스테로이드 전신투여가 갑상샘눈병증 연관 사시 예후에 미치는 영향 분석
Effect and Prognostic Factors of Systemic Steroid Treatment for Strabismus Associated Thyroid Ophthalmopathy
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목적: 스테로이드 전신투여가 갑상샘눈병증과 연관된 사시에 미치는 영향을 알아보고자 하였다. 대상과 방법: 갑상샘눈병증과 연관된 사시가 있는 환자에서 경구 또는 정맥으로 스테로이드를 전신투여한 후 1년 이상 경과관찰된 환자를 대상으로 의무기록을 후향적으로 분석하였다. 치료 후 최종 경과관찰 때까지 사시가 없어진 군을 개선 군, 변화 없는 군을 안정 군, 사시가 심해진 군을 악화 군으로 분류하여 각 군의 특징을 알아보았다. 결과: 총 22명의 환자에서 개선 군과 안정 군은 15명(68.1%), 악화 군이 7명(31.9%)이었다. 성별 분포에서 개선 군과 안정 군 15명 중에 11명이 여성이었고, 악화 군은 7명 중 6명이 남성이었다(p=0.012). 또한 개선 군과 안정 군 15명 중 2명이 흡연력이 있었지만 스테로이드 치료 시작 이후에는 금연을 하였고, 악화 군에서는 7명 중 5명이 흡연력이 있었고 치료 후에도 흡연을 지속하였다(p=0.001). 그밖에 연령, 복시기간, 치료 방법, 치료 전 사시각 및 갑상샘 기능 등은 두 군 간에 차이가 없었다. 결론: 스테로이드 치료는 갑상샘눈병증에 동반된 사시를 개선 또는 안정시킬 수 있으나 치료 중 흡연과 금연 여부에 따라 치료 효과가 다를 수 있을 것으로 생각된다.
Abstract
Purpose: To investigate the effect of steroid treatment on strabismus associated with thyroid ophthalmopathy. Methods: The present retrospective study was conducted on 22 patients diagnosed with strabismus associated with thyroid ophthalmopathy, who were treated with steroids orally or intravenously and followed up for more than one year. Patients were divided into three groups for analysis: an improved group, with no strabismus at the final follow-up visit; a stable group, with no change in the strabismus angle; and a deteriorated group, in which the strabismus angle had worsened. We investigated the characteristics of each group. Results: In the gender/sex distribution of the 22 patients, 11 of the 15 patients in the improved or stable group were female; six of seven patients in the deteriorated group were male (p = 0.012). Two of the 15 patients in the improved or stable group had a smoking history. However, none smoked after the treatment had started. On the other hand, five of seven patients in the deteriorated group had a smoking history and continued to smoke during and after treatment (p = 0.001). No significant between-group differences were observed with respect to age, diplopia period, strabismus angle, or thyroid function level. Conclusions: Treatment with steroids may improve or stabilize strabismus associated with thyroid ophthalmopathy. However, the effect of treatment may differ, depending on whether the patient continues to smoke after treatment is initiated.
참고문헌 (23)
- Tagami T, "High-dose intravenous steroid pulse therapy in thyroid-associated ophthalmopathy", Endocr J, 43, pp.689~699 (1996)
- Kauppinen-Mäkelin R, "High dose intravenous methylprednisolone pulse therapy venous oral prednisone for thyroid-associated ophthalmopathy", Acta Ophthalmol Scand, 80, pp.316~321 (2002)
- Kahaly GJ, "Randomized, single blind trial of intravenous versus oral steroid monotherapy in graves’ orbitopathy", J Clin Endocrinol Metab, 90, pp.5234~5240 (2005)
- Cockerham KP, "Thyroid eye disease", Neurol Clin, 28, pp.729~755 (2010)
- Dolman PJ, "Orbital radiotherapy for thyroid eye disease", Curr Opin Ophthalmol, 23, pp.427~432 (2012)
- Ye X, "Efficacy and safety of mycophenolate mofetil in patients with active moderate-to-severe graves’ orbitopathy", Clin Endocrinol, 8, pp.247~255 (2017)
- Prendiville P, "The role of restricted motility in determining outcomes for vertical strabismus surgery in graves’ ophthalmology", Ophthalmology, 107, pp.545~549 (2000)
- 최경준, "사시가 동반된 갑상샘눈병증 환자군과 사시가 없는 갑상샘눈병증 환자군의 특징 비교", 대한안과학회지, 56(10), pp.1610~1616 (2015), 대한안과학회
- 이연희, "갑상샘눈병증과 관련된 사시의 자연경과", 대한안과학회지, 47(12), pp.1993~1998 (2006), 대한안과학회
- 우경인, "한국인 갑상샘 기능 이상 환자에서 갑상샘눈병증의 임상 특징", 대한안과학회지, 49(9), pp.1387~1396 (2008), 대한안과학회
- Lim NC, "Thyroid eye disease : a southeast Asian experience", Br J Ophthalmol, 99, pp.512~518 (2015)
- Bertelsen JB, "Cigarette smoking and the thyroid", Thyroid, 4, pp.327~331 (1994)
- Bartalena L, "Cigarette smoking and treatment outcomes in graves ophthalmopathy", Ann Intern Med, 129, pp.632~635 (1998)
- Eckstein A, "Impact of smoking on the response to treatment of thyroid associated ophthalmopthy", Br J Ophthalmol, 87, pp.773~776 (2003)
- Metcalfe RA, "Stimulation of extraocular muscle fibroblasts by cytokines and hypoxia : possible role in thyroid-associated ophthalmopathy", Clin Endocrinol, 40, pp.67~72 (1994)
- Tan GH, "Interleukin-1(IL-1)receptor antagonist and soluble IL-1 receptor inhibit IL-1 induced glycosaminoglycan production in cultured human orbital fibroblasts from patients with graves’ ophthalmopathy", J Clin Endocrinol Metab, 81, pp.449~452 (1996)
- Hofbauer LC, "Soluble interleukin-1 receptor antagonist serum levels in smokers and nonsmokers with graves’ ophthalmopathy undergoing orbital radiotherapy", J Clin Endocrinol Metab, 82, pp.2244~2247 (1997)
- Bartalena L, "Treating severe graves’ophthalmopathy", Baillieres Clin Endocrinol Metab, 11, pp.521~536 (1997)
- Kendall-Taylor P, "Intravenous methylprednisolone in the treatment of graves’ ophthalmopathy", BMJ, 297, pp.1574~1578 (1988)
- Ohtsuka K, "Effect of high-dose intravenous steroid pulse therapy followed by 3-month oral steroid therapy for graves’ ophthalmopathy", Jpn J Ophthalmol, 46, pp.563~567 (2002)
- Marcocci C, "Comparison of the effectiveness and tolerability of intravenous or oral glucocorticoids associated with orbital radiotherapy in the management of severe graves’ ophthalmopathy : results of a prospective, single-blind, randomized study", J Clin Endocrinol Metab, 86, pp.3562~3567 (2001)
- Marcocci C, "Novel aspects of immunosuppressive and radiotherapy management of graves’ophthalmopathy", J Endocrinol Invest, 27, pp.272~280 (2004)
- Marinó M, "Acute and severe liver damage associated with intravenous glucocorticoid pulse therapy in patients with graves’ ophthalmopathy", Thyroid, 14, pp.403~406 (2004)