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目的评价球后放射治疗甲状腺相关眼病(TAO)的疗效及其相关影响因素。方法系统收集南方医科大学附属南方医院1998年1月至2009年4月的122例接受球后放射治疗的TAO患者资料,其中男57例,女65例,年龄22～62岁。治疗采用美国VARIAN2100C型直线加速器,分次照射剂量为200cGy,总剂量2000cGy(10次/2周)。治疗后随访1～12年。结果 (1)球后放射治疗后疗效显著23例,疗效较好57例,疗效一般13例,病情无变化24例,病情进展5例,总有效率为76.23%。软组织受累程度、眼外肌受累程度均较治疗前显著减轻(P<0.01),眼球突眼度治疗后(20.22±2.81)mm较治疗前(21.86±2.59)mm有显著下降(P=0.017);(2)治疗有效和治疗无效两组间临床活动评分(CAS)、吸烟、眼外肌MRI信号强度差异均有统计学意义(P=0.001),年龄、性别、TAO病程差异无统计学意义。结论球后放射治疗可以有效地改善甲状腺相关眼病的症状,CAS、眼外肌MRI信号强度、吸烟等因素影响治疗效果。
Objective To evaluate the efficacy and related factors of posterior radiation therapy for thyroid associated ophthalmopathy (TAO). Methods The data of 122 TAO patients who received ball-back radiotherapy at Nanfang Hospital Affiliated to Southern Medical University from January 1998 to April 2009 were collected. There were 57 males and 65 females aged 22 to 62 years old. Treatment with the United States VARIAN2100C linear accelerator, fractionated irradiation dose of 200cGy, a total dose of 2000cGy (10 times / 2 weeks). Follow-up after treatment for 1 to 12 years. Results (1) After the ball radiotherapy, the curative effect was remarkable in 23 cases, the curative effect was better in 57 cases, the curative effect in general was in 13 cases, the condition was unchanged in 24 cases, the condition was improved in 5 cases, the total effective rate was 76.23%. The degree of soft tissue involvement and extraocular muscle involvement were significantly lower than those before treatment (P <0.01). The degree of eyeball exophthalmos (20.22 ± 2.81) mm was significantly lower than that before treatment (21.86 ± 2.59) mm (P = 0.017) ; (2) There was significant difference between the two groups in clinical activity score (CAS), smoking and extraocular muscle MRI signal intensity (P = 0.001), but there was no significant difference in age, sex and TAO course between the two groups . Conclusions Posterior radiation therapy can effectively improve the symptoms of thyroid-associated ophthalmopathy, CAS, extraocular muscle MRI signal intensity, smoking and other factors affect the therapeutic effect.