Wang Yang, Zhang Shuo, Zhang Yidan, Liu Xingtong, Gu Hao, Zhong Sisi, Huang Yazhuo, Fang Sijie, Sun Jing, Zhou Huifang, Fan Xianqun
Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639 ZhiZaoJu Road, Shanghai, 200011, China.
Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
BMC Endocr Disord. 2018 Feb 20;18(1):13. doi: 10.1186/s12902-018-0240-8.
Intravenous glucocorticoids (ivGC) have been recommended as a first-line treatment of moderate-to-severe and active thyroid-associated ophthalmopathy (TAO). However, not all patients are responsive to ivGC. The identification of potential factors used to predict their efficacy and the selection of suitable patients have both been lacking.
It was a single center retrospective study. Potential factors related to the effects of ivGC were analyzed using logistic regression in 90 consecutive patients with moderate-to-severe and active TAO, who received 4.5 g ivGC therapy. Response was defined as the achievement of at least three points of the overall response.
Fifty-two (57.8%) patients showed a positive response to ivGC therapy. Significant correlations were observed between the effects of ivGC and pretreatment clinical activity score (CAS), duration of eye symptoms, and restoration of euthyroidism. The two latter factors were both independent. The duration of eye symptoms was negatively correlated with the effects of ivGC, with an odds ratio (OR) of 0.984 (p = 0.012). Restoration of euthyroidism (OR = 3.282, p = 0.039) and pretreatment CAS (OR = 1.653, p < 0.01) were both positively correlated with the effects of ivGC. The diagnostic accuracy of the duration of eye symptoms was ≤13 months (p = 0.000), with a specificity of 76.9%, and sensitivity of 65.8%. The diagnostic accuracy of the pretreatment CAS was more than 2.5 (p = 0.000), with a specificity of 61.5% and sensitivity of 80.5%. Besides, a multi-variables prediction model were established as well, which was better in the forecasting aspect with an area under curve of 0.784 (p = 0.000).
The duration of eye symptoms and restoration of euthyroidism are independent factors that are associated with the effects of ivGC. The following practical implications were inferred: firstly, the shorter the duration of eye symptoms, the more favorable the effects of ivGC therapy. Thus, prompt diagnosis and treatment (within 13 months) is important. Secondly, the restoration of euthyroidism improves the efficacy of ivGC. Thirdly, hope the multi-variables prediction model can be applied to clinical therapy in the future.
静脉注射糖皮质激素（ivGC）已被推荐作为中重度活动性甲状腺相关性眼病（TAO）的一线治疗方法。然而，并非所有患者对ivGC都有反应。目前缺乏用于预测其疗效的潜在因素的识别以及合适患者的选择。
这是一项单中心回顾性研究。对90例接受4.5g ivGC治疗的中重度活动性TAO连续患者，采用逻辑回归分析与ivGC疗效相关的潜在因素。反应定义为总体反应至少达到三分。
52例（57.8%）患者对ivGC治疗有阳性反应。观察到ivGC疗效与治疗前临床活动评分（CAS）、眼部症状持续时间和甲状腺功能正常的恢复之间存在显著相关性。后两个因素均为独立因素。眼部症状持续时间与ivGC疗效呈负相关，比值比（OR）为0.984（p = 0.012）。甲状腺功能正常的恢复（OR = 3.282，p = 0.039）和治疗前CAS（OR = 1.653，p < 0.01）均与ivGC疗效呈正相关。眼部症状持续时间诊断准确性≤13个月（p = 0.000），特异性为76.9%，敏感性为65.8%。治疗前CAS诊断准确性>2.5（p = 0.000），特异性为61.5%，敏感性为80.5%。此外，还建立了一个多变量预测模型，其预测方面更好，曲线下面积为0.784（p = 0.000）。
眼部症状持续时间和甲状腺功能正常的恢复是与ivGC疗效相关的独立因素。由此推断出以下实际意义：首先，眼部症状持续时间越短，ivGC治疗效果越好。因此，及时诊断和治疗（13个月内）很重要。其次，甲状腺功能正常的恢复可提高ivGC的疗效。第三，希望多变量预测模型未来能应用于临床治疗。
