Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Radiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Endocr Res. 2023 Jul 3;48(2-3):55-67. doi: 10.1080/07435800.2023.2219734. Epub 2023 Jun 22.
Intravenous glucocorticoid (IVGC) remains the main treatment for moderate-to-severe and active thyroid-associated ophthalmopathy (TAO). However, a substantial number (20-30%) of active moderate-to-severe TAO patients may not respond to IVGC. Some patients may have disease progression despite IVGC treatment or relapse after steroid withdrawal.
To analyze risk factors for clinical activity and predictive factors for clinical outcomes of 4.5 g IVGC therapy in patients with moderate-to-severe TAO.
Our study was performed in two steps: step 1 involved 110 moderate-to-severe TAO patients and analyzed risk factors for TAO activity; step 2 involved 53 active moderate-to-severe TAO patients from step 1 who were treated with 4.5 g IVGC therapy and analyzed predictive factors for clinical outcomes of IVGC therapy. Multivariate logistic regression analysis was used to identify the independent predictors and establish the predictive model.
Abnormal TRAb (OR = 4.717; = 0.019) and the percentage of CD3+CD4+ T cell (OR = 1.092; = 0.028) were independently associated with the activity of moderate-to-severe TAO patients. The pretreatment CAS-max in both eyes (OR = 7.221; = 0.013) and the percentage of pretreatment CD3+T cell (OR = 0.718; = 0.037) were independently associated with therapeutic efficacy. The pretreatment CAS-max in both eyes (OR = 156.53; = 0.028) and the percentage of post-treatment CD3+T cell (OR = 0.554; = 0.043) were independently associated with therapeutic efficacy. Besides, multivariable prediction models were established, which were better in the forecasting aspect than single-variable prediction models.
Based on the findings of this study, we should monitor the peripheral blood T cell subsets for TAO, which could be helpful to timely judge the condition of clinical manifestation and effect of treatment for TAO patients. Multivariable prediction models have been established, which have great significance for clinical work.
静脉内糖皮质激素（IVGC）仍然是治疗中重度和活动期甲状腺相关眼病（TAO）的主要方法。然而，相当数量（20-30%）的活动期中重度 TAO 患者可能对 IVGC 无反应。一些患者可能在 IVGC 治疗期间疾病进展或类固醇停药后复发。
分析 4.5g IVGC 治疗中重度 TAO 患者的临床活动危险因素和临床结局预测因素。
我们的研究分两步进行：第 1 步纳入 110 例中重度 TAO 患者，分析 TAO 活动的危险因素；第 2 步纳入第 1 步中的 53 例活动性中重度 TAO 患者，接受 4.5g IVGC 治疗，分析 IVGC 治疗临床结局的预测因素。采用多变量逻辑回归分析确定独立预测因素并建立预测模型。
异常 TRAb（OR=4.717；P=0.019）和 CD3+CD4+T 细胞百分比（OR=1.092；P=0.028）与中重度 TAO 患者的活动独立相关。双眼治疗前 CAS-max（OR=7.221；P=0.013）和治疗前 CD3+T 细胞百分比（OR=0.718；P=0.037）与治疗疗效独立相关。双眼治疗前 CAS-max（OR=156.53；P=0.028）和治疗后 CD3+T 细胞百分比（OR=0.554；P=0.043）与治疗疗效独立相关。此外，建立了多变量预测模型，这些模型在预测方面优于单变量预测模型。
基于本研究的结果，我们应该监测 TAO 的外周血 T 细胞亚群，这有助于及时判断 TAO 患者的临床表现和治疗效果。已经建立了多变量预测模型，对临床工作具有重要意义。
