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在患有潜在结核病或慢性乙型肝炎的患者中,甲状腺眼病 (TED) 的多学科管理
John S Vekinis1, Jonathan Lee1, Vickie Lee2,3
1Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK.
Thyroid research
|January 30, 2026
概括
用免疫抑制治疗甲状腺眼病 (TED) 在患有全身感染的患者中是可行的,如结核病 (TB) 或乙型肝炎病毒 (HBV). 多学科的方法确保了安全性和有效性,通过与TED治疗一起管理感染风险.
科学领域:
- 眼科医生 眼科 眼科
- 内分泌学 在内分泌学.
- 传染性疾病 传染性疾病
背景情况:
- 静脉注射甲基prednisolone (IVMP) 是适度至严重的甲状腺眼病 (TED) 的主要治疗方法.
- 系统性感染,如潜伏性结核病 (TB) 和慢性乙型肝炎病毒 (HBV),由于重新激活的风险,对免疫抑制具有禁忌.
- 对于患有这些并发感染的患者管理TED的数据有限.
研究的目的:
- 评估在甲状腺眼病 (TED) 患者中启动免疫抑制疗法的安全性和有效性,这些患者由于全身感染而有禁忌.
- 在患有潜在结核病或慢性HBV的患者中探索TED的治疗策略.
主要方法:
- 五个中度至重度TED患者的回顾性病例系列,对免疫抑制有禁忌.
- 由多学科团队 (MDT) 输入为指导的治疗决定.
- 患者接受了含有或不含mycophenolate mofetil (MMF) 的IVMP,以及感染管理或保守护理. 监测的结果包括TED活动,感染状态和不良事件.
主要成果:
- 三名患有潜伏结核病的患者接受了预防性治疗 (伊索尼亚齐德±利芬素);一名接受了IVMP与MMF,而两人接受了保守的TED管理.
- 两名患有慢性HBV的患者接受了IVMP和抗病毒疗法 (tenofovir或 entecavir) 的治疗.
- 没有发生系统性感染或不良事件的进展. 接受治疗的患者表现出改善的临床活动评分 (CAS) 和稳定或改善的格雷夫斯眼科医疗生活质量 (GO-QOL) 评分.
结论:
- 通过多学科策略,TED的免疫抑制可以安全地在患有全身感染的患者中进行.
- 成功的关键因素包括早期查,仔细选择患者,协调护理和预防性感染管理.
- 这种方法有效地平衡了治疗疗效与高风险TED患者的风险减轻.
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