Elevated Immunoglobulin G4 Levels in Patients with Thyroid Eye Disease and Their Clinical Implications
Elevated Immunoglobulin G4 Levels in Patients with Thyroid Eye Disease and Their Clinical Implications
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甲状腺眼病患者免疫球蛋白 G4 水平升高及其临床意义
DOI：
10.1167/iovs.61.5.57
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Huasheng Yang
中科院分区：
文献类型：
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作者：
Huijing Ye;Wei Xiao;Rongxin Chen;Ping Zhang;Lijuan Tang;Jingqiao Chen;Te Zhang;Xian Ji;Lu Shi;Huasheng Yang
目的探讨眼眶减压术中甲状腺眼病(TED)与免疫球蛋白G4(IgG4)水平的关系。方法对185例经眼眶减压术确诊为TED的患者进行前瞻性观察队列研究。测定血清IgG4水平，并对眶脂肪组织进行免疫组织化学染色。对与临床病理特征相关的资料进行分析。结果在入选的185例TED患者中，(34.6%)为IgG4阳性。IgG4阳性患者年龄较大，临床活动评分(CAS)较高，最佳矫正视力(BCVA)较差。IgG4阳性患者的促甲状腺激素受体抗体(TRAb)水平、病理组织学中的IgG4计数、IgG4/Ig G比值和密集的淋巴细胞浸润均明显高于IgG4阴性患者。明确的和可能的IgG4亚型与TED患者的活动期独立相关。结论IgG4亚型在TED中较为常见。IgG4阳性的TED患者可能年龄更大，病情更严重，临床活动评分更高。IgG4可能在TED的发病机制中起重要作用。
Purpose The purpose of this study was to assess the relationship between thyroid eye disease (TED) in patients undergoing orbital decompression and immunoglobulin G4 (IgG4) levels. Methods A prospective observational cohort study was conducted among 185 consecutive patients who were diagnosed with TED and underwent orbital decompression. Serum levels of IgG4 were measured, and immunohistochemical staining for IgG and IgG4 was performed in orbital adipose tissue. Data related to clinicopathologic features were analyzed. Results Among the 185 enrolled patients with TED, 64 (34.6%) were IgG4-positive. The IgG4-positive patients were older, had higher clinical activity scores (CAS), and had worse best-corrected visual acuity (BCVA) than the IgG4-negative patients. Higher thyrotropin receptor antibody (TRAb) levels, histopathological IgG4 counts, IgG4/IgG ratios, and dense lymphocyte infiltration were more frequently observed in IgG4-positive than in IgG4-negative patients. Definitive and probable IgG4 subtypes were independently associated with the active stage in patients with TED. Conclusions Our data suggest that the IgG4 subtype in TED is common. IgG4-positive patients with TED may be older, have more severe disease, and have higher clinical activity scores. IgG4 may play an important role in the pathogenesis of TED.