甲状腺相关眼病的放射治疗研究进展

甲状腺相关眼病(TAO)是成人最常见的眼眶疾病，发病率逐年增高，临床表现为眼球突出、眼睑退缩、眼球运动障碍及视力障碍，严重损害患者的生理和心理健康。西医常用糖皮质激素治疗、放射治疗和眼眶减压术等。其中，糖皮质激素治疗是针对中重度活动性TAO患者的一线治疗方案； 眼眶减压术主要针对严重眼球突出、眶压增高导致视神经受压损伤患者； 而对于不耐受或禁用糖皮质激素以及拒行眼眶减压术的TAO患者，可选用放射治疗。放射治疗通过发挥非特异性抗炎作用，能有效地改善患者临床症状，是治疗TAO的重要手段。随着计算机技术和医学影像学不断更新，放射治疗技术取得快速发展，三维适形放射治疗及调强放射治疗技术的出现使病灶精准定位成为可能。大量临床结果表明放射治疗TAO疗效好、不良反应可控。本文就放射治疗TAO的作用机制、技术特点、临床方案、放射剂量参数选择及并发症进行综述，以期为同行提供临床参考，制定个性化的TAO治疗方案。

Research progress of radiotherapy for thyroid-associated ophthalmopathy

Thyroid-associated ophthalmopathy(TAO)is the most common orbital disease in adults, and its incidence is increasing year by year. The clinical manifestations include proptosis, eyelid retraction, ocular motility disturbance and visual impairment, which seriously damage the physical and mental health of patients. Treatment options for TAO mainly include glucocorticoids, radiotherapy and orbital decompression. Among them, the glucocorticoids are the mainstay of treatment for moderate-to-severe and active disease; Orbital decompression is mainly for patients with severe proptosis and increased orbital pressure leading to optic nerve compression injury; And radiotherapy is used for TAO patients who are intolerant of glucocorticoids and who refuse orbital decompression. Radiation therapy can effectively improve the clinical symptoms of patients by exerting a non-specific anti-inflammatory effect, and it is an important means of treating TAO. With the continuous update of computer technology and medical imaging, radiotherapy techniques have developed rapidly. The emergence of three-dimensional conformal radiotherapy technology and intensity-modulated radiotherapy technology has made it possible to locate the lesions accurately. Recently, a large number of clinical results show that radiotherapy for TAO has good curative effects and manageable adverse reactions. This article reviews the mechanism of action, technical characteristic, clinical protocol, radiation dose parameter selection and complications of radiotherapy for TAO, in order to provide clinical reference for peers and formulate personalized TAO treatment plans.