Factors associated with the efficacy of intravenous methylprednisolone in moderate-to-severe and active thyroid-associated ophthalmopathy: A single-centre retrospective study
Factors associated with the efficacy of intravenous methylprednisolone in moderate-to-severe and active thyroid-associated ophthalmopathy: A single-centre retrospective study
复制标题
与静脉注射甲基强的松龙治疗中度至重度和活动性甲状腺相关眼病疗效相关的因素：单中心回顾性研究
DOI：
10.1111/cen.13855
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发表时间：
2019-01-01
影响因子：
3.2
通讯作者：
Shi, Bingyin
中科院分区：
文献类型：
--
作者：
Hu, Shiqian;Wang, Yue;Shi, Bingyin
目的静脉注射甲基强的松龙（IVMP）是治疗中重度活动性甲状腺相关眼病（TAO）的首选药物。本研究旨在确定潜在的预测因素，并建立IVMP治疗疗效的多变量预测模型。设计：单中心回顾性研究。患者：共纳入了302例连续诊断为中重度和活动性TAO并接受IVMP全疗程治疗的患者。方法将被试分为训练集（n = 200）和验证集（n = 102）。采用多因素Logistic回归分析确定独立的预测因素并建立预测模型。结果除治疗前临床活动评分外，（OR = 3.506，P < 0.001），治疗期间促甲状腺激素（TSH）水平升高（OR = 0.145，P = 0.005），治疗前抗TSH受体抗体水平治疗前甘油三酯水平与疗效有显著相关性（OR = 0.090，P = 0.001）。预测模型显示出良好的校准和出色的区分度，在训练集和验证集中的曲线下面积分别为0.915（P < 0.001）和0.885（P < 0.001）。结论这项研究为与IVMP治疗疗效相关的因素提供了一些新的见解。已经建立并验证了多变量预测模型，以帮助确定IVMP治疗的适应症和预后。此外，对TAO患者的管理提出了几点建议：早期诊断和治疗（15个月内）;及时恢复和维持甲状腺功能正常，特别是仔细控制TSH水平（
Objective Intravenous methylprednisolone (IVMP) is recommended as the first-line treatment for moderate-to-severe and active thyroid-associated ophthalmopathy (TAO). This study aimed to identify potential predictors and establish a multivariable prediction model for the efficacy of IVMP therapy. Design A single-centre retrospective study. Patients A total of 302 consecutive patients diagnosed with moderate-to-severe and active TAO who underwent the full course of IVMP therapy were included. Methods Participants were sequentially divided into the training set (n = 200) and the validation set (n = 102). Multivariate logistic regression analysis was used to identify the independent predictors and establish the predictive model. Results In addition to the pretreatment clinical activity score (OR = 3.506, P < 0.001), elevated thyroid-stimulating hormone (TSH) levels during treatment (OR = 0.145, P = 0.005), pretreatment anti-TSH receptor antibody levels (OR = 0.061, P < 0.001) and duration of eye symptoms (OR = 0.878, P = 0.017), a significant relationship was found between therapeutic efficacy and the pretreatment triglyceride levels (OR = 0.090, P = 0.001). The prediction model showed good calibration and excellent discrimination, with an area under curve of 0.915 (P < 0.001) and 0.885 (P < 0.001) in the training and validation sets, respectively. Conclusions This study provides some novel insights into the factors associated with the efficacy of IVMP therapy. A multivariable prediction model has been established and validated to help determine the indication and prognosis of IVMP therapy. Moreover, several suggestions have been made in the management of TAO patients: early diagnosis and treatment (within 15 months); prompt restoration and maintenance of euthyroidism, especially meticulous control of TSH levels (