Lanzolla Giulia, Vannucchi Guia, Ionni Ilaria, Campi Irene, Sileo Federica, Lazzaroni Elisa, Marinò Michele
Endocrinology Units, Department of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Pisa, Italy.
Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.
Front Endocrinol (Lausanne). 2020 Jan 22;10:933. doi: 10.3389/fendo.2019.00933. eCollection 2019.
Graves' Orbitopathy (GO) is the most frequent extrathyroidal manifestation of Graves' disease (GD). Its ultimate cause remains unclear, but it is commonly considered an autoimmune disorder due to self recognition of autoantigens constitutively expressed by orbital fibroblasts (OFs), and thyroid epithelial cells. High dose intravenous glucocorticoids (ivGC) are the most commonly used treatment for moderately severe and active GO. However, based on the complex pathogenesis of GO, a number of factors may have a protective and maybe a therapeutic role. The use of other medications improving the effect of GC may increase the overall effectiveness of the therapy and reduce GC doses, thereby limiting side effects. Recently, a possible protective role of 3-hydroxy-3-methylglutaryl-coenzyme reductase inhibitors, the so-called statins, and perhaps of lowering cholesterol levels, has been proposed. Thus, statins have been reported to be associated with a reduced frequency of GO in GD patients and in recent cross-sectional and retrospective studies a significant correlation was found between the occurrence of GO and both total and LDL-cholesterol in patients with a GD of relatively recent onset, suggesting a role of cholesterol in the development of GO. Moreover, a correlation was found between the GO clinical activity score and total as well as LDL-cholesterol in untreated GO patients, depending on GO duration, indicating a role of cholesterol on GO activity. Therefore, statin treatment may be beneficial for GO. Here we review this subject, which offers new therapeutic perspectives for patients with GO.
格雷夫斯眼眶病（GO）是格雷夫斯病（GD）最常见的甲状腺外表现。其根本病因尚不清楚，但通常被认为是一种自身免疫性疾病，是由于眼眶成纤维细胞（OFs）和甲状腺上皮细胞组成性表达的自身抗原被自身识别所致。高剂量静脉注射糖皮质激素（ivGC）是治疗中度严重和活动性GO最常用的方法。然而，基于GO复杂的发病机制，许多因素可能具有保护作用，甚至可能具有治疗作用。使用其他能提高糖皮质激素效果的药物可能会提高治疗的总体有效性并降低糖皮质激素剂量，从而限制副作用。最近，有人提出3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂（即所谓的他汀类药物）以及降低胆固醇水平可能具有保护作用。因此，据报道他汀类药物与GD患者GO发病率降低有关，并且在最近的横断面和回顾性研究中发现，近期发病的GD患者中GO的发生与总胆固醇和低密度脂蛋白胆固醇均显著相关，这表明胆固醇在GO的发生发展中起作用。此外，在未经治疗的GO患者中，根据GO病程，发现GO临床活动评分与总胆固醇以及低密度脂蛋白胆固醇之间存在相关性，这表明胆固醇对GO活动有影响。因此，他汀类药物治疗可能对GO有益。在此我们对这一主题进行综述，它为GO患者提供了新的治疗前景。
