频域相干光层析成像术观察甲状腺相关眼病患者黄斑区中心凹脉络膜厚度的临床研究

摘要

目的 观察频域相干光层析成像术(SD-OCT)检测甲状腺相关眼病(TAO)活动期、非活动期以及健康者间黄斑区中心凹脉络膜厚度(CMCT)的差异,评估CMCT是否可以作为TAO患者活动度及随访的指标.方法 横断面研究.选取2015年1月至2017年12月就诊于南通市第一人民医院眼科的11例(22只眼)活动期TAO患者[活动期TAO组,男性4例,女性7例,年龄(49±10)岁]、21例(42只眼)非活动期TAO患者[非活动期TAO组,男性7例,女性14例,年龄(49±10)岁]以及与其年龄相匹配的23名(46只眼)健康受试者[健康对照组,男性12名,女性11名,年龄(50±9)岁].采用TAO临床活动度评分(CAS)评估TAO的活动性.所有受试者进行最佳矫正视力检测、裂隙灯显微镜检查、Goldmann眼压计测量眼压、直接眼底镜检查、A超眼轴测量、眼球突出度测量和SD-OCT检测CMCT.采用方差分析比较3组间眼压、眼球突出度、CMCT等检测指标的差异,采用单变量线性回归分析法及多因素线性回归分析法分析CMCT与各临床指标间的相关性.结果 活动期TAO组眼压为(20.16±3.49)mmHg(1 mmHg=0.133 kPa),眼球突出度为(18.68±1.64)mm;非活动期TAO组眼压为(15.42±2.49)mmHg,眼球突出度为(15.64±1.01)mm;健康对照组眼压为(15.72±2.38)mmHg,眼球突出度为(12.02±0.83)mm;活动期TAO组眼压及眼球突出度均高于非活动期TAO组和健康对照组,差异有统计学意义(均P<0.001).活动期TAO组CMCT值为(391.27±33.89)μm,非活动期TAO组为(317.31±29.62)μm,健康对照组为(304.26±42.26)μm,活动期TAO组的CMCT显著高于非活动期TAO组和健康对照组,差异有统计学意义(均P<0.001).在单变量分析中,较厚的CMCT与眼压显著相关(t=4.600,P<0.001);校正眼压后,较厚的CMCT与CAS显著相关(β=0.848,95％CI 15.608～21.499,P<0.001).多变量分析结果显示较厚的CMCT与CAS(P<0.001)、甲状腺功能(P<0.001)、眼压(P=0.039)存在相关性.结论 活动期TAO患眼的CMCT增高,CMCT检查对评估TAO患者病变的活动度可能具有一定参考价值.%Objective To compare the differences in the central macular choroidal thickness (CMCT) between thyroid-associated ophthalmopathy (TAO) patients in active and inactive stages, and the healthy subjects used spectral-domain optical coherence tomography (SD-OCT) and assess the potential of using CMCT as an indicator for follow-up of TAO patients. Methods Cross-sectional study. Eleven active stage TAO patients (22 eyes, active TAO group) and 21 inactive stage TAO patients (42 eyes, inactive TAO group) who received treatment at the Department of Ophthalmology, First People's Hospital of Nantong during January 2015 and December 2017 were enrolled. Twenty-three healthy subjects (46 eyes) with comparable ages to the two TAO groups were enrolled in the healthy control group. TAO activity was assessed using the TAO clinical activity score (CAS) system. All subjects underwent best corrected visual acuity, slit lamp examination, Goldmann tonometer for intraocular pressure measurement, direct ophthalmoscopy, A-superelocular measurement, ocular protrusion measurement, and SD-OCT detection of CMCT. The variance analysis was used to compare the differences of intraocular pressure, eyeball protrusion and CMCT between the three groups. The correlation between CMCT and various clinical indicators was analyzed by univariate linear regression analysis and multivariate linear regression analysis. Results The intraocular pressure and eyeball protrusion indicators of the active TAO group, the inactive TAO group, and the control group were (20.16 ± 3.49) mmHg (1 mmHg=0.133 kPa) and (18.68 ± 1.64) mm, (15.42 ± 2.49) mmHg and (15.64 ± 1.01) mm, (15.72 ± 2.38) mmHg and (12.02 ± 0.83) mm, respectively. The intraocular pressure and ocular protrusion of the active TAO group were higher than those of the inactive TAO group and the healthy control group, the differences between the groups are of statistical significance (all P<0.001). The CMCT value of the active TAO group, the inactive TAO group and the healthy control group were (391.27± 33.89)μm, (317.31±29.62)μm, and (304.26±42.26)μm, respectively. The CMCT of the active TAO group was significantly higher than the inactive group and the healthy control group, the differences between the groups are of statistical significance (all P<0.001). Based on univariate analysis, thicker CMCT was significantly associated with intraocular pressure (t=4.600, P<0.001);after correction of intraocular pressure, thicker CMCT was significantly associated with CAS (β =0.848, 95％CI 15.608-21.499, P<0.001). Multivariate analysis showed a correlation between thicker CMCT and CAS scores (P<0.001), thyroid function (P<0.001), and intraocular pressure(P=0.039). Conclusions The CMCT in the eyes of active TAO patients is higher than that of the inactive TAO patients and healthy people. The CMCT examination is of referential value, and may be used as a tool for assessing the activity of lesions in patients with TAO and clinical follow-up.