方法：对2015-01/2016-01期间在上海交通大学医学院附属第九人民医院眼科就诊并确诊为甲状腺相关眼病的125例患者进行甲状腺相关眼病-生活质量量表(TAO-QOL)问卷调查，调查内容分为视功能和外观两个维度，每个维度包含8个相关问题，最终指标为各维度评分。同时记录患者临床资料，包括性别、年龄、眼睑、结膜充血水肿情况、球后疼痛情况、泪阜肿大程度、眼球突出度、眼睑退缩量、视力、复视程度。根据临床活动性评分(clinical activity score，CAS)将患者分为两组：活动期组、静止期组； 根据EUGOGO标准将患者分为三组：轻度组、中重度组、极重度组。根据复视情况分为无复视组，水平或垂直方向复视组； 正前方间歇复视组，正前方持续复视组。运用SPSS 22.0软件进行组间评分独立样本t检验、方差分析，LSD-t检验和多元回归分析。

结果：共纳入88份有效问卷，视功能评分为72.6±28.3分，外观评分为66.8±26.0分； 其中活动期组(28/88)视功能和外观评分为59.4±28.8、56.1±26.0分； 低于静止期组(60/88)为78.8±26.1、71.8±24.6分，差异有统计学意义(P=0.002、0.008)； 轻度组(26/88)86.2±17.1、82.1±17.8分，中重度组(55/88)70.3±28.3、63.3±25.5分，极重度组(7/88)41.1±34.6、37.6±22.7分； 极重度组较中重度组视功能和外观评分降低，差异有统计学意义(P=0.006、0.007)，中重度组视功能和外观评分较轻度组显著降低，差异有统计学意义(P=0.012、0.001)； 持续复视组(17/88)视功能评分低于无复视组、水平或垂直复视组和间歇复视组，差异有统计学意义(P<0.001、<0.001、=0.002)； 多因素回归分析表明，视功能与视力、复视程度线性相关(R²=0.470)； 外观评分与突眼度、眼睑退缩量、复视程度相关(R²=0.375)。

结论：TAO-QOL是可用于评估TAO患者生活质量的一项简单有效的工具； 甲状腺相关眼病患者的生活质量下降与疾病临床分期和分级相关。因此，在TAO的治疗方面，缩短活动期病程，改善复视、提高视力和回退眼球是提高患者生活质量的有效方法。

METHODS: Totally 125 patients diagnosed with thyroid associated ophthalmopathy from January 2015 to January 2016 at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine were included. Clinical data including gender, age, eyelid, conjunctival hyperemia and edema, lacrimal caruncle swelling, degree of proptosis, eyelid retraction volume, vision, diplopia were recorded. TAO-QOL questionnaire were investigated. The content was divided into two dimensions: visual function and appearance. Each dimension contains eight related questions. Final indicators for each dimension was the score. Independent t test, ANOVA and multiple regression analysis were performed using SPSS tactics 22.0 software.

RESULTS: Eighty-eight valid questionnaires were included. The average score of visual function was 72.6±28.3 and that of appearance was 66.8±26.0; 28 cases(28/88)were in active phase while 60 cases(60/88)were in inactive phase. Visual function and appearance scores were 59.4±28.8 and 56.1±26.0 in active group; 78.8±26.1 and 71.8±24.6 in inactive group. Active group has decreased score for both visual function sore and appearance score(P=0.002 and P=0.008). The score of patients with mild TAO(26/88 )was 86.2±17.1 and 82.1±17.8; 70.3±28.3 and 63.3±25.5 for moderate-severe patients(55/88), 41.1±34.6 and 37.6±22.7 for extremely severe patients(7/88). The score of both visual function and appearance in severe group were significantly lower than those in the moderate-severe group(P=0.006 and P=0.007).Compared to mild group, those of moderate-severe group were significantly lower(P=0.012, P=0.001).The visual function score of patients in constant diplopia group were significantly lower than the no diplopia group, horizontal or vertical gaze diplopia and inconstant diplopia group(P<0.001, <0.001, =0.002). By multivariate regression analysis, we found the factors that influence visual function score were visual acuity and diplopia(R²=0.470), and those correlated to appearance score were exophthalmos, retraction and diplopia(R²=0.375).

CONCLUSION: TAO-QoL can be used as a simple and effective tool to evaluate the quality of life in TAO patients. The QoL score is related to disease staging and grading. Thus, shortening the course of active phase, decreasing the degree of diplopia and improving visual acuity are critical ways to improve the quality of life in TAO patients.