發(fā)布時間：2018-03-08 16:26

  本文選題：甲狀腺相關性眼病　切入點：眼眶磁共振　出處：《南方醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：甲狀腺相關性眼病(Thyroid Associated Ophthalmopathy,TAO)是一種病因復雜的自身免疫性疾病,基本病變包括脂肪從頭合成(DeNovo Adipogenesis)、透明質酸形成、間質水腫、眼外肌增大。眼球突出是TAO最常見的癥狀,患者通�？砂殡S眼瞼攣縮、眼瞼腫脹、結膜發(fā)紅等一系列影響容貌的癥狀。同時,該疾病通常表現(xiàn)為癥狀快速進展的活動期和癥狀緩慢消退的非活動期,在活動期進行免疫抑制、球后放射等治療效果較好,非活動期則效果差。所以,早期識別激素有效的治療時機對疾病預后至關重要。定量測量TAO患者球后軟組織體積有助于進一步理解該病的發(fā)病機制,也為臨床診治提供更多客觀依據(jù)。研究目的:1.本研究擬應用Mimics(Materialise,Louvain,Belgium)軟件建立TAO患者及正常人球后軟組織(球后脂肪及眼外肌)體積的精準化三維重建測量技術,并驗證該方法的精準度和可行性。2.利用TAO患者球后脂肪體積指標結合現(xiàn)已公認的活動期指標及臨床相關指標,初步探索TAO患者球后脂肪體積測定的臨床價值。材料與方法:我們手工利用黃油及雞肉制作模擬球后軟組織的模具,并將模具已知體積和3D重建體積進行比較,以驗證該方法的精準度,同時募集10名TAO患者,分別由3名觀察者三維重建并計算TAO患者球后軟組織體積,通過比較觀察者內誤差和觀察者間誤差以驗證該方法的可重復性。此外,我們收集2016-1月～2016-12月在我院初診的35例TAO患者的臨床資料。測量1.5T眼眶MRI球后脂肪體積及SIR值分析其與臨床各項指標的相關性,并收集12例健康人,初步比較TAO組及健康組球后脂肪體積的差異。研究結果:1.兩名觀察者測量模具所得體積與其真實體積相比的相對誤差顯示:球后脂肪組織為-4.60%～-2.78%之間,眼外肌在-4.13%～0.71%之間。球后脂肪測量觀察者內誤差在4%以內,眼外肌為5.84%。由三名觀察者測量所得組內相關系數(shù)在0.976～0.996 之間。2.脂肪體積與病程有相關性(r=0.521,P0.01),病程1年以上為脂肪生成的高峰期;脂肪體積與突眼度存在相關性(r=0.609,P0.01),突眼度每增加1mm,脂肪體積增加0.82ml;脂肪體積是疾病嚴重度的獨立危險因素;臨床活動性評分(CAS)與SIR值及TRAb存在相關性(r=0.536,r=0.416,P0.01);TAO組球后脂肪體積顯著高于正常組(P0.01)。結論:1.在薄層MRI(0.8mm)通過Mimics軟件三維重建眼眶軟組織,并定量測量球后軟組織體積是一種科學、精準、高效的方法。2.TAO病程1年以上可能是球后脂肪組織增多的高峰階段,球后脂肪體積結合SIR值的測量有助于最佳激素治療時機的探索及預后分析。
[Abstract]:Thyroid associated ophthalmopathy (Thyroid Associated ophthalmopathy) is an autoimmune disease with complex etiology. Basic diseases include DeNovo Adipogenesism, hyaluronic acid formation, interstitial edema, and extraocular muscle enlargement. Exophthalmos is the most common symptom of TAO. Patients are usually accompanied by eyelid contracture, swelling of the eyelid, redness of the conjunctiva, and a series of symptoms that affect appearance. Immunosuppression in the active phase, Retrobulbar radiation and other treatments are better, but the inactivity phase is poor. So, The timing of early hormone recognition is crucial to the prognosis of the disease. Quantitative measurement of the volume of retrobulbar soft tissue in patients with TAO helps to further understand the pathogenesis of the disease. Objective\\\%\\\ -\\\. The accuracy and feasibility of the method were verified. 2. Using the Retrobulbar Fat Volume Index of TAO patients combined with the accepted active stage index and clinical related indexes, To explore the clinical value of retroglobular fat volume measurement in TAO patients. Materials and methods: we use butter and chicken to make a model of soft tissue behind a ball by hand, and compare the known volume with 3D reconstruction volume. To verify the accuracy of the method, 10 patients with TAO were recruited, and 3 observers were used to reconstruct and calculate the volume of soft tissue at the back of the ball in patients with TAO. The repeatability of the method is verified by comparing the intra-observer error with the inter-observer error. We collected the clinical data of 35 patients with TAO who were first diagnosed in our hospital from June to December, 2016-12. We measured 1.5 T orbital MRI ball fat volume and SIR value to analyze their correlation with clinical indexes, and collected 12 healthy people. The results of the study showed that the relative error between the two observers in measuring the volume of the mould compared with its real volume was -4.60% -2.78%. The extraocular muscle was between -4.13% and 0.71%. The intraobserver error of retrobulbar fat measurement was less than 4%. The extraocular muscle was 5.84. The correlation coefficient was between 0.976 and 0.996 in the group measured by three observers. There was a correlation between the volume of fat and the course of the disease. The peak period of adipogenesis was more than one year. There was a correlation between the volume of fat and the degree of exophthalmos. The volume of fat increased by 0.82ml with the increase of 1 mm in the degree of exophthalmos, and the volume of fat was an independent risk factor for the severity of the disease. The correlation between clinical activity score and SIR value and TRAb is that the volume of retrobulbar fat in group A is significantly higher than that in group A (P 0.01). Conclusion: 1. Three-dimensional reconstruction of orbital soft tissue by Mimics software is a scientific and accurate method. 2. The course of TAO for more than one year may be the peak stage for the increase of retrobulbar adipose tissue. The measurement of retrobulbar fat volume and SIR value may be helpful to explore the best time for hormone therapy and to analyze the prognosis.
【學位授予單位】：南方醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R581;R771.3

