Correlation Analysis Of Initial Serum LDL Level And Clinical Efficacy Of Methylprednisolone Shock In Graves Ophthalmopathy

Background:Graves ophthalmopathy（GO）,also known as thyroid-associated ophthalmopathy,is an inflammatory orbital disease,which is often associated with hyperthyroidism caused by Graves’disease（GD）.GO is an autoimmune disease,and its pathogenesis is not fully understood.At present,it is believed that the pathogenesis is cellular immunity.The clinical manifestations are different degrees of proptosis,ocular soft tissue involvement,photophobia and lacrimation,spontaneous eye movement pain,eyelid contracture,diplopia and vision loss,and so on.According to the 2021 Graves Ophthalmopathy clinical practice management guideline,high-dose intravenous glucocorticoids are the first-line treatment for patients with moderately or severely active GO.Studies at home and abroad have shown that the increase of serum cholesterol（TC）and low-density lipoprotein（LDL）levels is related to the incidence of GO.Hypercholesterolemia is a risk factor for GO,and high LDL levels will reduce the effect of glucocorticoid pulse therapy.At present,there are few studies on the correlation between serum LDL level and the clinical effect of glucocorticoid pulse therapy for GO.Therefore,this study retrospectively observed the clinical data of patients with moderate to severe active GO,analyzed the factors related to the activity of GO patients,and explored the relationship between the fasting serum low-density lipoprotein level and the improvement of ocular symptoms after glucocorticoid pulse therapy in GO patients,and explored the correlation between the initial serum LDL level and the efficacy of glucocorticoid pulse therapy.It is hoped to guide clinical work to a certain extent.Purpose:To explore the factors related to GO activity and the correlation between initial serum LDL level and the effect of glucocorticoid pulse therapy in GO patients.Method:A total of 60 patients with moderate to severe active GO who received glucocorticoid pulse therapy from September 2020 to December 2022 were selected,including 21 males,accounting for 35%of the total number,and 39 females,accounting for 65%of the total number.The basic information and clinical data of the patients were collected,including name,gender,age,BMI,smoking,and GO course.Fasting blood glucose before treatment,CAS score before treatment,improvement of ocular inflammation after completion of pulse therapy,intraocular pressure and exophthalmos before treatment,thyroid volume（left lobe+right lobe+isthmus）before treatment,blood lipids（total cholesterol,TG,LDL,HDL）before treatment,thyroid hormones（FT₃,FT₄,TSH）before treatment,thyroid autoantibody before treatment（TRAb,TPOAb,Tg Ab）,25-OHvit D before treatment,comorbidities,and adverse reactions during glucocorticoid pulse therapy.The factors related to GO activity were analyzed.The patients were divided into two groups according to the improvement of GO（improved and unimproved）.The differences in each indicator between the two groups were compared,and the relevant variables were further analyzed.Results:1.The course of GO,smoking,initial serum TC,LDL,FT₃,FT₄,25-OHvit D levels,thyroid volume,intraocular pressure before treatment,exophthalmos were correlated with GO activity（CAS score）（p<0.05）.The duration of GO,smoking,initial serum TC,LDL levels,thyroid volume,degree of exophthalmos and intraocular pressure were positively correlated with GO activity（CAS score）（r_s>0）.Serum FT₃,FT₄levels and 25-OHvit D levels were negatively correlated with GO activity（CAS score）（r_s<0）.2.There were significant differences in initial serum TC and LDL levels,CAS score before treatment,thyroid volume,intraocular pressure and exophthalmos before treatment between the two groups（improved group and non-improved group）（p<0.05）.3.The initial serum TC and LDL levels in the improved group were lower than those in the non-improved group.4.The higher the initial serum LDL level,the lower the probability of GO improvement after pulse therapy（B=-2.335,OR=0.097,p=0.007）.Initial serum TC level,CAS before treatment,thyroid volume,exophthalmos and intraocular pressure before treatment were not correlated with GO improvement（p>0.05）.5.The area of LDL curve was AUC=0.890,p<0.001,the sensitivity was 83.33%,the specificity was 92.86%,the 95%confidence interval was 0.784-0.996,and the cut-off value was 3.30mmol/L.The initial serum LDL level has a good predictive value for the efficacy of glucocorticoid pulse therapy for GO.Conclusion:The initial serum TC and LDL levels are positively correlated with GO activity.At the same time,the initial serum LDL level has a good clinical value in predicting the improvement of ocular inflammation in GO patients after glucocorticoid pulse therapy.High serum LDL level may reduce the efficacy of glucocorticoid pulse therapy and cannot achieve the clinical effect of disease improvement.In order to improve the effect of glucocorticoid pulse therapy and better improve orbital inflammation,it is recommended to strengthen the management of blood lipids in patients with GO.