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目的回顾性分析56例甲状腺相关性眼病(thyroidassociatedophthalmopathy,TAO),提出TAO不典型病例的临床特征,为早期进行临床诊断提供依据。方法总结56例TAO患者的主诉、眼征、斜视度、眼球运动等临床特征和眼外肌的影像学检查结果,进行统计学分析。结果本组有94.7%的患者表现为眼球运动受限,83.9%的病例以复视为主诉就诊,53.6%出现眼球突出,46.4%出现眼睑退缩和迟落。TAO以多条眼外肌受累为特点,眼外肌厚度增加以上直肌最为明显,以上转运动受限频率最高(69.6%)。本组TAO的发生先于甲状腺功能异常23人(41.1%),其中有9人(16.1%)是TAO发生1年以上才发生甲状腺功能异常的。结论大多数TAO患者依据其临床表现易于确诊,对不典型患者应注意眼征特点,分析眼外肌受累的情况,并排除其他原因引起的限制性斜视。牵拉试验和影像学检查对确诊有重大意义。
Objective To retrospectively analyze 56 cases of thyroid associated opthalmopathy (TAO), and to present the clinical features of atypical cases of TAO, providing the basis for early clinical diagnosis. Methods Fifty-six patients with TAO were retrospectively analyzed. The main features, such as the main symptoms, ocular sign, strabismus, eye movement and other imaging features of the extraocular muscle were analyzed statistically. Results In this group, 94.7% of the patients showed limited eye movement. 83.9% of the patients presented with diplopia as the main complaint, 53.6% with prominent eyes and 46.4% with eyelid withdrawal and delayed. TAO with multiple extraocular muscle involvement as the characteristics of the extraocular muscle thickness increased above the rectus muscle most obvious, the upper limit of motion limited to the highest frequency (69.6%). The incidence of TAO before the thyroid dysfunction in 23 (41.1%), of which 9 (16.1%) TAO occurred more than 1 year before the occurrence of thyroid dysfunction. Conclusion Most patients with TAO are easy to diagnose according to their clinical manifestations. Atypical patients should pay attention to the characteristics of ocular signs, analyze the involvement of extraocular muscles, and exclude restrictive strabismus caused by other reasons. Stretch test and imaging examination of great significance for the diagnosis.