本文關(guān)鍵詞： Graves眼病 T2RT 眼外肌面積 CAS Graves眼病 眼眶MR 甲基強(qiáng)的松龍 T2RT 眼外肌面積 Graves眼病 生長抑素類似物 臨床活動性評分（CAS） 突眼度 Meta分析　出處：《華中科技大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的通過磁共振（MR）測定眼外肌面積和T2弛豫時間（T2RT）來分析GO患者與正常人眼外肌的影像學(xué)差異以及T2RT相對于臨床活動性評分（CAS）對GO活動性判斷的價值。 方法GO組收錄106名GO患者，對照組選取24名正常人。所有人均進(jìn)行眼眶MR檢查，記錄眼外肌面積及T2RT，同時詳細(xì)記錄患者癥狀及CAS評分。比較兩組T2RT、眼外肌面積的差異以及與CAS的相關(guān)性。 結(jié)果活動性GO組與非活動性GO組各條眼外肌T2RT均高于正常人，且眼外肌面積均較正常人大。活動性GO組比非活動性GO組T2RT高（上直肌96.2vs84.2，t=-3.6，P0.01；下直肌99.9vs91.1，t=-3.7，P0.01；內(nèi)直肌90.2vs79.4，t=-3.5，P=00.01；外直肌89.9vs83.4，，t=-3.3，P=0.002），眼外肌面積更大（上直肌67.8vs51.2，t=-3.1，P=0.002；下直肌75.2vs53.9，t=-3.5，P=0.01；內(nèi)直肌61.2vs51.8，t=-2.1，P=0.041；外直肌89.9vs83.4，t=-2.0，P=0.047）。GO患者T2RT與CAS呈正相關(guān)（r=0.55，P0.001）。 結(jié)論MR判斷GO活動性較CAS有更高的敏感性。 目的比較兩種大劑量甲基強(qiáng)的松龍（甲強(qiáng)龍）沖擊方案治療中-重度活動性GO的療效；探討治療前后眼眶MR中T2RT和眼外肌面積的動態(tài)變化及與療效之間的關(guān)系。 方法40例中-重度活動性GO患者，隨機(jī)分為兩組，治療方案A組為甲強(qiáng)龍0.5g+250mlNS靜滴，連續(xù)3d，每4周一次，第一周的前三天內(nèi)完成，循環(huán)3~4次（共12-16周，甲強(qiáng)龍總量4.5~6g），B組為甲強(qiáng)龍0.5g+250mlNS靜滴，每周第一天一次，連續(xù)6周；隨后0.25g+250mlNS，每周第一天一次，持續(xù)6周（共12周，甲強(qiáng)龍總量4.5g）。治療前和每次治療結(jié)束后均接受眼眶MR檢查。 結(jié)果治療有效率A組為82.35%(14/17)，B組為73.3%(11/15)，兩組之間的差異無統(tǒng)計學(xué)意義(x2=0.379;P=0.678)；副反應(yīng)發(fā)生率A組為82.4%，B組為60%，兩組之間的差異無統(tǒng)計學(xué)意義(P=0.243)。治療前兩組間各條眼外肌T2RT和肌面積無統(tǒng)計學(xué)差異（P0.05）；第一次治療后兩組的T2RT和眼外肌面積均較治療前減少(A組SUM(T2RT)691.98vs665.94, t=-2.601, P=0.02)(Mean(Area)59.83vs54.58,t=6.039, P0.001； B組SUM(T2RT)706.78vs674.78, t=-3.374, P=0.006)(Mean(Area)58.39vs54.48, t=3.725, P=0.003)，且第一次治療后兩組間T2RT和肌面積較治療前的減少幅度比較無顯著差異(SUM(T2RT)26.04vs31.22, t=-0.368,P=0.716)(Mean(Area)5.25vs3.91, t=0.995, P=0.329)；隨后各次沖擊治療后T2RT和眼外肌面積可以進(jìn)一步減小，但是無統(tǒng)計學(xué)意義。 結(jié)論方案A的治療有效率和副反應(yīng)發(fā)生率稍高于方案B。眼眶MR顯示眼外肌T2RT和肌面積隨各次甲強(qiáng)龍沖擊治療逐漸減小。 目的系統(tǒng)評價生長抑素類似物治療Graves眼�。℅O）的有效性。 方法計算機(jī)檢索PubMed、EMbase、CNKI、The Cochrane Library、WanFang Data、VIP和CBM中關(guān)于生長抑素類似物治療Graves眼病的隨機(jī)對照試驗（RCT），檢索時間不限，截止至2012年3月，文種不限，并追溯納入文獻(xiàn)的參考文獻(xiàn)。由2位研究者按納入標(biāo)準(zhǔn)篩選文獻(xiàn)、提取資料并評價質(zhì)量后，采用RevMan5.0軟件進(jìn)行Meta分析。 結(jié)果最終納入5個RCT，共210例患者。Meta分析結(jié)果顯示生長抑素類似物治療GO可降低臨床活動性評分［MD=0.58，95%CI（0.02，1.13），P=0.04］，尚不能證實生長抑素類似物可降低突眼度（mm）［MD=0.21，95%CI（ 0.14，0.56），P=0.24］；對復(fù)視程度、球后體積、眼壓、視力及眼球活動受限未顯示出明顯療效；目前證據(jù)尚不能說明生長抑素類似物治療GO有效［OR=1.32，95%CI（0.45，3.9），P=0.61］。 結(jié)論生長抑素類似物治療GO可降低患者CAS，但臨床意義不夠顯著，尚不能說明可使突眼度降低。目前證據(jù)尚不能證實生長抑素類似物治療GO有效。受納入研究的質(zhì)量和數(shù)量限制，上述結(jié)論尚需開展更多高質(zhì)量RCT加以驗證。
