Graves’眼病患者血清IL-2、sIL-2R和TGF-β测定的临床意义

目的：探讨Graves’眼病患者血清IL-2、sIL-2R和TGF-β水平的变化、病情进展和病因学的关系。方法：对照组30名和Graves眼病30例患者的血清TGF-β含量均采用放射免疫分析;血清IL-2、sIL-2R均采用酶联免疫吸附试验。结果：30例Graves’眼病患者血清IL-2治疗前水平非常显著低于对照组（P〈0.01）;经免疫抑制剂治疗6个月后水平较治疗前升高非常显著,与对照组比较已无显著性差异（P〉0.05）;sIL-2R含量治疗前非常显著的高于治疗后组和对照组（P〈0.01）;经用上述方案治疗后与对照组比较下降非常显著,但仍存在显著性差异（P〈0.05）;血清TGF-β浓度在治疗前非常显著地高于对照组（P〈0.01）;经治疗后显著下降,但与对照组比较差异仍非常显著（P〈0.01）。结论：Graves’眼病患者血清IL-2、sIL-2R和TGF-β三项血清指标的测定对于了解和认识其发病机理及预估病情有帮助。     

微创治疗甲状腺相关眼病临床分析

目的探讨经鼻内镜开眶减压治疗甲状腺相关眼病的临床疗效。方法采用经鼻内镜治疗36例（42眼）甲状腺相关眼病,观察患者术后视力、眼球突出度、眼球活动度及复视变化。结果42眼术后眼睑均能完全闭合,突眼度平均回缩5 mm,角膜病变均恢复,视力28眼提高,5眼视力没有改变,眼球活动度及外观均改善。23例复视患者仅有20例仍有复视。结论鼻内镜眶减压术治疗甲状腺相关眼病是挽救视力、改善外观的有效疗法。     

(99m)Tc-HYNIC-TOC scintigraphy in evaluation of active Graves' ophthalmopathy (GO)

Objective A promising radiopharmaceutical ^99mTc-HYNIC-TOC (^99mTc-HYNIC-Octreotide) can be applied for somatostatin receptor scintigraphy with the potential to replace Indium-111 labeled somatostatin analogus. Here we evaluate whether orbital ^99mTc-HYNIC-TOC scintigraphy can be used as a Graves’ ophthalmopathy (GO) activity parameter to predict the retrobulbar irradiation response. Methods Orbital ^99mTc-HYNIC-TOC scintigraphy was performed on 14 consecutive patients demonstrating moderated to severe Graves’ ophthalmopathy. The patients were treated with retrobulbar irradiation following the octreoscan and the response to this therapy was assessed at 3 months after the start of treatment. The orbital ^99mTc-HYNIC-TOC uptake was calculated to assess the effects of treatment. Results Among the 14 GO patients, eight (57.1%) responded to retrobulbar radiotherapy; six (42.9%) showed no change. We compared the eight responders and six non-responders in terms of orbital ^99mTc-HYNIC-TOC uptake, using the orbital/occipital ratio. On the 4-h ^99mTc-HYNIC-TOC scintigraphy, responders had a higher orbital/occipital uptake ratio than the no-responders (P = 0.001). A significant correlation was found between the orbital/occipital ratio and the clinical activity score (CAS) (P = 0.034). The Receiving-Operator-Characteristic curve showed the best threshold for discriminating active and inactive disease was 1.40 (sensitivity, 100%; specificity, 83.3%). In the responders group, all these eight patients had positive scintigraphy. While there were five patients who had negative scintigraphy in the non-responders group. Conclusion Orbital ^99mTc-HYNIC-TOC scintigraphy can be a useful method for the estimation of disease activity and prediction the response to subsequent radiotherapy in GO patient. And the patients with positive octreoscan were more likely to respond to irradiation. Hua Sun and Xu-Feng Jiang contribute equally to this article.     

光学相干断层扫描血流成像在眼科应用的研究现状

光学相干断层扫描血流成像（OCTA）是一种非染料的、无创的新型眼底成像技术,安全、迅速且清晰,是目前眼科检查中发展最迅速的检查方法之一。它不仅可以对视网膜和脉络膜各层中的微血管病变进行高分辨率成像,而且可以量化血流灌注,这在眼科临床实践中具有不可替代的价值。目前,OCTA已广泛应用于眼科各个领域,现对OCTA在眼科疾病的研究现状进行简要综述。     

