頁籤選單縮合
題 名 | 甲狀腺眼病變的致病機轉和處置=Pathogenesis and Management of Graves' Ophthalmopathy |
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作 者 | 張天鈞; | 書刊名 | 內科學誌 |
卷 期 | 8:2 1997.06[民86.06] |
頁 次 | 頁58-61 |
分類號 | 415.931 |
關鍵詞 | 葛瑞夫茲氏眼病變; 甲狀腺眼病變; 葛瑞夫茲氏病; 甲促素受器; Graves' ophthalmopathy; Thyroid-associated ophthalmopathy; Graves' disease; TSH receptor; |
語 文 | 中文(Chinese) |
中文摘要 | 典型的葛瑞夫茲氏病(Graves' disease)的臨床表現包括瀰 漫性甲狀腺腫併甲狀腺機能亢進症、眼病變、脛前黏液水腫和甲狀腺肢端病 變。甲狀腺機能亢進症的主要原因乃因病人血中有甲促素受器(TSH receptor)抗體,刺激甲狀腺,導致甲狀腺荷爾蒙的分泌過多。至於葛瑞 夫茲氏眼病變,簡稱甲狀腺眼病變,其致病機轉可能是可以和甲促素受器反 應的T細胞,認知到眼肌肉或眼球後結締組織的纖維細胞上的甲促素受器, 與之作用,然後分泌各種細胞激素,刺激它增生和分泌黏多醣。對其處置, 除了抽血測甲狀腺功能、甲狀腺抗體,用抗甲狀腺藥物將甲狀腺機能亢進控 制到正常外,可以做眼睛的電腦斷層攝影評估甲狀腺眼病變的程度、影響的 範圍,並評估活動性。若病人眼病變有活動性,可以使用藥物來治療。若沒 有活動性,且穩定不變,則視必要,可以手術,包括眼窩減壓手術、眼肌肉 手術、眼皮手術和美容手術。由於早期發現、早期治療可以得到最好的效果, 減少開刀的機會,因此在甲狀腺機能亢進時宜多注意有否眼病變,必要時給 予適當的治療。 |
英文摘要 | Typical clinical manifestations of Graves' disease may include diffuse goiter with hyperthyroidism, ophthalmopathy, pretibial myxedema and thyroid acropachy. Hyperthyroidism is related to the TSH receptor antibodies that stimulate thyroid gland to overproduce thyroid hormones. However, the exact pathogenesis of Graves' ophthalmopathy is unclear. It is possible that T-cells that react with TSH receptors of the thyroid, will also be targeted to the TSH receptors on fibroblasts of orbit, and secrete various cytokines that stimulate fibroblasts to proliferate, to express MHC class II antigens, and to synthesize collagen and glycosaminoglycans. The management of Graves' ophthalmopathy includes evaluation of thyroid function and determination of thyroid antibodies, then control of thyroid function to euthyroid state, and evaluation of the ophthalmopathy by orbit computed tomography and activity scores. If patients are in active state, they may be treated with immunosuppressive agents. if patients are in inactive and stable state, they may be treated with surgery which includes orbital decompression, eye muscle surgery, eye lid surgery and cosmetic surgery, if necessary. Early detection and early treatment are important for the management of Graves' ophthalmopathy.(J Inter Med Taiwan 1997;8:58-61) |
本系統中英文摘要資訊取自各篇刊載內容。