专家述评
ENGLISH ABSTRACT
关注适合中国人群的甲状腺眼病临床活动性评分方法
雷超宇
王慧
孙静
周慧芳
作者及单位信息
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DOI: 10.3760/cma.j.cn115989-20240418-00112
Focusing on clinical activity score of thyroid eye disease suitable for Chinese population
Lei Chaoyu
Wang Hui
Sun Jing
Zhou Huifang
Authors Info & Affiliations
Lei Chaoyu
Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Center for Basic Medical Research and Innovation in Visual System Diseases of Ministry of Education, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
Wang Hui
Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Center for Basic Medical Research and Innovation in Visual System Diseases of Ministry of Education, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
Sun Jing
Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Center for Basic Medical Research and Innovation in Visual System Diseases of Ministry of Education, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
Zhou Huifang
Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Center for Basic Medical Research and Innovation in Visual System Diseases of Ministry of Education, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
·
DOI: 10.3760/cma.j.cn115989-20240418-00112
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摘要

甲状腺眼病(TED)是与甲状腺疾病密切相关的致盲眼眶病,严重影响患者的视功能和生活质量。25%~50%的弥漫性毒性甲状腺肿患者会继发TED。活动性分期是TED的重要评估指标,对于临床病情评估、治疗方案制定、预后评估等十分关键,而临床活动性评分(CAS)是目前国内外应用广泛的分期方法。为了提升CAS评价的准确性和一致性,欧洲Graves眼病专家组在TED指南中推荐使用CAS评分图谱。然而,该图谱主要基于高加索人,鉴于中国人与高加索人眼眶的解剖学差异以及眼部特征的不同,需要综合现有指南中评分细则进一步完善CAS评分,从而规范其在中国TFD患者中的操作方法和判断标准,为疾病精准诊疗提供可靠依据。

甲状腺眼病;临床活动性评分;图谱
ABSTRACT

Thyroid eye disease (TED) is an orbital disease closely associated with thyroid disorders, with 25%-50% of patients with diffuse toxic goiter (Graves Disease) developing secondary TED, which can lead to blindness and disability and significantly impair patients' visual function and quality of life.Activity staging is a crucial assessment index for TED and is essential for clinical evaluation, treatment planning, and prognosis.The Clinical Activity Score (CAS) is currently the most widely used method for this purpose both domestically and internationally.To improve the accuracy and consistency of CAS evaluations, the European Group of Graves' Orbitopathy (EUGOGO) recommended the use of a CAS scoring atlas in the TED guidelines.However, existing atlases are primarily based on Caucasians.Considering the anatomical differences in the orbit between Chinese and Caucasians and the resulting divergent ocular characteristics, there is a need for a comprehensive interpretation of the CAS scoring details in the current guidelines.This should be followed by further refinement to tailor the CAS scoring criteria to Chinese patients with TED.Such measures will standardize the operational methods and judgment criteria of CAS scoring in China, thereby providing a reliable basis for the accurate diagnosis and treatment of the disease.

Thyroid eye disease;Clinical activity score;Atlas
Zhou Huifang, Email: nc.defudabe.utjsgnafzzgnaf;
Sun Jing, Email: mocdef.6ab21jsaihpos
引用本文

雷超宇,王慧,孙静,等. 关注适合中国人群的甲状腺眼病临床活动性评分方法[J]. 中华实验眼科杂志,2024,42(11):977-982.

DOI:10.3760/cma.j.cn115989-20240418-00112

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*以上评分为匿名评价
甲状腺眼病(thyroid eye disease,TED)是一种与甲状腺疾病密切相关的器官特异自身免疫性疾病,为成人常见的眼眶病;25%~50%的弥漫性毒性甲状腺肿(Graves disease)患者会继发TED;TED亦可见于甲状腺功能减退和甲状腺功能正常人群 [ 1 , 2 , 3 ]。该病的临床表现为眼球、眼睑、眼表的形态、位置或功能异常,主要包括眼球突出、眼睑退缩、限制性斜视、复视、眼睑肿胀、暴露性角膜病变等,甚至在5%~6%的患者中会出现视神经病变,同时损害视功能与外观,严重影响患者的生活质量 [ 4 ]。按照疾病发生的不同阶段,TED可分为活动期和静止期,初始的活动期以炎症性改变为特征,包括眼睑肿胀、眼睑充血、结膜水肿、结膜充血和泪阜水肿等,在起病18~24个月后进入静止期,充血水肿消退,表现为稳定的眼球突出、眼睑退缩和眼外肌受累 [ 2 ]。对TED进行活动性评估,是治疗方案制定、手术时机选择与预后评估的重要依据。
临床活动性评分(clinical activity score,CAS)是常用的评估TED活动性分期的方法,由Mourits等 [ 5 ]于1989年首次提出,该方法纳入7项临床指标(5项眼部外观改变结合2项患者眼部疼痛情况)进行评分,每项阳性记为1分,总分≥3分即为活动期,否则为静止期。由于该评分方法仅纳入眼部表现、评估标准简单易学、可操作性强、无需使用特殊设备,以及良好的激素冲击治疗疗效预测能力,使其历经30余年,仍然为国际上广泛使用。目前,该方法由2021年欧洲Graves眼病专家组(EUGOGO)甲状腺眼病临床实践指南(以下简称"EUGOGO指南") [ 6 ]、中国甲状腺眼病诊断和治疗指南(2022年) [ 7 ]、2022年欧洲甲状腺学会(ETA)与美国甲状腺学会(ATA)联合发布的甲状腺眼病管理的共识声明(以下简称"ATA/ETA共识") [ 8 ]共同推荐。
为了提高CAS评分的准确性和一致性,EUGOGO指南和ATA/ETA共识均推荐使用CAS评分图谱,其包含了各个项目的详细描述和示例图片,以便评估者进行对比和参考 [ 9 ]。然而,该评分图谱中的描述与示例图片均来源于高加索人。考虑到中国人和高加索人的眼眶解剖学差异,以及由此产生的眼部特征不同 [ 10 , 11 ],有必要综合解析现有评分标准进一步完善CAS评分从而规范其在中国TED人群中的操作方法和判断标准。
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备注信息
A
周慧芳,Email: nc.defudabe.utjsgnafzzgnaf
B
孙静,Email: mocdef.6ab21jsaihpos
C
所有作者均声明不存在利益冲突
D
国家自然科学基金 (82388101、82071003、82271122)
上海交通大学医学院附属第九人民医院管理研究项目 (YGA202303)
上海交通大学医学院附属第九人民医院临床研究助力计划 (JYLJ202120)
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