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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 features of thyroid associated ophthalmopathy (TAO) in children and the value of 99Tc m-somatostatin analogue orbital imaging in the diagnosis of thyroid associated ophthalmopathy. Design retrospective case series. Subjects From October 2008 to August 2015, 20 children with TAO were enrolled in the First Hospital of Shanxi Medical University. Their ages ranged from 6 to 14 years, with an average of (10.85 ± 1.42) years. Methods Clinical data of all infants were analyzed. Thirteen of them had orbital B-mode ultrasound and 99Tc-m-somatostatin analogue orbital imaging. The orbital ~ (99) Tc ~ m-somatostatin analog imaging agent uptake ratio (UR) was calculated and compared with 25 adult TAO patients and 30 healthy adult volunteers. Main indicators Thyroid function, ocular sign, eyeball protrusion, eye movement, extraocular muscle B ultrasound, orbital ~ (99) Tc ~ m-somatostatin analog imaging. Results In 20 children, hyperthyroidism (hyperthyroidism) or subclinical hyperthyroidism was found in 18 cases (90%) and thyroid function was normal in 2 cases (10%). Thyroid disease duration of 10 days to 36 months, with an average (12.48 ± 10.33) months; eye disease course of 1 to 36 months, an average of (10.40 ± 10.17) months. 18 cases of binocular onset (90%). Eyelid retraction in 17 cases (85%), prominent in 19 cases (95%), eye movement disorders in 2 cases (10%). There were 10 cases (76.9%) with ocular muscle enlargement in B-mode ultrasound examination, in which 5 cases (38.5%) had two muscles, 4 cases (30.8%) had 3 muscles, 1 case %). The frequencies of medial rectus, inferior rectus, superior rectus and lateral rectus were 75%, 65%, 40% and 10%, respectively. The mean UR values of somatostatin analogues in the three groups were 1.48 ± 0.16, 1.65 ± 0.20 and 1.05 ± 0.17, respectively. There was no significant difference in UR value between the two groups (P = 0.294), but both were significantly higher The normal control group (P <0.01). The values of UR in both eyes were 1.63 ± 0.13 for the right eye and 1.69 ± 0.15 for the left eye respectively. There was no significant difference between the two eyes (P = 0.372). Conclusions The incidence of bilateral eyes, eyelid retraction and eyeball protrusion are the most typical clinical features in children with TAO. Children with abnormal thyroid function should be followed up regularly for at least 1 year. 99Tc-m-somatostatin analogues orbital significant Like childhood TAO patients have a clear diagnostic value.