医学--graves眼病的诊治进展.ppt

TAO发病呈双峰表现，40岁左右是高峰，60岁左右是次高峰，首发症状是眼睑挛缩，占70%， 不是所有的TAO病程都是由0级向6级顺序典型发展的，有的病人眼球突出并不严重就产生了压迫视神经的病变。 活动性指征： 病程18 m 预测GO活动性为76%； CAS ≥4 预测GO活动性为65% ；眼眶CT（ 奥曲肽扫描眶与枕骨摄取比？） 1.85 预测GO活动性为68% ；眼肌US 30 % 预测GO活动性为85%；MRI 炎症致粘多糖眶后沉积，水肿，T2加权信号增强。最大T2相眼肌松弛时间 130Msee预测GO活动性为64%；血清/尿标志物：GAGs (glycosaminoglycans)为长链多糖复合物，可作为Graves眼病活动性的指标；协助选择抗炎/免疫抑制治疗的患者；追踪疗效；简单、价廉。1、2和4同时存在预测GO活动性为79% ； 辅助检查的进步不断为估计疗效提供依据。 QOL生活质量量表 EUGOGO recommends the following classification of patients with GO (IV, C): 1. Sight-threatening GO: patients with dysthyroid optic neuropathy (DON) and/or corneal breakdown. This category warrants immediate intervention. Moderate to severe GO: patients without sight-threatening GO whose eye disease has sufficient impact on daily life to justify the risks of immunosuppression (if active) or surgical intervention (if inactive). Patients with moderate to severe GO usually have any one or more of the following: lid retraction ≥2mm, moderate or severe soft tissue involvement, exophthalmos $3mm above normal for race and gender, inconstant or constant diplopia. Mild GO: patients whose features of GO have only a minor impact on daily life insufficient to justify immunosuppressive or surgical treatment. They usually only have one or more of the following: minor lid retraction (2mm), mild soft tissue involvement, exophthalmos3mm above normal for race and gender,transient or no diplopia, corneal exposure responsive to lubricants. EUGOGO recommends the following classification of patients with GO (IV, C): 1. Sight-threatening GO: patients with dysthyroid optic neuropathy (DON) and/or corneal breakdown. This category warrants immediate intervention. Moderate to severe GO: patients without sight-threatening GO whose eye disease has sufficient impact on daily life to justify the risks of immunosuppression (if active) or surgical intervention (if inactive). Patients with moderate to severe GO usually have any one or more of the following: lid retractio