糖皮质激素冲击治疗对活动期中重度甲状腺相关眼病患者的疗效及影响因素分析

Analysis of the Efficacy and Factors Influencing Flucocorticoid Shock Therapy in Patients with Moderate to Severe Thyroid-Related Ophthalmopathy in the Active Phase

目的:探究影响糖皮质激素冲击治疗活动期中重度甲状腺相关眼病(thyroid associated ophthalmopathy,TAO)效果的可能因素。方法:回顾性分析2018年6月至2020年3月在珠海市第五人民医院内分泌科采用标准化糖皮质激素冲击治疗的活动期中重度TAO患者103例,根据治疗后眼睑退缩、眼球突出、眼球运动及临床活动性评分(clinical activity score,CAS)等指标的改善程度分为疗效显著组80例和疗效欠佳组23例,对比两组患者的年龄、性别、吸烟史、突眼度、C-反应蛋白(C-reactive protein,CRP)、血沉(erythrocyte sedimentation rate,ESR)、中性粒细胞计数(neutrophil count,NEU)、淋巴细胞计数(lymphocyte count,LYM)、中性粒-淋巴细胞比值(neutrophil-lymphocyte ratio,NLR)、促甲状腺素受体抗体(thyroid stimulating hormone receptor antibodies,TRAb)、甲状腺球蛋白抗体(anti-thyroglobulin antibodies,TGAb)、甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)等相关指标,分析影响疗效的有关因素。结果:疗效显著组和疗效欠佳组对比,年龄、性别和LYM无统计学差异(P>0.05);吸烟史、突眼度、CRP、ESR、NEU、NLR、TRAb、TGAb、TPOAb等指标存在统计学差异(P<0.05)。Logistic回归分析表明吸烟史、突眼度、CRP、ESR、NEU、NLR、TRAb、TGAb、TPOAb等因素与疗效相关(P<0.05)。结论:对于中重度TAO患者,使用糖皮质激素冲击治疗时,性别、年龄、LYM与疗效无关,突眼度、吸烟史、CRP、ESR、NEU、NLR、TRAb、TGAb、TPOAb等因素与疗效有关,戒烟、积极治疗甲状腺疾病有助于提高疗效。

Objective:To explore possible factors affecting the effect of glucocorticoid shock therapy for active thyroid associated ophthalmopathy(TAO)in moderate to severe ophthalmopathy.Methods:In this retrospective study,103 patients with moderate to severe TAO during active period who received standardized pulse glucocorticoid therapy who were admitted to the Department of Endocrinology of the fifth people's hospital of zhuhai from June 2018 to March 2020 were enrolled in this study.According to the changes of eyelid retraction,exophthalmos,eye movement,and clinical activity score(CAS)after treatment,the patients were assigned into two groups:80 cases in the significant effectiveness group and 23 cases in the ineffectiveness group.The age,gender,smoking history,exophthalmos,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),neutrophil count(NEU),lymphocyte count(LYM),neutrophil-lymphocyte ratio(NLR),thyroid stimulating hormone receptor antibodies(TRAb),anti-thyroglobulin antibodies(TGAb),thyroid peroxidase antibody(TPOAb)were collected and the related factors affecting the curative effect were analyzed.Results:There were no statistical differences in age,sex and LYM between the two groups(P>0.05).Smoking history,degree of exophthalmos,CRP,NEU,NLR ESR,TRAb,TGAb,TPOAb were statistically different between the two groups(P<0.05).Logistic regression analysis also showed that smoking history,degree of exophthalmos,CRP,ESR,NEU,NLR,TRAb,TGAb,TPOAb were associated with the effectiveness(P<0.05).Conclusion:For patients with moderate to severe TAO,age,gender,LYM were not associated with prognosis,while smoking history,exophthalmia,CRP,ESR,NEU,NLR,TRAb,TGAb,TPOAb were associated with the effectiveness.Smoking cessation and active treatment of thyroid disease can help improve the curative effect.