甲状腺相关眼病的治疗现状
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摘要
甲状腺相关眼病(TAO)是一种通常伴有甲状腺功能异常的眼部症状,其治疗是临床的一大难点,需要同时考虑患者主观感受和病情的客观需求。目前主要有基础治疗、药物治疗(激素、免疫抑制剂、生长抑素及类似物、球后放疗等)、手术治疗。药物治疗适用于活动性TAO患者,目前首选的是激素类;手术治疗则可用于药物治疗不能控制的视力损害,以及为了追求更好疗效和外观,手术方式以眼眶减压术、眼肌手术、眼睑手术为主。各种治疗手段均存在着不同的优缺点。
Thyroid associated ophthalmopathy(TAO) is an eye symptom that is usually associated with abnormal thyroid function,and the treatment is a major clinical difficulty because the subjective and objective needs of the patients should be considered simultaneously.Treatment options for TAO can be grouped into adjuvant,medical(steroids,immunosuppressive therapies,somatostatin analogues,orbital radiotherapy etc.),and surgical therapies.Medical therapy is applicable to patients with active hyperthyroidism and steroids is the first choice,while surgical interventions can be implemented in cases where the threat to vision cannot be controlled with medical treatment,and in cases with inactive disease in order to protect function and improve appearance.Orbital decompression,ocular muscle surgery and blepharoplasty are the main methods of operation.All kinds of treatments have different advantages and disadvantages.
Thyroid associated ophthalmopathy(TAO) is an eye symptom that is usually associated with abnormal thyroid function,and the treatment is a major clinical difficulty because the subjective and objective needs of the patients should be considered simultaneously.Treatment options for TAO can be grouped into adjuvant,medical(steroids,immunosuppressive therapies,somatostatin analogues,orbital radiotherapy etc.),and surgical therapies.Medical therapy is applicable to patients with active hyperthyroidism and steroids is the first choice,while surgical interventions can be implemented in cases where the threat to vision cannot be controlled with medical treatment,and in cases with inactive disease in order to protect function and improve appearance.Orbital decompression,ocular muscle surgery and blepharoplasty are the main methods of operation.All kinds of treatments have different advantages and disadvantages.
引文
[1]爦ahlE,Gündüz K.Thyroid-associated Ophthalmopathy[J].Turk J Ophthalmol,2017,47(2):94-105.
[2]Bartalena L,Pinchera A,Marcocci C.Management of Graves'ophthalmopathy:Reality and perspectives[J].Endocr Rev,2000,21(2):168-199.
[3]顾鸣宇,彭永德.甲状腺相关眼病药物治疗[J].中国实用内科学杂志,2015,35(7):569-571.
[4]蔡季平.甲状腺相关眼病手术治疗[J].中国实用内科学杂志,2015,35(7):577-580.
[5]Hgg E,Asplund K.Is endocrine ophthalmopathy related to smoking[J].Br Med J(Clin Res Ed),1987,295(6599):634-635.
[6]王蕾,马建民.甲状腺相关眼病发病机制的研究进展[J].中华眼科杂志,2017,53(6):474-478.
[7]Thornton J,Kelly SP,Harrison RA,et al.Cigarette smoking and thyroid eye disease:A systematic review[J].Eye,2007,21(9):1135-1145.
[8]夏丹,汪虹,邵迎新.甲状腺相关眼病的中西医研究现状[J].世界中西医结合杂志,2011,6(6):536-538.
[9]Perros P,Kendall-Taylor P,Neoh C,et al.A prospective study of the effects of radioiodine therapy for hyperthyroidism in patients with minimally active Graves'ophthalmopathy[J].J Clin Endocrinol Metab,2005,90(9):5321-5323.
[10]Dickinson J,Perros P.Thyroid-associated orbitopathy:Who and how to treat?[J].Endocrinol Metab Clin North Am,2009,38(2):373-388.
[11]朱红云,张福仙.甲泼尼龙冲击联合曲安奈德球后注射治疗甲状腺相关眼病的临床效[J].中国当代医药,2016,23(5):152-154.
[12]Kahaly GJ.Management of moderately severe Graves'orbitopathy[M]//Wiersinga WM,Kahaly GJ.Graves orbitopathy:A multidisciplinary approach.Basel:Karger,2007:120-152.
