본문 바로가기
KERD
논문KCI 등재

갑상샘관련 근병증과 비특이성 안근염에서의안와지방과 외안근 밀도의 비교

Density of Orbital Fat and Extraocular Muscle in Thyroid-Associated Myopathy and Idiopathic Orbital Myositis

정우진|안희배|정혜미
대한안과학회 (The Korean Ophthalmological Society)|2013.11|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제54권 제11호|pp. 1641-1648

1

조회

0

다운로드

0

인용

0

참고문헌

키워드

Hounsfield UnitIdiopathic orbital myositisDensity of extraocular muscleDensity of orbital fatThyroid-asso ciated myopathy
주제분류안과학

초록

목적: 갑상샘관련 근병증과 비특이성 안근염, 그리고 정상안의 감별진단을 위하여 안와 컴퓨터 단층촬영상에서 안와지방과 외안근밀도를 정량화하고 비교분석하였다. 대상과 방법: 2005년 2월부터 2013년 1월까지 본원에서 진단받은 갑상샘눈병증 중 갑상샘관련 근병증이 있는 환자 47명 90안, 비특이성 안근염 환자 14명 18안, 10-70대 정상인 140명 280안을 대상으로 안와 컴퓨터 단층촬영을 하여 안와지방과 외안근 밀도를Hounsfield Unit으로 측정하여 비교하였다. 또한 갑상샘관련 근병증 환자군과 정상인군과의 연령별 비교를 시행하였으며 갑상샘관련근병증에서의 임상활동도 점수, 안구돌출 유무, 그리고 유병기간에 따른 밀도 차이를 분석하였다. 결과: 갑상샘관련 근병증의 안와지방과 외안근의 밀도는 -87.8 ± 12.5 HU, 48.7 ± 7.1 HU였고 비특이성 안근염에서는 각각 -79.9± 9.9 HU, 49.2 ± 9.1 HU로 나타나 갑상샘관련 근병증에서 안와지방의 밀도가 유의하게 낮은 결과를 보였으나(p=0.002) 외안근의밀도는 통계학적으로 유의한 차이를 보이지 않았다(p=0.775). 정상인의 안와지방과 외안근의 밀도는 각각 -79.0 ± 11.2 HU, 54.3± 6.3 HU로 측정되어 정상인보다 갑상샘관련 근병증에서 모두 유의하게 낮은 결과를 보였다(p=0.000). 갑상샘관련 근병증의 임상활동도 점수가 4 이상 활동성인 경우와 안구돌출이 동반된 경우 안와지방 밀도는 큰 차이가 없는 반면(p=0.345, p=0.952), 외안근의밀도는 유의하게 감소하였다(p=0.007, p=0.003). 결론: 안와 컴퓨터 단층촬영으로 얻어지는 Hounsfield Unit를 통해 갑상샘관련 근병증과 비특이성 안근염의 안와지방 및 외안근의 밀도차이를 정량적으로 확인할 수 있었다.

Abstract

Purpose: To perform and compare differential diagnosis of patients with thyroid-associated myopathy, idiopathic orbital myositis and normal controls based on orbital computed tomography. Orbital fat and extraocular muscle densities were quantified using Hounsfield Unit (HU) and their characteristics were compared and analyzed. Methods: From February 2005 to January 2013, orbital computed tomography was performed on 90 eyes of 47 thyroid-associated myopathy patients, 18 eyes of 14 idiopathic orbital myositis patients and 280 eyes of 140 normal subjects. The average values of orbital fat and extraocular muscle densities were measured and compared using HU. The density differences between the patients with thyroid-associated myopathy and the normal group were analyzed by age, clinical activity score, ocular protrusion and disease duration. Results: In the thyroid-associated myopathy group, orbital fat and extraocular muscle densities were -87.8 ± 12.5 HU and 48.7 ± 7.1 HU, respectively. In the idiopathic orbital myositis group, the orbital fat and extraocular muscle densities were 79.9 ± 9.9 HU and 49.2 ± 9.1 HU, respectively. There was a statistically significant lower result of orbital fat in the thyroid-associated myopathy group (p = 0.002), however, the extraocular muscle density did not show a statistically significant difference (p = 0.775). The orbital fat and extraocular muscle densities of the normal group were -79.0 ± 11.2 HU and 54.3 ± 6.3 HU, respectively. There were significantly lower results in both orbital fat and extraocular muscle densities in the thyroid-associated myopathy group than normal group (p = 0.000). In active cases and those accompanied by ocular protrusion, there was no significant difference in orbital fat density (p = 0.345 and p = 0.952, respectively), while extraocular muscle density significantly decreased (p = 0.007 and p = 0.003, respectively). Conclusions: A difference between the orbital fat and extraocular muscle densities in thyroid-associated myopathy and idiopathic orbital myositis could be quantitatively found using HU and orbital computed tomography.