[Abstract]:Objective To evaluate the imaging difference of extraocular muscle area and T2 relaxation time ( T2RT ) in patients with GO by magnetic resonance ( MR ) and evaluate the value of T2RT in the determination of GO activity with respect to clinical activity score ( CAS ) . Methods106 GO patients were recorded in GO group and 24 normal controls were selected in the control group . All the patients underwent orbital MR examination , the area of extraocular muscle and T2RT were recorded , and the symptoms and CAS scores were recorded in detail . The differences of T2RT , extraocular muscle area and the correlation with CAS were compared between the two groups . Results The peripheral muscle T2RT of the active GO group and the non - active GO group was higher than that of the normal controls , and the area of the extraocular muscles was higher than that in normal controls ( 96.2 vs 84.2 , t = - 3.6 , P = - 3.5 , P = 0.01 ; external rectus muscle 89.9 vs 83.4 , t = - 3.3 , P = - 3.1 , P = - 2.1 , P = 0.041 ; external rectus muscle 89.9 vs 83.4 , t = - 2.0 , P = 0.047 ) . The T2RT of GO was positively correlated with CAS ( r = 0.55 , P0.001 ) . Conclusion : MR is more sensitive to GO activity than CAS . Objective To compare the effect of two large doses of Methylprednisolone ( Methylprednisolone ) in the treatment of moderate to severe active GO ( GO ) , and to investigate the dynamic changes of T2RT and extraocular muscle area in orbital MR before and after treatment and the relationship between them . Methods 40 patients with moderate to severe active GO were randomly divided into two groups : group A , 0.5 g + 250 ml NS intravenous drip , 3 - 4 weeks ( 12 - 16 weeks , 4.5 -6 g ) in the first week and 0.5 g + 250 ml NS in group B . The first day of the week was 0 . 25 g + 250 ml NS , the first day of the week , 6 weeks ( total 12 weeks , 4 . 5 g ) . Orbital MR examination was performed both before and after each treatment . Results There was no significant difference between the two groups ( P = 0.379 , P = 0.639 , P = 0.374 , P = 0.006 ) ( Mean ( Area ) 58.39 vs 54.48 , t = 3.725 , P = 0.003 ) . Conclusion The effective rate of treatment and the incidence of side effects of the regimen A were slightly higher than that of regimen B . The orbital MR showed that the extraocular muscle T2RT and muscle area gradually decreased with the treatment of each nail . Objective To evaluate the effectiveness of somatostatin analogues in the treatment of Graves ' ophthalmicdiseases ( GO ) . Methods A randomized controlled trial ( RCT ) of somatostatin analogues in the treatment of Graves ' ophthalmicopathy was searched by computer . The search time was not limited . By March 2012 , the search time was not limited , and the references in the literature were retrospectively included . After the literatures were screened by 2 researchers , the data was extracted and the quality was evaluated , Meta - analysis was performed with RevMan5.0 software .

緇撴灉鏈

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