【參考文獻】

相關期刊論文 前10條

1 李寶豐;章瑩;邰國良;代元元;謝會斌;郭曉澤;朱昌榮;王非;;3D數(shù)字骨科技術在髖臼骨折治療中的應用[J];南方醫(yī)科大學學報;2016年07期

2 甘露;羅清禮;唐飛;吳文文;唐莉;;TAO患者眼眶CD90~+和CD90~-成纖維細胞亞群脂成纖維細胞轉化的研究[J];四川大學學報(醫(yī)學版);2016年03期

3 雷玲;趙駿;吳毅;王延洲;陳偉;楊鏵琦;曹莉莉;徐惠成;;基于磁共振成像子宮脫垂患者盆底結構三維重建與分析[J];實用婦產(chǎn)科雜志;2016年04期

4 蔣麗瓊;何小寒;劉桂琴;衣曉明;;利用ImageJ軟件測量眼眶脂肪體積[J];中國CT和MRI雜志;2016年03期

5 周堅鋒;蘇秀云;李建濤;李志銳;李辰;張浩;尹鵬;陳宇翔;唐佩福;張立海;;三維重建技術塑形髖臼后柱鋼板的效果觀察[J];山東醫(yī)藥;2016年09期

6 吳娜;孫豐源;李佳;簡天明;;甲狀腺相關眼病患者血清TRAb、TPOAb、TGAb水平變化及意義[J];山東醫(yī)藥;2015年30期

7 張曉薇;吳浩;溫彥麗;許麗;陳禮全;;基于磁共振成像在體盆腔及骶前區(qū)血管三維重建模型構建方法探討[J];中國實用婦科與產(chǎn)科雜志;2015年05期

8 賀冶冰;項楠;石少敏;穆可濤;張菁;胡蜀紅;;眼眶磁共振成像T2-Mapping診斷活動性Graves眼病的臨床應用[J];中華內分泌代謝雜志;2015年04期

9 王嬌;劉洋;張曉玲;王衍;穆建玲;趙燕;;Mimics軟件在醫(yī)學圖像三維重建中的應用[J];醫(yī)療衛(wèi)生裝備;2015年02期

10 李靜;馬建民;;糖皮質激素在眼眶病中的應用及研究進展[J];臨床眼科雜志;2014年04期

相關碩士學位論文 前1條

1 胡昊;3T-MRI眼眶結構定量測量在Graves眼病診斷及分期中的價值[D];南京醫(yī)科大學;2015年

，

本文編號：1584675