血脂水平与甲状腺相关性眼病病情及疗效相关性研究

Study on the correlation between blood lipid level and the disease condition as well as curative effect of thyroid-associated ophthalmopathy

目的观察甲状腺相关性眼病(TAO)患者血脂水平,与眼病病情和糖皮质激素冲击治疗疗效的相关性。方法选取2018年1月至2019年12月在上海长征医院内分泌科住院行糖皮质激素冲击治疗的TAO初治患者,收集患者一般资料,并于激素冲击治疗前后,检测甲状腺功能、抗体、空腹血清血脂水平,评估临床活动度评分(CAS)和严重程度评级(NOSPECS),测量眼眶MRI的眼外肌信号强度比值(SIR)、眼外肌厚度、眼球内侧脂肪厚度等指标。结果60例TAO患者(男性21例,女性39例)纳入分析,平均年龄(46.15±12.06)岁。患者基线空腹血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-c)水平与CAS评分、SIR值、眼外肌厚度呈显著正相关;而血脂水平与NOSPECS评级、眼球内侧脂肪厚度无明显相关性。高LDL-c组和高TC组患者较正常血脂组患者的CAS评分、SIR值、眼外肌厚度均显著升高。激素冲击治疗后,患者TC和LDL-c升高程度与其眼外肌厚度改善水平呈显著负相关。结论 TAO患者空腹血清血脂水平与眼病炎症活动水平密切相关,而冲击治疗后血脂水平改善与眼病疗效相关。因此,关注TAO患者血脂水平,有利于对眼病病情进行评价,并对激素冲击治疗的疗效进行预测,这为TAO综合治疗提供新的临床证据。

Objective To investigate the association between serum lipids and the diseaes condition as well as the effect of glucocorticoid pulse therapy in thyroid-associated ophthalmopathy(TAO). Methods The TAO patients who received glucocorticoid pulse therapy in the Department of Endocrinology of Shanghai Changzheng Hospital from Jan. 2018 to Dec.2019 were selected and we collected the following information before and after the treatment: general information of patients,thyroid function,thyroid antibodies,fasting serum lipid levels,clinical activity score(CAS)and Severity Rating(NOSPECS),signal intensity ratio(SIR)of extraocular muscle,extraocular muscle thickness,the width of the inner fat of eyeballs. Results Sixty patients(21 males and 39 females)were included in the study,with an average age of 46.15±12.06 years. The baseline fasting serum total cholesterol(TC)and low-density lipoprotein cholesterol(LDL-c)levels were positively correlated with CAS value,SIR value,and extraocular muscle thickness;while there was no correlation between the lipids level and NOSPECS grade or the width of the inner fat of eyeballs. Compared with patients in normal LDL-c group,the CAS score,SIR value,and extraocular muscle thickness of patients in high LDL-c group and high-Tc group were increased. After glucocorticoid pulse therapy,the degree of LDL-c increase was significantly negatively correlated with the improrement in extraocular muscle thickness. Conclusion The fasting serum lipid lerel in patients with TAO is closely related to in flammatary actirity of ophthalmopathy and extraocular muscle thickness,and the improvement in serum lipid level after pulse treatment may be related to the efficacy of TAO. Therefore,we should pay attention to the serum lipid level of TAO patients,it is useful to evaluate the condition of TAO and predict the efficacy of the therapy,and it provides new evidence for comprehensire treatment of TAO.