摘要
目的探讨儿童甲状腺相关性眼病(thyroid associated ophthalmopathy,TAO)的临床特点及^(99)Tc^m-生长抑素类似物眼眶显像在其诊断中的应用价值。设计回顾性病例系列。研究对象2008年10月-2015年8月于山西医科大学第一医院就诊的儿童TAO患者20例,年龄6~14岁,平均(10.85±1.42)岁。方法分析所有入组患儿的临床资料。其中13例患儿行眼肌B超及^(99)Tc^m-生长抑素类似物眼眶显像。计算眼眶^(99)Tc^m-生长抑素类似物显像剂摄取比值(UR),并与25例成年人TAO患者及30例健康成年人志愿者进行对比。主要指标甲状腺功能、眼征、眼球突出度、眼球运动、眼外肌B超、眼眶^(99)Tc^m-生长抑素类似物显像。结果在20例患儿中,眼病初发时伴有甲状腺功能亢进症(甲亢)或亚临床甲亢18例(90%),甲状腺功能正常2例(10%)。甲状腺病病程10天~36个月,平均(12.48±10.33)个月;眼病病程1~36个月,平均(10.40±10.17)个月。双眼发病者18例(90%)。眼睑退缩17例(85%),眼球突出19例(95%),眼球运动障碍2例(10%)。眼肌B超检查眼肌增大者10例(76.9%),其中两条肌肉增大5例(38.5%),三条肌肉增大4例(30.8%),四条肌肉均增大1例(7.7%);内直肌、下直肌、上直肌及外直肌增大的频率分别是75%、65%、40%及10%。三组眼眶生长抑素类似物UR均数分别为1.48±0.16、1.65±0.20和1.05±0.17,患儿组UR值与成年人患者无明显差异(P=0.294),但两者均明显高于正常对照组(P<0.01);患儿双眼UR值分别为右眼:1.63±0.13,左眼:1.69±0.15,双眼间无显著差异(P=0.372)。结论双眼发病、眼睑退缩和眼球突出是儿童TAO患者最典型的临床特点;甲功异常的患儿应常规进行至少1年的眼科随访;^(99)Tc^m-生长抑素类似物眼眶显像对儿童TAO患者具有明确的诊断价值。
Objective To investigate the clinical characteristics and the 99Tcm-octreotide scintigraph orbital imaging diagnostic values for pediatric thyroid associated ophthalmopathy （TAO）. Design Retrospective case series. Participants During October 2008 to July 2015, 20 children were diagnosed as TAO in First Hospital of Shanxi Medical University. Methods We reviewed clinical manifestations, and medical records of 20 children in whom TAO was diagnosed. To evaluate the diagnostic value of the 99Tcm-octreotide scintigraph tomography, 13 children had TAO served as experimental group, 25 adult patients diagnosed as TAO and 30 healthy adult volunteers were involved as control group. The orbital 99Tcm-somatostatin analogues uptake ratio were compared among the groups. Main Outcome Measures Thyroid function,ophthalmic signs, exophthalmometry, ocular movement, B-mode ultrasound, 99Tcm-octreotide scintigraph tomography. Results Among 20 patients with a mean age of 10.85±1.42 years old with TAO, 5 of them were male and 15 female （F：M=3：1）. 18（90%） cases had hyperthyroidism and 2（10%） were euthyroid. The mean duration of dysthyroid symptoms was 12.48±10.33 months （10 days^36 months） while the mean duration of ocular symptoms was 10.40±10.17 （1~36） months. TAO occurred bilaterally in 18 patients. Eyelid retraction was presented in 17 patients （85%）, whereas the approximate frequency of exophthalmos was 19 patients （95%）. Restrictive extraocular myopathy happened in 2 patients （10%）. Extraocular enlargement was detected on B-mode ultrasound in 10 of 13（76.9%） patients who were evaluated. The frequencies of two enlarged muscles, three enlarged muscles and four enlarged muscles were 38.5%, 30.8% and 7.7%, respectively. Medial, inferior, superior and lateral rectuses enlarged in 75%, 65%, 40% and 10% of the orbits respectively. The UR level was not significantly different in children patients and adult patients （P=0.294）, while in both patient group it was significantly higher compare
出处
《眼科》
CAS
CSCD
北大核心
2016年第6期366-370,共5页
Ophthalmology in China
基金
山西省自然科学基金(2013011059-2)
关键词
儿童
甲状腺相关性眼病
眼眶显像
children
thyroid associated ophthalmopathy
orbital imaging
