Clinical relevance of serum immunoglobulin G4 in glucocorticoid therapy of Graves' ophthalmopathy
Clinical relevance of serum immunoglobulin G4 in glucocorticoid therapy of Graves' ophthalmopathy
复制标题
血清免疫球蛋白 G4 在糖皮质激素治疗 Graves 眼病中的临床意义
DOI：
10.1111/cen.14493
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发表时间：
2021-07-16
影响因子：
3.2
通讯作者：
Yuan, Gang
中科院分区：
文献类型：
--
作者：
Li, Yaling;Luo, Ban;Yuan, Gang
目的以往研究表明IgG 4水平与Graves眼病（GO）的发生发展有关。本研究的目的是探讨IgG 4水平在GO患者糖皮质激素（GC）治疗中的作用。设计69例GO患者入组。进行血清甲状腺激素、甲状腺抗体、IgG、IgG 4、眼科检查和眼眶MRI检查。此外，还比较了32例活动性中重度GO患者接受大剂量静脉GC治疗后的临床结局（包括临床活动评分（CAS）、眼球突出、视力、眼内压、复视和眼睑宽度的复合反应终点）。患者69例连续的GO患者被要求参加这项研究。69例GO患者中有32例接受了大剂量静脉GC治疗。测定血清IgG和IgG 4、血清甲状腺激素和甲状腺自身抗体。在治疗前（第0周）和治疗后（第12周）进行总体眼科评估。结果33.3%（23/69）的GO患者血清IgG 4水平升高。IgG 4水平与GO的严重程度和活动性呈正相关。GO患者经GC治疗后，IgG 4、IgG 4/IgG、视力、CAS均明显改善。高IgG 4水平的患者与正常IgG 4水平的患者相比，眼外肌面积（EOM）显著减少，临床结局更好。结论IgG 4升高的GO患者可能存在一个亚组，与IgG 4正常的GO患者相比，其眼病更严重，对GCs治疗的反应更好。
Objective Previous study suggested IgG4 levels were associated with the development of Graves' ophthalmopathy (GO). The aims of the present study were to investigate the role of IgG4 levels in glucocorticoid (GC) treatment in GO patients. Design 69 GO patients were enrolled. Serum thyroid hormones, thyroid antibodies, IgG, IgG4, ophthalmological examinations and orbital MRI were performed. Furthermore, the clinical outcomes (a composite response endpoint including the clinical activity score (CAS), proptosis, vision, intraocular pressure, diplopia and lid width) after high-dose intravenous GC treatment in 32 active moderate-to-severe GO patients were compared. Patients 69 consecutive patients with GO were asked to participate in the study. 32 of 69 GO patients were treated with high-dose intravenous GCs. Measurements Measurement of serum IgG and IgG4, serum thyroid hormones and thyroid autoantibodies. An overall ophthalmic assessment was performed pretherapy (week 0) and post-therapy (week 12). Results 33.3% of GO patients (23/69) had elevated IgG4 levels. IgG4 levels were positively correlated with the severity and activity of GO. After GC therapy, IgG4, IgG4/IgG, vision and CAS were significantly improved in GO patients. Patients with high IgG4 levels had a significantly reduced extraocular muscle area (EOMs) and better clinical outcomes than patients with normal IgG4 levels. Conclusions Our results suggest a possible subgroup of elevated IgG4 GO patients, with more severe ophthalmopathy and better response to GCs treatment compare with normal IgG4 GO patients.