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引导托西利祖马布治疗的关键指标,以防止在抗激素的双甲状腺视神经病变中进行轨道减压手术

Wenjun Shu^1,2,3,4, Mingxu Yan^1,2,3,4, Lu Gan^1,2,3

¹Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.

Frontiers in immunology

|June 13, 2025

概括

甲状腺刺激激素受体抗体 (TRAb) 的基线值和托西利祖马布 (TCZ) 治疗后SIR,EOM/temporalis_MAX的变化预测了对激素耐药性双甲状腺视神经病变 (DON) 进行手术的需要. 这些标记物有助于个性化TCZ治疗,避免不必要的手术.

科学领域:

眼科医生眼科眼科
内分泌学在内分泌学.
免疫学免疫学免疫学

背景情况:

甲状腺相关眼病 (TAO) 是一种影响眼睛的自身免疫性疾病.
托西利祖马布 (TCZ) 在TAO中表现出有效性,但其在激素耐药性双甲状腺视神经病变 (DON) 中的作用不太清楚.
在接受TCZ治疗的DON患者中预测需要手术对于个性化护理至关重要.

研究的目的:

确定基线和治疗后的指标,预测TCZ治疗的激素耐药DON患者的手术干预的必要性.
评估眼科评估,生物标志物和轨道MRI发现的预测价值.

主要方法:

对31名接受TCZ治疗的激素耐药DON患者的回顾性分析,分为手术 (n=15) 和非手术 (n=16) 组.
治疗前后眼科数据,生物标志物 (TRAb) 和轨道MRI (SIR(EOM/temporalis) 的比较.
接收器运行特征 (ROC) 曲线和物流回归分析用于预测价值评估.

主要成果:

在手术组中观察到较高的基线TRAb和阳性SIR (EOM/temporalis) _MAX变化.
非手术组显示了负的SIR (EOM/temporalis) 变化.
TRAb ≤5.07 IU/L 和 SIR ((EOM/temporalis) _MAX ≤-1.83 是非手术结局的显著预测因素 (AUC 分别为0.846和0.863).
SIR ((EOM/temporalis) _MAX变化是手术干预的独立预测因素.

结论:

在SIR ((EOM/temporalis) _MAX和基线TRAb水平的百分比变化预测了在TCZ治疗后对抗激素的DON患者进行手术的需要.
这些指标促进了个性化的TCZ治疗策略.
利用这些预测因素可以帮助避免在DON患者中不必要的手术干预.

关键词:

磁共振成像技术的使用视神经病变是一种视神经病变.甲状腺相关的眼科病变甲状腺刺激激素受体抗体这就是为什么tocilizumab.

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