참고문헌 (38)

  1. Lutt JR, "Orbital inflammatory disease", Semin Arthritis Rheum, 37, pp.207~222 (2008)
  2. Tanenbaum M, "Grave's Ophthalmopathy. In Oculoplastic Surgery", pp.379~416 (1995), Raven Press, Ltd
  3. Kiljanski JI, "The ocular muscle cell is a target of the immune system in endocrine ophthalmopathy", Int Arch Allergy Immunol, 106, pp.204~212 (1995)
  4. Bahn RS, "Pathogenesis of Graves’ ophthalmopathy", N Engl J Med, 329, pp.1468~1475 (1993)
  5. Nunery WR, "Ophthalmic Graves’ disease: A dual theory of pathogenesis", Ophthalmol Clin North Am, 4, pp.73~87 (1991)
  6. 김재련, "갑상샘안병증에서 건성안에 영향을 미치는 인자", 대한안과학회지, 52(7), pp.771~776 (2011), 대한안과학회
  7. Bartley GB, "Clinical features of Graves’ ophthalmopathy in an incidence cohort", Am J Ophthalmol, 121, pp.284~290 (1996)
  8. Mombaerts I, "Current status in the treatment of orbital myositis", Ophthalmology, 104, pp.402~408 (1997)
  9. Mannor GE, "Outcome of orbital myositis. Clinical features associated with recurrence", Ophthalmology, 104(409), pp.13~ (1997)
  10. Scott IU, "Idiopathic orbital myositis", Curr Opin Rheumatol, 9, pp.504~512 (1997)
  11. Nugent RA, "Graves orbitopathy: Correlation of CT and clinical findings", Radiology, 177, pp.675~682 (1990)
  12. Regensburg NI, "Densities of orbital fat and extraocular muscles in Graves’ orbitopathy patients and controls", Ophthal Plast Reconstr Surg, 27, pp.236~240 (2011)
  13. Gerding MN, "Association of thyrotrophin receptor antibodies with the clinical features of Graves’ ophthalmopathy", Clin Endocrinol (Oxf), 52, pp.267~271 (2000)
  14. 15)Werner SC, "Modification of the classification of the eye changes of Graves’ disease: Recommendations of the Ad Hoc Committee of the American thyroid association", J Clin Endocrinol Metab, 44, pp.203~204 (1977)
  15. Eckstein AK, "Thyrotropin receptor autoantibodies are independent risk factors for Graves’ ophthalmopathy and help to predict severity and outcome of the disease", J Clin Endocrinol Metab, 91, pp.3464~3470 (2006)
  16. Dijkstal JM, "Normal exophthalmometry measurements in United states pediatric population", Ophthal Plast Reconstr Surg, 28, pp.54~56 (2012)
  17. Yang YW, "A clinical analysis of thyroid diseases among Korean", J Korean Surg Soc, 46, pp.781~794 (1994)
  18. Choi KM, "Thyroid diseases in Korean", J Korean Surg Soc, 40, pp.13~19 (1991)
  19. Dolman PJ, "VISA Classification for Graves’ orbitopathy", Ophthal Plast Reconstr Surg, 22, pp.319~324 (2006)
  20. Kendler DL, "The initial clinical characteristics of Graves’ orbitopathy vary with age and sex", Arch Ophthalmol, 111, pp.197~201 (1993)
  21. Jang SY, "Clinical features of thyroid associated ophthalmopathy in clinically euthyroid Korean patients", Eye (Lond), 26, pp.1263~1269 (2012)
  22. Forbes GS, "Computed tomography of orbital tumors, including late-generation scanning techniques", Radiology, 142, pp.387~394 (1982)
  23. Feldon SE, "Quantitative computed tomography of Graves’ ophthalmopathy. Extraocular muscle and orbital fat in development of optic neuropathy", Arch Ophthalmol, 103, pp.213~215 (1985)
  24. Hallin ES, "Graves’ ophthalmopathy: I. simple CT estimates of extraocular muscle volume", Br J Ophthalmol, 72, pp.674~677 (1988)
  25. Chen YL, "Relationship of eye movement to computed tomographic findings in patients with Graves’ ophthalmopathy", Acta Ophthalmol (Acta Ophthalmol), 72, pp.472~477 (1994)
  26. 박정민, "안과 초진시 갑상선항진증 환자의 안증상 및 외안근의 변화", 대한안과학회지, 44(10), pp.2~2203 (2003), 대한안과학회
  27. Mull RT, "Mass estimates by computed tomography: Physical density from CT numbers", AJR Am J Roentgenol, 143, pp.1101~1104 (1984)
  28. Kim DJ, "Relations between extracorporeal shockwave lithotripsy success and hounsfield units", Kwandong Med J, 10, pp.13~15 (2006)
  29. Choi HJ, "The clinical significance of hounsfield number of metallic and non-metallic foreign bodies in the soft tissue", Soonchunhyang Med J, 16, pp.226~230 (2010)
  30. Kim HC, "Differentiation of chromophobe renal cell carcinoma and clear cell renal cell carcinoma by using helical CT", Yeungnam Univ J Med, 29, pp.14~18 (2012)
  31. Garrity JA, "Pathogenesis of graves ophthalmopathy: Implications for prediction, prevention, and treatment", Am J Ophthalmol, 142, pp.147~153 (2006)
  32. Bahn RS, "Graves’ ophthalmopathy", N Engl J Med, 362, pp.726~738 (2010)
  33. Bartalena L, "Novel immunomodulating agents for Graves’ orbitopathy", Ophthal Plast Reconstr Surg, 24, pp.251~256 (2008)
  34. Prabhakar BS, "Current perspective on the pathogenesis of Graves’ disease and ophthalmopathy", Endocr Rev, 24, pp.802~835 (2003)
  35. Smith TJ, "Stimulation of glycosaminoglycan accumulation by interferon gamma in cultured human retroocular fibroblasts", J Clin Endocrinol Metab, 72, pp.1169~1171 (1991)
  36. Smith TJ, "Leukoregulin is a potent inducer of hyaluronan synthesis in cultured human orbital fibroblasts", Am J Physiol, 268(2 Pt 1), pp.C382~C388 (1995)
  37. Smith TJ, "Immunoglobulins from patients with Graves’ disease induce hyaluronan synthesis in their orbital fibroblasts through the self-antigen, insulin-like growth factor-I receptor", J Clin Endocrinol Metab, 89, pp.5076~5080 (2004)
  38. 김대홍, "한국인의 정상 외안근 크기 및 갑상선 안병증 환자에서 외안근의 크기 변화", 대한안과학회지, 42(2), pp.321~328 (2001), 대한안과학회

