血脂联合磁共振参数在甲状腺相关性眼病糖皮质激素治疗疗效预测中的价值

Value of serum lipid combined with MRI parameters in predicting the efficacy of glucocorticoid in treatment of thyroid⁃associated ophthalmopathy

目的:评估血清脂代谢指标联合眼眶磁共振成像(magnetic resonance imaging,MRI)定量参数在预测中重度活动期甲状腺相关性眼病(thyroid-associated ophthalmopathy,TAO)患者糖皮质激素(glucocorticoid,GC)治疗疗效中的价值。方法:回顾性纳入44例接受GC治疗的中重度活动期TAO患者,根据GC疗效将患者分为敏感组(n=28)和抵抗组(n=16)。收集两组患者在GC治疗前的血清脂代谢指标和基于眼眶MRI测得的泪腺突出度/眼眶脂肪厚度(lacrimal gland herniation/orbital fat thickness,LGH/OFT)及其他临床参数,并比较两组间各参数差异。采用Logistic回归和受试者工作特征曲线分析与GC治疗疗效相关的独立预测因子并评估其预测价值。结果:敏感组患者血清总胆固醇和低密度脂蛋白胆固醇水平显著低于抵抗组(P=0.005,P=0.019),且敏感组病程更短(P=0.037)。敏感组患者LGH/OFT显著高于抵抗组(P<0.001)。总胆固醇和LGH/OFT是TAO患者激素是否敏感的独立预测因子(OR值分别为0.230、1.395_(每0.1单位),P均<0.05)。联合血清总胆固醇≤4.8 mmol/L和LGH/OFT≥1.51预测GC治疗敏感性,可以获得最佳预测效能(曲线下面积为0.838,灵敏度为87.5%,特异度为65.6%)。结论:血脂参数和眼眶MRI定量参数均可预测中重度活动期TAO患者GC治疗敏感性,两者联合可进一步提高预测效能。

Objective:To evaluate the value of serum lipid metabolism and orbital magnetic resonance imaging(MRI)quantitative parameters in predicting the efficacy of glucocorticoid(GC)therapy in patients with active and moderate⁃to⁃severe thyroid⁃associated ophthalmopathy(TAO).Methods:The study retrospectively enrolled 44 patients with active and moderate⁃to⁃severe TAO receiving GC therapy,according to GC efficacy,patients were divided into the GC⁃sensitive group(n=28)and the GC⁃insensitive group(n=16).Serum lipid metabolism,orbital MRI⁃based lacrimal gland herniation/orbital fat thickness(LGH/OFT)as well as other clinical parameters before GC therapy were collected and compared between the two groups.Multivariate logistic regression and receiver operating characteristic curve were used to analyze the independent predictors related to GC therapy efficacy and evaluate their predictive value.Results:The serum total cholesterol and serum low⁃density lipoprotein cholesterol in GC⁃sensitive group were significantly lower than those in the insensitive group(P=0.005,P=0.019),and the disease duration was shorter in the sensitive group(P=0.037).The ratio of LGH/OFT in the sensitive group was higher than that in the insensitive group significantly(P<0.001).Serum total cholesterol and LGH/OFT were found to be independent predictors of sensitivity to GC therapy in TAO patients through multivariate analysis(odds ratio were 0.230 and 1.395_(per 0.1 units),respectively)(both P<0.05).Combining serum total cholesterol≤4.8 mmol/L and LGH/OFT≥1.51,the best predictive efficacy could be obtained(area under the curve 0.838,sensitivity 87.5%,specificity 65.6%).Conclusion:Both serological lipid parameters and orbital MRI quantitative parameters can predict the sensitivity of GC therapy in patients with active and moderate⁃to⁃severe TAO,and their combinations can further improve the predictive performance.