations were eyelid retraction, soft tissue involvement, and exophthalmos, EUGOGO severity assessment was mostly in mild patients. Age was positively correlated with clinical activity of TAO patients and clinical severity (P0.05 or P0.01); the course of disease was negatively correlated with the clinical activity of TAO patients and clinical severity (P0.01); smoking and clinical activity, clinical There is a positive correlation between severity and severity (P0.05). There is no significant relationship between sex and clinical activity and clinical severity (P0.05). The efficacy of corticosteroid combined with post ball radiotherapy is the most significant. Corticosteroid combined with post ball radiotherapy may be the first choice for clinical treatment of moderate and severe TAO.

【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R581;R771.3

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