摘要
背景 儿童及青少年Graves眼病发病率低,临床上较为少见,故相关研究报道较少,对儿童及青少年Graves眼病的临床特点及疗效进行总结和分析对于其临床诊治有一定的指导意义. 目的 总结并分析儿童及青少年Graves眼病的临床表现、治疗及预后. 方法 采用回顾性病例分析方法,连续收集2007年1月至2012年12月于上海长征医院诊断为Graves眼病的儿童及青少年患者29例54眼的临床资料,对患者的眼部检查、甲状腺功能检查和影像学检查结果进行分析,采用临床活动度评分（CAS）对患眼进行临床评分.根据患者的病情采用不同的治疗方案进行治疗并进行随访,24例其中CAS≤2分患者44眼接受人工泪液点眼,3例CAS≥3分患者接受糖皮质激素静脉滴注疗法,2例3眼分别接受双侧眶减压术和M＆#252;ller肌切除术.患者接受随访1.5～6年,评估儿童及青少年Graves眼病的治疗效果,以眼球突出度及上睑退缩变化程度作为判断疗效的标准. 结果 29例患者中男5例,女24例;患者年龄5 ～18岁,平均12.9岁.患者的临床表现主要为眼球突出、眼睑退缩和眼睑肿胀,可伴有结膜充血、眼睑闭合不全.所有患眼最佳矫正视力（BCVA）均≥ 0.8.CAS评分为0～2分者26例48眼,≥3分者（活动期）3例6眼.CT/MRI检查显示患眼眼眶脂肪组织容积增加,部分患眼可见眼外肌肌腹增粗.实验室检查显示甲状腺功能正常者12例,占41.4％;甲状腺功能亢进者15例,占51.7％;甲状腺功能减退者2例,占6.9％.随访期间11例20眼症状好转,占37.9％;16例29眼病情稳定,占55.2％;2例4眼病情加重,占6.9％. 结论 儿童及青少年Graves眼病中女性明显多于男性.儿童及青少年Graves眼病临床症状较轻,病情活动性较低,预后较好.
Background Juvenile Graves ophthalmopathy has a low prevalence and few relevant studies.Analyzing and reviewing the clinical features and therapeutic effectiveness of juvenile Graves ophthalmopathy is helpful to its diagnosis and management.Objective This study was to evaluate the clinical characteristics of Graves ophthalmopathy and its management in children and adolescents.Methods The clinical data of 54 eyes from 29 patients with Graves ophthalmopathy who were diagnosed in Shanghai Changzheng Hospital from January 2007 to December 2012 were retrospectively analyzed.The ocular manifestations,thyroid function,CT or MRI testing results were collected,and the activity of Graves ophthalmopathy was scored based on the criteria of CAS.Artificial tears was topically administered in 44 eyes with CAS ≤ 2.In the eyes with CAS ≥ 3,corticosteroids drug was systemically used in 3 patients,and orbital decompression surgery and excision of M＆#252;ller muscle were performed in 3 eyes of 2 patients respectively.The follow-up was carried out for 1.5-6 years.The treatment outcomes were evaluated according to the reduction of exophthalnos and the improvement of upper eyelid retraction.Results The patients were 5-18 years old with an average age of 12.9 years old.Out of 29 Graves ophthalmopathy patients,5 males and 24 females were included.The initial clinical manifestations were proptosis,eyelid retraction and swelling,and accompanied by conjunctival congestion and hypophasis.The best corrected visual acuity （BCVA） was ≥ 0.8 in all the eyes.CAS scores wcre 0-2 in 48 eyes of 26 patients and ≥ 3 （active Graves ophthalmopathy） in 6 eyes of 3 patients.The increase of orbital adipose volume was exhibited in all the eyes and the enlargement of extraocular muscle was revealed in parts of eyes by CT/MRI.Laboratory examination showed normal thyroid function in 12 patients （41.4%）,hyperthyreosis in 15 patients （51.7%） and hypothyroidism in 2 patients （6.9%）.The ocular symptom was improved in 20 eyes of 11 patients （37.9%）,stabilized in 29 eyes of 16 patients （55.2%） and worsen in4 eyes of 2 patients （6.9%） in following-up duration.Conclusions Graves ophthalmopathy occurs much more in female than in male.The clinical manifestations are mild,with low activity and good prognosis in children and adolescents Graves ophthalmopathy.
出处
《中华实验眼科杂志》
CAS
CSCD
北大核心
2016年第8期716-719,共4页
Chinese Journal Of Experimental Ophthalmology