[13]Bartalena L,Marcocci C,Manetti L,et al.Orbital radiotherapy for Graves'ophthalmopathy[J].Thyroid,1998,8(5):439-441.
[14]梁文君,张韵.放疗对中重度活动期甲状腺相关性眼病疗效的临床分析[J].医药前沿,2016,6(26):35-36.
[15]Gerling J,Kommerell G,Henne K,et al.Retrobulbar irradiation for thyroid-associated orbitopathy:Double blind comparison between 2.4 and 16 Gy[J].Int J Radiat Oncol Biol Phys,2003,5(1):182-189.
[16]Wakelkamp IM,Tan H,Saeed P,et al.Orbital irradiation for Graves ophthalmopathy:Is it safe?A long-term follw-up study[J].Ophthalmology,2004,111(8):1557-1562.
[17]Ng CM,Yuen HK,Choi KL,et al.Combined orbital irradiation and systemic steroids compared with systemic steroids alone in the management of moderate-to-severe Graves'ophthalmopathy:A preliminary study[J].Hong Kong Med J,2005,11(5):322-330.
[18]Wémeau JL,Caron P,Beckers A,et al.Octreotide(long acting release formulation)treatment in patients with Graves orbitopathy:Clinical results of a four-month,randomized,placebo-controlled,double-blind study[J].J Clin Endocrinol Metab,2005,90(2):841-848.
[19]Baschieri L,Antonelli A,Nardi S,et al.Intravenous immunoglobulin vs.corticosteroid in treatment of Graves'ophthalmopathy[J].Thyroid,1997,7(4):579-585.
[20]Stan MN,Garrity JA,Bahn RS.The evaluation and treatment of Graves ophthalmopathy[J].Med Clin North Am,2012,96(2):311-328.
[21]Salvi M,Vannucchi G,Campi I,et al.Treatment of Graves'disease and associate ophthalmopathy with the anti-CD20monoclonal antibody rituximab:An open study[J].Eur J Endocrinol,2007,156(1):33-40.
[22]El Fassi D,Banga JP,Gilbert JA,et al.Treatment of Graves'disease with rituximab specifically reduces the production of thyroid stimulating autoantibodies[J].Clin Immunol,2009,130(3):252-258.
[23]Salvi M,Vannucchi G,CurròN,et al.Efficacy of B-cell targeted therapy with rituximab in patients with active moderate to severe Graves'orbitopathy:A randomized controlled study[J].J Clin Endocrinol Metab,2015,100(2):422-431.
[24]朱焕高,廖琳,董建军.利妥昔单抗治疗甲状腺相关性眼病的研究进展[J/CD].中华临床医师杂志(电子版),2016,10(19):2913-2916.
[25]Gartner R,Gasnier BC.Selenium in the treatment of autoimmune thyroiditis[J].Biofactors,2003,19(3/4):165-170.
[26]Marek R,Nadia SG.Advances in the pharmacological treatment of Graves'orbitopathy[J].Expert Rev Clin Pharmacol,2016,9(7):981-989.
[27]Rivera-Grana E,Lin P,Suhler EB.Methotrexate as a corticosteroid-sparing agent for thyroid eye disease[J].J Clin Exp Ophthalmol,2015,6(2):422-422.
[28]范景丽,马玉琴,汪春雷.锝(99Tcm)亚甲基二膦酸盐注射液与泼尼松治疗中重度甲状腺相关性眼病疗效比较[J].中国基层医药,2017,24(1):56-59.
[29]欧阳明,刘桂琴,樊宁.小檗碱对甲状腺相关眼病眼眶前脂肪细胞分化的影响[J].眼科新进展,2016,36(1):12-14.
[30]孙丰源,吴桐.再谈眼眶减压术治疗甲状腺相关眼病的临床价值[J].中华眼科杂志,2017,53(6):401-403.
[31]秦焦,蔡昌枰,刘小红.内窥镜眶减压术治疗甲状腺功能障碍性视神经病变[J].中华眼外伤职业眼病杂志,2017,39(7):481-484.
[32]沈杰.甲状腺相关眼病所致限制性斜视的手术治疗[J].中华眼外伤职业眼病杂志,2016,38(3):207-210.
