Endocr Pract. 2016 Oct;22(10):1177-1186. doi: 10.4158/E161376.OR.
Intravenous (iv) glucocorticoids (GC) (ivGC) are used for active Graves orbitopathy (GO), but factors affecting GO outcome are poorly understood. We performed a retrospective study to investigate the variables affecting GO after ivGC.
We evaluated 83 consecutive GO patients treated with ivGC but not orbital radiotherapy (ORT) and re-examined them after a median of 47 months. The endpoints were the relationships between GO outcome or additional treatments with age, sex, smoking habits, thyroid volume, thyroid treatment, time since thyroid treatment, antithyroid-stimulating hormone receptor antibodies (TRAb), GO duration, GO features, and follow-up time.
GO features improved after treatment, resulting in moderate and marked amelioration in ~75% and ~41% of patients respectively. By multivariate analysis, a moderate GO improvement correlated with diplopia at first observation, which was more severe in responders. A marked GO improvement correlated with time between first and last observation and time after thyroid treatment, which were longer in responders. This likely reflected the combination of an early effect of GC and a late, spontaneous improvement of GO, as shown by analyses of GO outcome at various time points. Additional treatments after ivGC correlated by multivariate analysis with eyelid aperture, diplopia and NOSPECS score (NOSPECS stands for no GO signs [N], only eyelid sign [O], soft tissue involvement [S], proptosis [P], extraocular motility restriction [E], corneal involvement [C], and sight loss [S]) at first observation, which were more severe in responders.
Our study shows that response to ivGC increases with time, likely reflecting the known tendency of GO to improve spontaneously, and is more pronounced when GO is more severe to begin with, which is associated with more additional treatments.
ANOVA = analysis of variance CAS = clinical activity score GC = glucocorticoids GO = Graves orbitopathy I = radioactive iodine iv = intravenous ivGC = high-dose intravenous glucocorticoid pulse therapy MMI = methimazole OD = orbital decompression ORT = orbital radiotherapy TRAb = antithyroid-stimulating hormone receptor antibodies.
静脉内（iv）糖皮质激素（GC）（ivGC）用于活动期格雷夫斯眼病（GO），但影响 GO 结局的因素知之甚少。我们进行了一项回顾性研究，以调查影响 ivGC 后 GO 的变量。
我们评估了 83 例连续接受 ivGC 治疗但未接受眼眶放射治疗（ORT）的 GO 患者，中位随访时间为 47 个月后再次检查。终点是 GO 结局或额外治疗与年龄、性别、吸烟习惯、甲状腺体积、甲状腺治疗、甲状腺治疗后时间、促甲状腺激素受体抗体（TRAb）、GO 持续时间、GO 特征和随访时间之间的关系。
GO 特征在治疗后得到改善，导致约 75%和 41%的患者分别出现中度和明显改善。通过多变量分析，中度 GO 改善与首次观察时的复视相关，在反应者中更严重。明显的 GO 改善与首次观察和最后一次观察之间的时间以及甲状腺治疗后的时间相关，在反应者中时间更长。这可能反映了 GC 的早期作用和 GO 的晚期自发改善的结合，正如对各个时间点的 GO 结局的分析所示。ivGC 后的额外治疗与多变量分析中的眼睑张开、复视和 NOSPECS 评分（NOSPECS 代表无 GO 迹象[N]、仅眼睑迹象[O]、软组织受累[S]、突眼[P]、眼球运动受限[E]、角膜受累[C]和视力丧失[S]）相关，在反应者中更严重。
我们的研究表明，ivGC 的反应随时间增加，可能反映了 GO 自发改善的已知趋势，并且在 GO 开始时更严重时更为明显，这与更多的额外治疗有关。