甲状腺相关眼病病情严重程度95例影响因素研究

目的研究甲状腺相关眼病(tyroid associated ophthalmopathy,TAO)病情严重程度的相关影响因素。方法回顾性分析2008年1月至2010年6月在南方医科大学南方医院内分泌科确诊的资料完整的95例TAO患者的临床资料,TAO的确诊参照Bartley标准,根据NOSPECS和磁共振(MRI)图像将TAO病情严重程度分为:轻度、中至重度、危及视力3个级别。用Logistic回归分析法分析95例TAO患者临床资料,如年龄、性别、吸烟史、Graves病治疗方式、甲状腺功能、甲状腺自身抗体(TRAb)等相关影响因素与TAO病情严重程度的关系。结果由于自变量间存在共线性,病情严重程度的影响因素用logitic多元有序回归分析显示:只有吸烟(β=-1.505,P=0.005)和促甲状腺素受体抗体(β=0.031,P=0.005)2个变量进入回归方程。结论甲状腺相关眼病的发生发展受多方面因素的影响,戒烟、恢复并维持甲状腺功能及其自身抗体水平的正常能够预防或改善甲状腺相关眼病的发生发展。     

Post-radioiodine De Novo Onset Graves’ Ophthalmopathy: Case Reports and a Review of the Literature

ABSTRACT

New-onset Graves’ ophthalmopathy (GO) following radioiodine treatment (RAI) and worsening of existing GO are well-described in the endocrinology literature. These phenomena are recognized by ophthalmologists, yet poorly documented in the ophthalmology literature. Two male patients, aged 43 and 62 years, respectively, with Graves’ disease without GO, received RAI. Four months later, one patient developed acute GO with unilateral reduction in visual acuity, conjunctival chemosis, lagophthalmos, bilateral severely restricted ocular motility, and lid retraction. High-dose intravenous steroids, followed by oral steroids, led to a dramatic clinical improvement. The second patient received a second dose of RAI for persistent hyperthyroidism and subsequently developed acute GO-comprising restricted ocular motility, peri-orbital swelling, and conjunctival chemosis. Symptoms gradually resolved on continued carbimazole treatment. Neither patient received pre-RAI prophylactic glucocorticoids, as currently they are only recommended for patients with pre-existing GO or multiple risk factors. We discuss the limitations of using this risk-based approach in preventing new-onset GO following RAI therapy.     

Orbital pathology in thyroid-associated ophthalmopathy

Thyroid-associated ophthalmopathy (TAO) is a disfiguring disease. The clinical symptoms are the consequence of inflammation in the orbital tissues in response to as yet unknown antigens, causing swelling of the extraocular muscles, edema and fibrosis, and subsequently eye movement impairment, exophthalmos and sometimes compression of the optic nerve. Analysis of orbits from 40 patients with Graves' ophthalmopathy showed an increased volume of both the extraocular muscles and the orbital adipose/connective tissue in 48%, increased muscle volume with normal adipose/connective tissue in 20% and normal muscles with increased adipose/connective tissue in 28%. The other orbits were normal (4%).

Knowledge of the overall anatomy and the distribution of immunocompetent cells may help to shed light on the pathophysiology of TAO. In normal orbital tissues B-lymphocytes were scarce, but T-lymphocytes were numerous in normal extraocular muscles, orbital connective tissue septa and in the loose connective tissue surrounding the adipose tissue. The most predominant cell type in normal extraocular muscles and in the orbital connective tissue is the macrophage. In TAO, irrespective of the activity state, significant increases in numbers of macrophages were found in the minor connective tissue septa and in the levator palpebrae/Miiller's muscle complex. In the latter muscle complex the number of macrophages per mm² is increased, whereas the number of HLA-DR⁺ cells is drastically reduced compared to controls. Overall these results show a shift in population from HLA-DRV macrophages, in control tissues, to HLA-DR7macrophages in orbital tissues obtained from patients with TAO.     

重度活动期甲状腺相关性眼病三维适形放射治疗观察

目的 探讨三维适形放射治疗重度活动期甲状腺相关性眼病(TAO)的疗效.方法 采用三维治疗计划系统(3D-TPS)对21例活动期TAO患者进行眼眶局部精确放射治疗,并作相关的放射治疗评估.结果 21例患者眼部炎症表现及自觉症状改善明显,眼肌运动、复视和眼突出度均有较好地治疗效果,放疗后患者无视力下降,未发生放射性白内障.结论 眼眶局部三维适形放射治疗有良好地疗效及耐受性,副反应小,可作为重度活动期TAO的一线治疗方法.     

外眼病泪液中Ca,Mg,Zn,Fe元素测定及发病机理探讨

微量元素广泛存在于人体及其它生物组织中,对机体的生长发育,新陈代谢有着极其重要的作用.缺乏或不足会导致疾病发生.微量元素同某些内眼病的关系已有报导,但同外眼病关系如何,却属未知.鉴于某些外眼病病因尚不十分清楚,本文应用原子吸收光谱法测定了九种外眼病泪液中Ca、mg、Zn、Fe四种元素含量,现报告如下.