Suppr超能文献

甲状腺眼病患者皮质激素抵抗的评估及利妥昔单抗作为二线治疗的应用。

Evaluation of corticoresistance in patients with thyroid eye disease and use of rituximab as a second-line treatment.

作者信息

Pekarova Klara, Schovanek Jan, Dohnal Roman, Radvansky Martin, Karasek David, Karhanova Marta

机构信息

Department of Internal Medicine III-Nephrology, Rheumatology and Endocrinology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic.

Department of Computer Science, Faculty of Electrical Engineering and Computer Science, VSB Technical University of Ostrava, Ostrava, Czech Republic.

出版信息

Endocrine. 2025 Mar;87(3):1112-1119. doi: 10.1007/s12020-024-04108-4. Epub 2024 Nov 28.

Abstract

PURPOSE

High-dose intravenous glucocorticoids are the standard first-line treatment in active, moderate to severe and severe thyroid eye disease (TED). We evaluate the usefulness of clinical activity score (CAS) and thyroid-stimulating immunoglobulin (TSI) as predictors and/or post-treatment markers of corticoresistance in patients with TED and the effect of rituximab in second-line treatment.

METHODS

We enrolled 236 patients with an active TED into this retrospective single-tertiary-center cohort study. All patients were initially treated with high-dose systemic glucocorticoids. Rituximab was later administered to 29 of 42 corticoresistant patients.

RESULTS

The CAS of the corticoresistant patients was significantly higher both before (p = 0.0001) and after (p = <0.0001) first-line treatment compared to the corticosensitive group. ROC analysis established the cut-point value as CAS ≥ 2.5 with a sensitivity of 96.3%, specificity of 57.5% and area under the curve of 82.8%. In 22 patients treated with rituximab, CAS gradually decreased to zero values without reactivation during extended follow-up. There was no difference in the TSI of corticosensitive and corticoresistant patients before or after first-line therapy.

CONCLUSION

CAS ≥ 2, after first-line treatment, could be used as a corticoresistance marker. Corticoresistant patients should be subject to long-term follow-up for early detection of reactivation to reduce the delay to second-line treatment. Rituximab is a well-tolerated choice of second-line treatment and has a long-lasting effect on disease activity. Although TSI is a valuable biomarker of Graves' disease and TED activity, according to our results, TSI cannot be used as a marker of corticoresistance.

摘要

目的

大剂量静脉注射糖皮质激素是活动性、中度至重度及重度甲状腺眼病(TED)的标准一线治疗方法。我们评估临床活动评分(CAS)和促甲状腺素免疫球蛋白(TSI)作为TED患者皮质激素抵抗的预测指标和/或治疗后标志物的有用性,以及利妥昔单抗在二线治疗中的效果。

方法

我们将236例活动性TED患者纳入这项回顾性单中心队列研究。所有患者最初均接受大剂量全身性糖皮质激素治疗。随后,42例皮质激素抵抗患者中的29例接受了利妥昔单抗治疗。

结果

与皮质激素敏感组相比,皮质激素抵抗患者在一线治疗前(p = 0.0001)和治疗后(p < 0.0001)的CAS均显著更高。ROC分析确定切点值为CAS≥2.5,敏感性为96.3%,特异性为57.5%,曲线下面积为82.8%。在22例接受利妥昔单抗治疗的患者中,CAS在延长随访期间逐渐降至零值且无复发。皮质激素敏感和皮质激素抵抗患者在一线治疗前后的TSI无差异。

结论

一线治疗后CAS≥2可作为皮质激素抵抗的标志物。皮质激素抵抗患者应接受长期随访,以便早期发现复发,减少二线治疗的延迟。利妥昔单抗是一种耐受性良好的二线治疗选择,对疾病活动有持久影响。尽管TSI是格雷夫斯病和TED活动的有价值生物标志物,但根据我们的结果,TSI不能用作皮质激素抵抗的标志物。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fb0/11845400/a84a9e60ca23/12020_2024_4108_Fig1_HTML.jpg

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验