Department of Ophthalmology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Endocrine. 2024 Nov;86(2):824-833. doi: 10.1007/s12020-024-03943-9. Epub 2024 Jul 5.
Aimed to create a nomogram using clinical and eye-specific metrics to predict the efficacy of intravenous glucocorticoid (IVGC) therapy in patients with active and moderate-to-severe Thyroid-Associated Ophthalmopathy (TAO).
This study was conducted on 84 eyes from 42 moderate-to-severe TAO patients who received systemic IVGC therapy, and 42 eyes from 21 controls. Data were collected retrospectively from June 2020 to December 2021. The least absolute shrinkage and selection operator (LASSO) method was used to identify predictive factors for "unresponsiveness" to IVGC therapy. These factors were then analyzed using logistic regression to create a nomogram. The model's discriminative ability was robustly assessed using a Bootstrap resampling method with 1000 iterations for receiver operating characteristic (ROC) curve analysis.
The LASSO analysis identified six factors with non-zero coefficients as significant, including Schirmer I test values, Meibomian gland (MG) diameter, MG length, disease duration, whole capillary vessel density (VD) in the radial peripapillary capillary (RPC), and whole macular VD for the superficial retinal capillary plexus (SRCP). The subsequent logistic regression model highlighted MG length, whole macular VD for SRCP, and disease duration as independent predictors of IVGC therapy response. The constructed nomogram demonstrated an area under the curve (AUC) of 0.82 (95% CI: 0.73-0.91), affirming the model's consistent and reliable ability to distinguish between responsive and non-responsive TAO patients.
Our nomogram, combining MG length (<4.875 mm), SRCP VD (<50.25%), and disease duration (>5.5 months), reliably predicts lower IVGC therapy effectiveness in active, moderate-to-severe TAO patients.
旨在使用临床和眼部特定指标创建一个列线图，以预测静脉内糖皮质激素（IVGC）治疗活动性和中重度甲状腺相关眼病（TAO）患者的疗效。
本研究纳入了 42 例中重度 TAO 患者的 84 只眼和 21 例对照者的 42 只眼，这些患者均接受了全身 IVGC 治疗。数据是在 2020 年 6 月至 2021 年 12 月间进行回顾性收集的。使用最小绝对收缩和选择算子（LASSO）方法来识别 IVGC 治疗“无应答”的预测因素。然后使用逻辑回归分析这些因素来创建一个列线图。使用 1000 次迭代的 Bootstrap 重采样方法对模型的判别能力进行稳健评估，用于进行接收者操作特征（ROC）曲线分析。
LASSO 分析确定了 6 个非零系数的因素具有显著意义，包括 Schirmer I 测试值、睑板腺（MG）直径、MG 长度、疾病持续时间、放射状周边毛细血管（RPC）的整个毛细血管密度（VD）和浅层视网膜毛细血管丛（SRCP）的整个黄斑 VD。随后的逻辑回归模型突出了 MG 长度、SRCP 的整个黄斑 VD 和疾病持续时间是 IVGC 治疗反应的独立预测因子。构建的列线图显示曲线下面积（AUC）为 0.82（95%CI：0.73-0.91），证实了该模型在区分有反应和无反应的 TAO 患者方面具有一致和可靠的能力。
我们的列线图结合了 MG 长度（<4.875mm）、SRCP VD（<50.25%）和疾病持续时间（>5.5 个月），可可靠地预测活动性和中重度 TAO 患者中 IVGC 治疗效果较低。
