甲状腺相关性眼病的研究及治疗进展

甲状腺相关性眼病(TAO)是具有一系列体征和症状的多因素自身免疫性疾病。糖胺聚糖(GAG)的过量沉积、炎性浸润以及细胞因子的过度产生是甲状腺相关性眼病的主要特征。甲状腺相关性眼病的临床表现多种多样,可以从轻度的眼睑肿胀、上睑退缩、结膜充血、眼球突出乃至重度的威胁视力的暴露性角膜溃疡和压迫性视神经病变。通常,根据病史和查体是可以直接诊断甲状腺相关性眼病。实验室检查和影像学检查对于诊断甲状腺相关性眼病也具有一定的作用。目前可以根据"NO SPECS"法、临床活动评分(CAS)和VISA分类这三种方法对TAO病情情况进行分类。甲状腺相关性眼部的治疗包括保守治疗、药物治疗、眼眶放射治疗和手术治疗等,需根据患者的病情来决定其治疗方案。本文的目的是帮助眼科医生了解甲状腺相关性眼病的分期(轻度,中度至重度和视力威胁)的重要性和相关的可用治疗方式。

Progress and Review in Thyroid-associated Ophthalmopathy

ABSTRACT: Thyroid-associated ophthalmopathy is a multifactorial autoimmune disease with a range of signs and symptoms. Overexpression of glycosaminoglycans (GAG), inflammatory infiltration, and overproduction of cytokines are major features of thyroid-associated ophthalmopathy. The clinical manifestations of thyroid-associated ophthalmopathy is varied, such as eyelid swelling, upper eyelid retraction, conjunctival hyperemia, proptosis, corneal ulcers and compressive optic neuropathy. Usually, it can be directly diagnosed according to medical history and physical examination. Laboratory examination and imaging examination also have a certain role for the diagnosis of thyroid-associated ophthalmopathy. Thyroid-associated ophthalmopathy can be classified by "NO SPECS", clinical activity score (CAS) and VISA. The treatments of thyroid-associated ophthalmopathy include conservative treatment, drug therapy, orbital radiation therapy and surgical treatment. Physician should determine the treatment program by a patient''s condition. The purpose of this article is to help ophthalmologists understand the relevant knowledge of thyroid-associated ophthalmopathy and give some help in the clinical diagnosis and treatment.