摘要
目的研究免疫抑制剂冲击治疗对甲状腺相关性眼病(TAO)患者眼表的影响,探讨其眼表损害的发病机制。设计前瞻性比较性病例系列。研究对象TAO患者(TAO组)及正常人(对照组)各30例60眼。方法 TAO组接受甲泼尼龙0.5 g及环磷酰胺0.2 g每日1次静脉滴注,连用3天。冲击开始前1天、结束后1周进行检查与眼表疾病评分问卷。主要指标眼球突出度、睑裂高度、眨眼次数、角膜荧光染色分值、泪膜破裂时间、泪液分泌试验及眼表疾病评分。结果 TAO组较对照组各眼表观察指标差异均有统计学意义(P均=0.000)。TAO患者冲击治疗后7天除眼球突出度(P=0.083)及睑裂高度(P=0.091)差异无统计学意义外,TAO组的眨眼次数减少(P=0.000)、角膜荧光染色分值减少(P=0.001)、泪膜破裂额时间缩短(P=0.000)、泪液分泌试验值延长(P=0.000)、眼表疾病评分降低(P=0.000)。结论免疫抑制剂冲击治疗对TAO患者的眼表有明显的保护和改善作用,其作用机制可能与抑制眼表和泪腺的炎症有关。
Objective To observe the ocular surface changes of thyroid associated ophthalmopathy （TAO） before and after immunosuppressive agents pulse therapy. Design Prospective comparative case series. Participants TAO patients and normal controls, 30 cases （60 eyes） respectively. Method The group of TAO patients received methylprednisolone 0.5 g in 250 ml physiological saline and cyelophosphamide 0.2 g in 500 ml physiological saline for intravenous drop, 1 times a day, for 3 days of shock treatment. The subjects were then proceeded for clinical examinations and recorded of ocular indexes of them. Main Outcome Measures exophthalmos, palpebral fissure height, blinking, cornea fluorescein staining （FL）, fluorescein break-up time （FBUT）, Schirmer I test （SIT）, and Ocular Surface Disease Index （OSDI） of these subjects. Results There were significant difference in every observation index of ocular surface mentioned above between normal subjects and TAO patients before immunosuppressive （all P=0.000）.There were no significant difference in recorded of exophthalmos （P=0.083）, palpebral fissure height （P=0.091） between TAO patients before and after immunosuppressive agents pulse therapy. After immunosuppressive agents pulse therapy, TAO patients have less blinking times （P=0.000）, lower FL （P=0.001）, shorter FBUT （P=0.000）, longer SIT （P=0.000） and lower OSDI （P=0.000） with statistic significant differences. Conclusions The damage of ocular surface in TAO patients is obvious. The ocular surface of TAO patients can be improved by immunosuppressive agents pulse therapy, and its mechanism may be through inhibition of ocular surface inflammation and the effect of lacrimal gland first.
出处
《眼科》
CAS
CSCD
北大核心
2016年第1期40-44,共5页
Ophthalmology in China
关键词
甲状腺相关性眼病
免疫抑制剂
眼表
thyroid associated ophthalmopathy
immunosuppressive agents
ocular surface
