사시가 동반된 갑상샘눈병증 환자군과 사시가 없는 갑상샘눈병증 환자군의 특징 비교
Comparison of Patient Characteristics in Thyroid-Associated Ophthalmopathy with and without Strabismus
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목적: 사시가 동반된 갑상샘눈병증 환자들이 사시가 없는 갑상샘눈병증 환자들과 비교하여 어떠한 혈청 자가항체와 안과 특징을 가지고 있는지 알아보고자 한다. 대상과 방법: 2011년 8월부터 2013년 12월까지 안과에 내원하여 갑상샘눈병증으로 진단 받은 환자 39명 중에 사시를 동반한 환자15명 25안과, 사시가 동반되지 않은 환자 24명 39안을 대상으로 후향적으로 의무기록을 분석하였다. 시력, 안압, Hertel 안구돌출계값, 연조직점수(soft tissue score), 전산화 단층촬영상 외안근의 비대 여부 등을 비교하였다. 첫 진단 시 또는 치료 시작 전 시행한갑상샘눈병증 관련 자가 혈청 항체 역가와 양성률을 비교하였다. 결과: 두 군 간에 성별, 흡연자의 비율은 유의한 차이가 없었다. 사시가 동반된 환자군 평균연령은 52.53세였고, 사시가 없는 환자군은40.33세로 전자의 경우가 더 높았다(p=0.004). 두 군 간 시력, 안압의 차이는 없었다. 사시가 동반된 갑상샘눈병증군에서 안구돌출이작은 것으로 나타났고(16.84 mm, 18.67 mm), 연조직점수는 유의한 차이가 없었다. 외안근의 비대 여부는 사시가 동반된 환자군에서높은 양성률을 보였다(p=0.000). 사시가 동반된 군에서 갑상샘자극호르몬 수용체 항체가 더 높은 항체 역가와 양성률을 보였다(역가=12.71, p=0.021). 결론: 갑상샘눈병증 환자 중 사시가 동반된 경우 연령이 더 높았고 갑상샘자극호르몬 수용체 항체의 역가와 양성률이 높았다. 그리고근육비대가 나타나는 비율이 더 높았고, 안구돌출 정도는 덜한 것으로 나타났다.
Abstract
Purpose: To determine immunochemical and clinical differences in thyroid-associated ophthalmopathy (TAO) patients with restrictive strabismus and without strabismus. Methods: A retrospective chart review of 15 TAO patients with strabismus (25 eyes) and 24 TAO patients without strabismus (39 eyes) who presented to the Ophthalmology Clinic between August 2011 and December 2013 was performed. Visual acuity, intraocular pressure (IOP), Hertel exophthalmometry, soft tissue score, and enlargement of extraocular muscles on computed tomography (CT) were obtained and compared in each group. Thyroid related autoantibody (thyroid-stimulating hormone receptor antibody, TRAb; thyroid peroxidase antibody, TPOAb; anti-thyroglobulin antibody, TgAb) titers and positive rates were obtained at the time of diagnosis or before treatment and analyzed. Results: The gender and smoking proportion were not significantly different between the 2 groups. The mean age of TAO patients with strabismus was 52.53 years and of TAO patients without strabismus 40.33 years (p = 0.004). The differences in visual acuity and IOP between the 2 groups were not significant. Hertel exophthalmometry showed less proptotis in the TAO with strabismus group than the TAO without strabismus group (16.84 mm versus 18.67 mm). The soft tissue score was not significantly different. The extraocular muscle enlargement rate of TAO with strabismus was significantly higher than in TAO without strabismus group. In the TAO with strabismus group, TRAb level was higher than in the TAO without strabismus group (p = 0.021). Conclusions: The TAO with strabismus group was older and had higher positive rate, level of TRAb, and extraocular muscle enlargement rate on CT than the TAO without strabismus group. Furthermore, proptosis was less definite in the TAO with strabismus group.
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