Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland.
Department of Ophthalmology, Chair of Ophthalmology and Optometry, Poznan University of Medical Sciences, Poznan, Poland.
Front Endocrinol (Lausanne). 2023 Mar 1;14:1083321. doi: 10.3389/fendo.2023.1083321. eCollection 2023.
The aim of the study was to evaluate the differences in clinical profile, laboratory parameters, and ophthalmological signs, and symptoms between patients with high IgG4 Graves orbitopathy and patients with normal IgG4 Graves orbitopathy.
This was a prospective observational study. We recruited adult patients with Graves Orbitopathy(GO) referred to our clinic for further diagnostics and treatment. Eventually, 60 patients with GO were enrolled in the study. All patients underwent ophthalmological assessment, magnetic resonance imaging (MRI) of the orbits, and laboratory tests, including IgG4 serum concentration measurement. High IgG4 GO was diagnosed if the IgG4 concentration exceeded 135 mg/dl. We used both the clinical activity score (CAS) and magnetic resonance imaging (MRI) to assess the activity of GO. Eventually, active GO was defined according to MRI results.
Among 60 GO patients, 15 (25%) patients had elevated IgG4 levels. Patients in the high IgG4 group had a higher prevalence of active GO by MRI than patients with normal IgG4 (100% vs. 64.44%, P=0.006). They also had a higher eosinophile count in peripheral blood, a lower bilirubin level, a more frequent lower eyelid retraction, and a lower prevalence of glaucoma. There were no statistically significant differences between the groups in CAS. Patients with active GO, had higher median IgG4 level [89.95 (55.48; 171.1) vs 43.45 (32.48; 49.68) mg/dl, P<0.001]. The receiver operating characteristic (ROC) analysis for IgG4 as a marker of active GO revealed the following results: AUC 0.848 for the cut-off value of 54.2 mg/dl, sensitivity 79.5%, specificity 87.5%, positive predictive value 94.6%, negative predictive value 59.1%.
We demonstrated that IgG4 is a marker of GO activity. Certain differences in the clinical profile of patients with high IgG4 GO, and normal IgG4 GO were observed. More data is needed to establish whether patients with high IgG4 GO are GO patients with particularly active disease or actually represent a distinct clinical entity related to IgG4-Related Disease.
本研究旨在评估高 IgG4 甲状腺眼病（GO）患者与 IgG4 正常 GO 患者在临床特征、实验室参数和眼部体征及症状方面的差异。
这是一项前瞻性观察性研究。我们招募了因进一步诊断和治疗而转诊至我们诊所的成人 GO 患者。最终，有 60 例 GO 患者纳入研究。所有患者均接受眼科评估、眼眶磁共振成像（MRI）和实验室检查，包括 IgG4 血清浓度测量。如果 IgG4 浓度超过 135mg/dl，则诊断为高 IgG4 GO。我们同时使用临床活动评分（CAS）和 MRI 评估 GO 的活动度。最终，根据 MRI 结果定义活动性 GO。
在 60 例 GO 患者中，有 15 例（25%）患者 IgG4 水平升高。高 IgG4 组患者的 MRI 表现为活动性 GO 的比例高于 IgG4 正常组（100%比 64.44%，P=0.006）。他们的外周血嗜酸性粒细胞计数较高，胆红素水平较低，下眼睑退缩更为频繁，青光眼的发生率较低。两组间 CAS 无统计学差异。活动性 GO 患者的 IgG4 中位数水平更高[89.95（55.48；171.1）vs 43.45（32.48；49.68）mg/dl，P<0.001]。以 IgG4 为活动性 GO 标志物的受试者工作特征（ROC）分析显示以下结果：截断值为 54.2mg/dl 时，AUC 为 0.848，敏感性为 79.5%，特异性为 87.5%，阳性预测值为 94.6%，阴性预测值为 59.1%。
我们证明 IgG4 是 GO 活动度的标志物。高 IgG4 GO 患者和 IgG4 正常 GO 患者的临床特征存在一定差异。需要更多数据来确定高 IgG4 GO 患者是否为疾病特别活跃的 GO 患者，或者实际上代表与 IgG4 相关疾病相关的独特临床实体。