관련 논문AI추천

갑상샘눈병증에서 갑상샘자극항체 수치 변화에 따른 외안근 두께 변화의 상관관계 분석곽지영, 이동철대한안과학회 · 대한안과학회지2021 · 제62권 제10호갑상샘눈병증에서 안와감압술 전후 외안근 부피 변화의 영상분석: Nunery 분류법 제1형과 2형 비교백지선, 양석우, 조원경, 황규연대한안과학회 · 대한안과학회지2013 · 제54권 제1호사시가 동반된 갑상샘눈병증 환자군과 사시가 없는 갑상샘눈병증 환자군의 특징 비교김승현, 이주연, 최경준대한안과학회 · 대한안과학회지2015 · 제56권 제10호위눈꺼풀뒤당김을 동반한 특발안와근염 사례군 연구사호석, 양민규, 조용하, 하성정대한안과학회 · 대한안과학회지2025 · 제66권 제3호그레이브스안병증에서 사시수술을 한 환자군과 하지 않은 환자군의 특징 비교안정효, 이상민, 정재호대한안과학회 · 대한안과학회지2020 · 제61권 제5호The Change of Lacrimal Gland Volume in Korean Patients with Thyroid-associated Ophthalmopathy김성재, 김지혜, 서성욱, 유지명, 허현도대한안과학회 · Korean Journal of Ophthalmology2016 · 제30권 제5호

이 간행물의 다른 논문 (24건)

24개월 이상 선천 코눈물관막힘 환아의 단계적탐침술을 동반한 단, 상하누소관 실리콘관 효과염지현, 백세현, 이태수, 장민욱, 이화pp. 1635-1640원발군날개 절제술 후 눈물막의 변화김상수, 김남억pp. 1649-1654공여편 삽입 방법에 따른 데스메막박리 각막내피층판이식술의 임상결과 비교황규연, 주천기, 백지원pp. 1655-1662대규모 불산 누출사고가 지역사회의 눈 건강에 미치는 영향박상혁, 김용준, 최경식pp. 1663-1668안내후방콘텍트렌즈 크기교체술을 시행한 후vault의 변화 양상김진국, 조은영, 김욱겸, 김희선pp. 1669-1674
원문 보기