[33]Huang CY,Lin HC,Yang ML.Necrotizing scleritis after strabismus surgery in thyroid eye disease[J].J AAPOS,2013,17(5):535-536.
[34]Doumit G,Abouhassan W,Yaremchuk MJ.Aesthetic refinements in the treatment of Graves ophthalmopathy[J].Plast Reconstr Surg,2014,134(3):519-526.
[35]肖采尹,许家骏,张南.从风论治配合针灸治疗甲状腺相关性眼病的探索[J].中华中医药杂志,2017,32(3):1375-1376.
[36]石晶琳.甲状腺相关眼病常见中医证候及证候要素的现代文献研究[J].中医文献杂志,2017,35(3):19-22.
[37]刘观鑫.抑亢丸联合131I治疗Graves'甲亢并突眼疗效分析[J].现代中西医结合杂志,2015,24(33):3731-3732.
[38]陈红霞,李双蕾.中医药治疗甲状腺功能亢进症的研究进展[J].湖南中医杂志,2016,32(11):188-189.
[39]Ling YZ,Chang S,Xue ML,et al.Intraorbital electroacupuncture therapy for thyroid-associated ophthalmopathy[J].Chin Med J(Engl),2017,131(15):1884-1885.
[2]Bartalena L,Pinchera A,Marcocci C.Management of Graves'ophthalmopathy:Reality and perspectives[J].Endocr Rev,2000,21(2):168-199.
[3]顾鸣宇,彭永德.甲状腺相关眼病药物治疗[J].中国实用内科学杂志,2015,35(7):569-571.
[4]蔡季平.甲状腺相关眼病手术治疗[J].中国实用内科学杂志,2015,35(7):577-580.
[5]Hgg E,Asplund K.Is endocrine ophthalmopathy related to smoking[J].Br Med J(Clin Res Ed),1987,295(6599):634-635.
[6]王蕾,马建民.甲状腺相关眼病发病机制的研究进展[J].中华眼科杂志,2017,53(6):474-478.
[7]Thornton J,Kelly SP,Harrison RA,et al.Cigarette smoking and thyroid eye disease:A systematic review[J].Eye,2007,21(9):1135-1145.
[8]夏丹,汪虹,邵迎新.甲状腺相关眼病的中西医研究现状[J].世界中西医结合杂志,2011,6(6):536-538.
[9]Perros P,Kendall-Taylor P,Neoh C,et al.A prospective study of the effects of radioiodine therapy for hyperthyroidism in patients with minimally active Graves'ophthalmopathy[J].J Clin Endocrinol Metab,2005,90(9):5321-5323.
[10]Dickinson J,Perros P.Thyroid-associated orbitopathy:Who and how to treat?[J].Endocrinol Metab Clin North Am,2009,38(2):373-388.
[11]朱红云,张福仙.甲泼尼龙冲击联合曲安奈德球后注射治疗甲状腺相关眼病的临床效[J].中国当代医药,2016,23(5):152-154.
[12]Kahaly GJ.Management of moderately severe Graves'orbitopathy[M]//Wiersinga WM,Kahaly GJ.Graves orbitopathy:A multidisciplinary approach.Basel:Karger,2007:120-152.
[13]Bartalena L,Marcocci C,Manetti L,et al.Orbital radiotherapy for Graves'ophthalmopathy[J].Thyroid,1998,8(5):439-441.
[14]梁文君,张韵.放疗对中重度活动期甲状腺相关性眼病疗效的临床分析[J].医药前沿,2016,6(26):35-36.
[15]Gerling J,Kommerell G,Henne K,et al.Retrobulbar irradiation for thyroid-associated orbitopathy:Double blind comparison between 2.4 and 16 Gy[J].Int J Radiat Oncol Biol Phys,2003,5(1):182-189.
[16]Wakelkamp IM,Tan H,Saeed P,et al.Orbital irradiation for Graves ophthalmopathy:Is it safe?A long-term follw-up study[J].Ophthalmology,2004,111(8):1557-1562.
[17]Ng CM,Yuen HK,Choi KL,et al.Combined orbital irradiation and systemic steroids compared with systemic steroids alone in the management of moderate-to-severe Graves'ophthalmopathy:A preliminary study[J].Hong Kong Med J,2005,11(5):322-330.
