갑상샘눈병증의 질병 활성도에 따른 건성안의 임상양상과 관련 인자 분석
Clinical Features of Dry Eye in Thyroid-Associated Ophthalmopathy According to Disease Activity
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목적: 갑상샘눈병증 환자에서 질병 활성도에 따른 건성안의 임상양상을 분석하고 관련 인자들과의 연관성을 알아보고자 하였다. 대상과 방법: 본원에서 갑상샘눈병증과 연관된 건성안으로 진단 받은 157명 환자를 임상 활동도 점수(clinical activity score, CAS)에따라 비활동기군 90명 90안(CAS＜3)과 활동기군 67명 67안(CAS≥3)으로 분류하였다. 각 군에서 임상양상과 눈물막파괴시간, 쉬르머검사, 각막상피병증점수, 안구표면질환지수를 비교하고 이 지표들과 나이, 안구돌출도, 눈꺼풀틈새폭, 갑상샘호르몬과의 상관관계를 분석하였다. 결과: 비활동기 및 활동기군의 CAS는 각각 1.24 ± 0.69, 4.23 ± 1.13이었다. 활동기군에서 비활동기군에 비해 갑상샘자극호르몬결합억제 면역글로불린(thyrotropine binding inhibitory immunoglobulin) 수치가 높았으며 안와 전산화단층촬영에서 외안근 비대가더 흔하게 관찰되었다. 활동기군에서 비활동기군에 비해 눈물막 파괴시간은 짧았으며, 안구표면질환지수는 높았다. 두 군 모두에서눈물막 파괴시간은 안구돌출도 및 눈꺼풀틈새폭과 음의 상관관계를 보였고, 활동기 환자군에서 안구표면질환지수와 안구돌출도는양의 상관관계를 보였다. 결론: 건성안을 동반한 갑상샘눈병증 환자에서 활동기군은 비활동기군에 비해 눈물막파괴시간이 더 짧았으며 건성안 증상은 더 심한양상을 보였다. 또한 눈물막파괴시간은 모든 갑상샘눈병증 환자에서 안구돌출이 심할수록, 눈꺼풀틈새폭이 클수록 짧았다.
Abstract
Purpose: To evaluate the clinical features of dry eye in thyroid-associated ophthalmopathy (TAO) according to disease activity and analyze the related factors. Methods: This study included 157 patients diagnosed with TAO and dry eye between March 2009 and March 2015. According to the clinical activity score (CAS), TAO patients were divided into inactive (CAS < 3) and active (CAS ≥ 3) groups. Clinical features included age, sex, visual acuity, proptosis, palpebral fissure width, orbital computed tomography (CT) findings, thyroid hormones, and ocular surface parameters including tear film break-up time (TFBUT), Schirmer tests, keratoepitheliopathy scores, and ocular surface disease index (OSDI) were obtained and compared between the groups. In addition, correlations between clinical features and ocular surface parameters were analyzed in both groups. Results: In the inactive and active TAO groups, CAS was 1.24 ± 0.69 and 4.23 ± 1.13, respectively (p = 0.001). Thyrotropin-binding inhibitory immunoglobulin was significantly higher in the active TAO group than in the inactive TAO group (p = 0.048). On orbital CT, extraocular muscle hypertrophy was more common in the active TAO group than the inactive TAO group (p = 0.020). No significant difference was found in age, sex, visual acuity, free T4, and thyroid-stimulating hormone between the two groups. During analysis of the tear film and ocular surface parameters, TFBUT (p = 0.006) was shorter and OSDI score (p = 0.028) was higher in the active TAO group than the inactive TAO group. TFBUT was negatively correlated with proptosis (r = -0.432, p = 0.001; r = -0.308, p = 0.032) and palpebral fissure width (r = -0.367 p = 0.012; r = -0.312, p = 0.031) in both groups. OSDI was positively correlated with proptosis in the active TAO group (r = 0.301, p = 0.033). Conclusions: TFBUT was shorter and OSDI score higher in dry eye patients with active TAO than in patients with inactive TAO. The TFBUT was negatively correlated with proptosis and palpebral fissure width in both groups.
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