血清IgG4与甲状腺相关性眼病的研究进展

Research progress of serum IgG4 and thyroid-associated ophthalmopathy

甲状腺相关性眼病(thyroid-associated ophthalmopathy,TAO)是一种威胁视力的自身免疫性疾病,患者通常出现突眼、复视或斜视,严重者可能会有视神经受压,造成视力受损甚或失明。血清免疫球蛋白G4(immunoglobulin G4,IgG4)是一种特异性抗体,与多种自身免疫性疾病有关。目前研究发现部分TAO患者血清IgG4水平升高,这些患者往往病情更加严重。在眼病的发生发展中,IgG4可能诱导眼眶成纤维细胞生成透明质酸,促进自身抗体产生,IgG4可能单独或联合促甲状腺激素受体抗体在TAO的发病机制中发挥作用。已有研究显示血清IgG4与眼病的临床活动性和严重程度相关,高IgG4可能预示TAO处于炎症活动早期,及时干预可减缓其肌肉病变和眼眶纤维化的进程。因此,本文对相关文献进行综述,探讨血清IgG4与甲状腺相关性眼病的关系,以期对TAO患者进行更早期和更有效的临床管理。

Thyroid-associated ophthalmopathy(TAO)is a vision-threatening autoimmune disease.Patients usually suffer from proptosis,diplopia or strabismus.In severe cases,the optic nerve may be compressed,resulting in visual impairment or even blindness.Serum immunoglobulin G4(IgG4)is a specific antibody that is associated with a variety of autoimmune diseases.Current studies have found that some TAO patients have elevated serum IgG4 levels,and these patients tend to have more severe symptoms.In the occurrence and development of ophthalmopathy,IgG4 may induce orbital fibroblasts to generate hyaluronic acid and promote the production of autoantibodies.IgG4 may play a role in the pathogenesis of TAO alone or in combination with thyrotropin receptor antibodies.Studies have shown that serum IgG4 is related to the clinical activity and severity of TAO.High IgG4 may indicate that TAO is in the early stage of inflammatory activity,and timely intervention can slow down the progression of muscle lesions and orbital fibrosis.Therefore,this article reviewed the relevant literature to explore the relationship between serum IgG4 and thyroid-associated ophthalmopathy,with a view to earlier and more effective clinical management of patients with TAO.