CLINICAL-CRITERIA FOR THE ASSESSMENT OF DISEASE-ACTIVITY IN GRAVES OPHTHALMOPATHY - A NOVEL-APPROACH
CLINICAL-CRITERIA FOR THE ASSESSMENT OF DISEASE-ACTIVITY IN GRAVES OPHTHALMOPATHY - A NOVEL-APPROACH
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DOI：
10.1136/bjo.73.8.639
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发表时间：
1989-08-01
影响因子：
4.1
通讯作者：
VANDERGAAG, R
中科院分区：
文献类型：
--
作者：
MOURITS, MP;KOORNNEEF, L;VANDERGAAG, R
严重的炎症性Graves眼病患者应在放射治疗时使用抗炎药物治疗，以防止纤维化等并发症，而非炎症性眼病患者可立即手术治疗。然而，通常很难区分炎症性和非炎症性Graves病。因此，我们在这里提出一个简单的临床分类来区分这两种情况。这种分类是基于炎症的经典体征-疼痛、发红、肿胀和功能受损。在连续两次临床检查后，可以确定“活动评分”，范围从0到10分。在一项回顾性研究中，我们测试了这种分类的有效性，发现治疗开始时活动评分为3或以上的患者对抗炎药物反应良好，而活动评分较低的患者大多数情况下没有反应。将治疗前的活动评分与CT扫描上眼外肌的增大程度进行比较，我们发现这两个参数之间存在显著相关性：活动评分越高，肌肉的增大程度越大。我们的结论是，这种分类有利于正确选择患者进行治疗。
Patients with serious inflammatory Graves'' ophthalmopathy should be treated with anti-inflammatory drugs on radiotherapy to prevent complications like fibrosis, while those with non-inflammatory opthalopathy may be treated by surgery immediately. It is often difficult, however, to distinguish inflammatory from non-inflammatory Graves'' disease. We therefore present a simple clinical classification here to differentiate between these two conditions. This classification is based on the classical signs of inflammation-pain, redness, swelling, and impaired function. After two consecutive clinical examinations an ''activity score'' can be determined, ranging from 0 to 10 points. In a retrospective study testing the efficacy of this classification we found that patients with an activity score of 3 or more at the beginning of therapy responded well to anti-inflammatory drugs, while those with a lower activity score mostly did not. Comparing the pretreatment activity score with the degree of enlargement of the extraocular muscles on the CT scan, we found a significant correlation between these two parameters: the higher the activity score, the more the enlargement of the muscles. We conclude that this classification facilitates the proper selection of patients for treatment.