Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Clin Endocrinol (Oxf). 2019 Jan;90(1):175-183. doi: 10.1111/cen.13855. Epub 2018 Oct 23.
Intravenous methylprednisolone (IVMP) is recommended as the first-line treatment for moderate-to-severe and active thyroid-associated ophthalmopathy (TAO). This study aimed to identify potential predictors and establish a multivariable prediction model for the efficacy of IVMP therapy.
A single-centre retrospective study.
A total of 302 consecutive patients diagnosed with moderate-to-severe and active TAO who underwent the full course of IVMP therapy were included.
Participants were sequentially divided into the training set (n = 200) and the validation set (n = 102). Multivariate logistic regression analysis was used to identify the independent predictors and establish the predictive model.
In addition to the pretreatment clinical activity score (OR = 3.506, P < 0.001), elevated thyroid-stimulating hormone (TSH) levels during treatment (OR = 0.145, P = 0.005), pretreatment anti-TSH receptor antibody levels (OR = 0.061, P < 0.001) and duration of eye symptoms (OR = 0.878, P = 0.017), a significant relationship was found between therapeutic efficacy and the pretreatment triglyceride levels (OR = 0.090, P = 0.001). The prediction model showed good calibration and excellent discrimination, with an area under curve of 0.915 (P < 0.001) and 0.885 (P < 0.001) in the training and validation sets, respectively.
This study provides some novel insights into the factors associated with the efficacy of IVMP therapy. A multivariable prediction model has been established and validated to help determine the indication and prognosis of IVMP therapy. Moreover, several suggestions have been made in the management of TAO patients: early diagnosis and treatment (within 15 months); prompt restoration and maintenance of euthyroidism, especially meticulous control of TSH levels (≤5 μIU/mL); and regular monitoring of triglyceride levels.
静脉注射甲基泼尼松龙（IVMP）被推荐作为中重度和活动期甲状腺相关眼病（TAO）的一线治疗方法。本研究旨在确定 IVMP 治疗疗效的潜在预测因素，并建立多变量预测模型。
单中心回顾性研究。
共纳入 302 例连续诊断为中重度和活动期 TAO 并接受完整 IVMP 治疗的患者。
患者被顺序分为训练集（n=200）和验证集（n=102）。多变量逻辑回归分析用于确定独立预测因素并建立预测模型。
除了治疗前临床活动评分（OR=3.506，P<0.001）外，治疗期间甲状腺刺激激素（TSH）水平升高（OR=0.145，P=0.005）、治疗前抗 TSH 受体抗体水平（OR=0.061，P<0.001）和眼部症状持续时间（OR=0.878，P=0.017）与治疗疗效显著相关。治疗疗效与治疗前甘油三酯水平呈显著负相关（OR=0.090，P=0.001）。预测模型具有良好的校准度和优秀的区分度，在训练集和验证集中的曲线下面积分别为 0.915（P<0.001）和 0.885（P<0.001）。
本研究为 IVMP 治疗疗效相关因素提供了一些新的见解。已经建立并验证了一个多变量预测模型，以帮助确定 IVMP 治疗的适应证和预后。此外，在 TAO 患者的管理中提出了一些建议：早期诊断和治疗（15 个月内）；迅速恢复和维持甲状腺功能正常，尤其是对 TSH 水平的细致控制（≤5μIU/mL）；以及定期监测甘油三酯水平。
