新型冠状病毒灭活疫苗接种与甲状腺相关性眼病临床活动性的相关性分析

Correlation analysis between novel coronavirus inactivated vaccine inoculation and clinical activity of thyroid associated ophthalmopathy

目的观察甲状腺相关性眼病(TAO)患者接种新型冠状病毒(SARS-Cov-2)灭活疫苗后临床活动性的影响及其相关性.方法回顾性病例系列研究.收集山西省眼科医院2021年7月至2022年4月完成2针剂SARS-Cov-2灭活疫苗接种的TAO患者53例.依据CAS评分将患者分为非活动性组22例(CAS<3分),活动性组31例(CAS≥3分);将活动性组患者分为轻度组27例(3≤CAS<5)及中重度组4例(CAS≥5).活动性TAO患者给予局部曲安奈德注射液40 mg球旁注射治疗.观察疫苗接种前后促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)、促甲状腺素受体抗体(TRAb),临床活动性评分(CAS)及^(99)Tc^(m)-DTPA SPECT-CT眼眶融合显像的摄取比值(UR).结果接种新冠疫苗前,ROC曲线显示,活动性及非活动性TAO患者的UR数值最佳截断点为1.355,灵敏度88.0%,特异度94.7%;UR值与CAS评分呈正相关(r=0.83,P<0.001);甲状腺功能及相关抗体分析:活动性与非活动性TAO患者接种SARS-Cov-2灭活疫苗前后TSH、FT3、FT4、TRAb、TPOAb和TGAb比较差异均无统计学意义(均P>0.05);临床活动性分析:非活动性TAO患者接种SARS-Cov-2灭活疫苗前后CAS评分差异无统计学意义(P>0.05),UR值显著升高(P<0.001);活动性TAO患者中,轻度及中重度组接种SARS-Cov-2疫苗后,CAS评分均显著降低(均P<0.05),UR值无显著改变(P>0.05);轻度组中,92.59%(25/27)的患者接受或完成局部激素治疗,接种SARS-Cov-2灭活疫苗后,CAS评分显著降低(P<0.001),UR值无显著改变(P>0.05).结论在控制TAO患者甲状腺功能联合局部激素治疗下,多数轻度活动性TAO患者可安全接种SARS-Cov-2灭活疫苗;对于非活动性TAO患者存在隐匿性加重的可能,在局部糖皮质激素注射治疗下可能实现安全接种.

Objective To observe the effect of clinical activity and its correlation in patients with thyroid associated ophthalmopathy(TAO)after receiving the inactivated coronavirus vaccine.Methods This was a retrospective case series study.The clinical data of 53 patients of TAO were collected in Shanxi Eye Hospital from Jul.2021 to Apr.2022 and completed two vaccinations of inactivated coronavirus vaccine.Thyroid stimulating hormone(TSH),free triiodothyronine(FT3),free thyroxine(FT4),thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TGAb),thyrotropin receptor antibody(TRAb),clinical activity score(CAS)and uptake ratio(UR)of ^(99)Tc^(m)-DTPA SPECT-CT orbital fusion imaging were recorded before and after vaccination.Based on the CAS score,the patients were divided into the inactive group with 22 cases(CAS<3 points)and the active group with 31 cases(CAS≥3 points).And the active group were subdivided into the mild group(27 cases)(3≤CAS<5)and the moderate-severe group(4 cases)(CAS≥5).Patients with active TAO were given 40mg parabulbar injection of triamcinolone acetonide injection.Results Before the vaccination of inactivated coronavirus vaccine,according to the ROC curve,the optimal cut-off point of the UR in active and inactive TAO patients was 1.355,with a sensitivity of 88.0%and a specificity of 94.7%.UR was positively correlated with CAS score(r=0.83,P<0.001).Analysis of thyroid function and related antibodies:There was no statistical difference in TSH,FT3,FT4,TRAb,TPOAb and TGAb between active and inactive TAO patients before and after injection of inactivated coronavirus vaccine(P>0.05).Analysis of clinical activity:there was no significant difference in CAS score of the inactive TAO patients between before and after injection of inactivated coronavirus vaccine(P>0.05).UR increased significantly after injection of inactivated coronavirus vaccine(P<0.001).The CAS scores of patients in the mild group and the moderate-severe group were significant reducing(P<0.05),while the UR value had no significant change(P>0.05)after receiving the vaccine.After vaccination,there were significant reducing(P<0.001)in CAS score and no significant change(P>0.05)in the UR value in 92.59%(25/27)of patients with mildly-active TAO who received or completed local hormone therapy.Conclusion With well-controlled thyroid function and local hormone therapy,most patients with mildly-active TAO can be safely vaccinated with inactivated coronavirus vaccine.In terms of the potential of aggravation of clinical activity,safe vaccination can be achieved under local glucocorticoid injection treatment in inactive TAO patients;^(99)Tc^(m)-DTPA SPECT-CT orbital fusion imaging as a sensitive index for the evaluation of orbital inflammation in TAO patients has important clinical reference value.