【摘要】  甲状腺相关性眼病（TAO）是眼眶病中最常见的疾病，大部分与甲状腺疾病相关，属于自身免疫性疾病。部分TAO有自愈倾向，尽管大多数TAO球后组织都有特征性的改变，但临床上只有30％～50％的患者出现明显眼部症状，3％～5％的患者视力累及。TAO具体的发病机制尚未明确。目前认为细胞因子，特别是TNF-α，是疾病主要的调节因子。而眼眶内成纤维细胞抗原的表达，是发病的关键因素。经过长期的临床研究，根据疾病活动性和严重程度，已经总结出相应有效的治疗方案。通过免疫学、病理学、分子生物学的研究，可以进一步明确TAO的发病机制。为指导各种有效新药物的开发，找到更合理、更有效的治疗开辟道路。

【关键词】  甲状腺相关性眼病；发病机制；治疗

    Thyroid-associated ophthalmopathy: cu-rrent concepts regarding etiopathogenesis and management

    Min Chen, Xiang-Tian Zhou, Wen Sheng, Jia Qu

    Eye Hospital of Wenzhou Medical College, Wenzhou 325027, Zhejiang Province, China

    Abstract  Thyroid-associated Ophthalmopathy (TAO) is the most frequent autoimmune disease in the orbit disease, which is always related to thyroid disease. Some TAO patients will recover without any treatments. Although characteristic changes in retrobulbar tissues are detectable on orbital imaging in almost all patients with TAO, clinically apparent ophthalmopathy occurs in 30%-50% of patients, with severe and potentially sight-threatening forms affecting 3%-5% of patients. The precise immunopathogenesis remains an enigma. Several clinical studies have provided a more rational basis for treatment of this distressing disease, according to the severity and activity of the eye disease. In recent years Cytokines (TNF et al) have been suggested to play a pivotal role in the pathogenesis of TAO as mediators of autoimmune inflammation, at the heart of orbital susceptibility to Graves' disease appears to be the peculiar phenotype of orbital fibroblasts. With the development of research with regard to immunology, pathology and molecular biology, we will know more about the pathogenesis for the TAO disease, which will also promote to create the new effective drugs and find more reasonable treatment plan.

    · KEYWORDS: thyroid-associated ophthalmopathy; pathogenesis; management

    Chen M, Zhou XT, Sheng W, Qu J. Thyroid-associated ophthalmopathy: current concepts regarding etiopathogenesis and management. Int J Ophthalmol(Guoji Yanke Zazhi) ,2006;6(4):875-878

      0 引言

    TAO具体发病机制不明确，目前公认属于自身免疫性疾病。淋巴细胞（主要是T细胞）参与了自身免疫。而各种细胞因子，特别是TNF-α，是自身免疫反应主要的调节因子。眼眶内成纤维细胞抗原的表达，是发病的关键因素[1]。目前已初步开展TNF-α的基因多态性、HLA与TAO相关性的研究。对于TAO的治疗，经过多年的临床研究和总结。根据疾病的活动性和严重程度，已经有不同的相对合理的治疗方案。全身大剂量的激素冲击治疗和放射治疗的联合或单独使用被证明是最有效的治疗方案。眼眶减压术经历一个多世纪的发展，在手术方案设计和手术技巧上已经取得了长足的进步。但是除了暴露性角膜炎或视神经压迫引起视力下降的情况，一般只应用于疾病处于静止期的患者。而从长远眼光看，眼眶减压术是TAO最为有效的治疗[2]。

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