[18]Wémeau JL,Caron P,Beckers A,et al.Octreotide(long acting release formulation)treatment in patients with Graves orbitopathy:Clinical results of a four-month,randomized,placebo-controlled,double-blind study[J].J Clin Endocrinol Metab,2005,90(2):841-848.
[19]Baschieri L,Antonelli A,Nardi S,et al.Intravenous immunoglobulin vs.corticosteroid in treatment of Graves'ophthalmopathy[J].Thyroid,1997,7(4):579-585.
[20]Stan MN,Garrity JA,Bahn RS.The evaluation and treatment of Graves ophthalmopathy[J].Med Clin North Am,2012,96(2):311-328.
[21]Salvi M,Vannucchi G,Campi I,et al.Treatment of Graves'disease and associate ophthalmopathy with the anti-CD20monoclonal antibody rituximab:An open study[J].Eur J Endocrinol,2007,156(1):33-40.
[22]El Fassi D,Banga JP,Gilbert JA,et al.Treatment of Graves'disease with rituximab specifically reduces the production of thyroid stimulating autoantibodies[J].Clin Immunol,2009,130(3):252-258.
[23]Salvi M,Vannucchi G,CurròN,et al.Efficacy of B-cell targeted therapy with rituximab in patients with active moderate to severe Graves'orbitopathy:A randomized controlled study[J].J Clin Endocrinol Metab,2015,100(2):422-431.
[24]朱焕高,廖琳,董建军.利妥昔单抗治疗甲状腺相关性眼病的研究进展[J/CD].中华临床医师杂志(电子版),2016,10(19):2913-2916.
[25]Gartner R,Gasnier BC.Selenium in the treatment of autoimmune thyroiditis[J].Biofactors,2003,19(3/4):165-170.
[26]Marek R,Nadia SG.Advances in the pharmacological treatment of Graves'orbitopathy[J].Expert Rev Clin Pharmacol,2016,9(7):981-989.
[27]Rivera-Grana E,Lin P,Suhler EB.Methotrexate as a corticosteroid-sparing agent for thyroid eye disease[J].J Clin Exp Ophthalmol,2015,6(2):422-422.
[28]范景丽,马玉琴,汪春雷.锝(99Tcm)亚甲基二膦酸盐注射液与泼尼松治疗中重度甲状腺相关性眼病疗效比较[J].中国基层医药,2017,24(1):56-59.
[29]欧阳明,刘桂琴,樊宁.小檗碱对甲状腺相关眼病眼眶前脂肪细胞分化的影响[J].眼科新进展,2016,36(1):12-14.
[30]孙丰源,吴桐.再谈眼眶减压术治疗甲状腺相关眼病的临床价值[J].中华眼科杂志,2017,53(6):401-403.
[31]秦焦,蔡昌枰,刘小红.内窥镜眶减压术治疗甲状腺功能障碍性视神经病变[J].中华眼外伤职业眼病杂志,2017,39(7):481-484.
[32]沈杰.甲状腺相关眼病所致限制性斜视的手术治疗[J].中华眼外伤职业眼病杂志,2016,38(3):207-210.
[33]Huang CY,Lin HC,Yang ML.Necrotizing scleritis after strabismus surgery in thyroid eye disease[J].J AAPOS,2013,17(5):535-536.
[34]Doumit G,Abouhassan W,Yaremchuk MJ.Aesthetic refinements in the treatment of Graves ophthalmopathy[J].Plast Reconstr Surg,2014,134(3):519-526.
[35]肖采尹,许家骏,张南.从风论治配合针灸治疗甲状腺相关性眼病的探索[J].中华中医药杂志,2017,32(3):1375-1376.
[36]石晶琳.甲状腺相关眼病常见中医证候及证候要素的现代文献研究[J].中医文献杂志,2017,35(3):19-22.
[37]刘观鑫.抑亢丸联合131I治疗Graves'甲亢并突眼疗效分析[J].现代中西医结合杂志,2015,24(33):3731-3732.
[38]陈红霞,李双蕾.中医药治疗甲状腺功能亢进症的研究进展[J].湖南中医杂志,2016,32(11):188-189.
[39]Ling YZ,Chang S,Xue ML,et al.Intraorbital electroacupuncture therapy for thyroid-associated ophthalmopathy[J].Chin Med J(Engl),2017,131(15):1884-1885.