A Preliminary Clinical Study On Patients With Active Moderate To Severe And Extremely Severe Graves'orbitopathy Treated With High-dose Methylprednisolone

Objective To study the effect of high-dose methylprednisolone intravenous pulse therapy on immunoglobulins and CD series and the changes of extraocular magnetic resonance imaging in patients with active moderate-to-severe and very severe Graves' orbitopathy(GO).Method 30 patients with active moderate-to-severe GO and 27 patients with active very severe GO were enrolled in this study,and respectively accept high-dose methylprednisolone intravenous pulse therapy for 12 weeks and 4 weeks.Serum thyroidal autoantibodies such as thyroid-stimulating hormone receptor antibody(TRAb),anti-thyroperoxidase antibody(TPOAb)and serum immunoglobulins like IgG,IgE,IgA,IgM were evaluated respectively before and after treatment.Percentages of CD3+,CD4+,CD8+T cells were also evaluated at each time point.And changes in the maximum transverse diameter,minimum transverse diameter and cross-sectional area of the total 8 extraocular muscles including both internal and external rectus as well as upper and lower rectus were evaluated by orbital enhanced magnetic resonance imaging(MRI).Results We found that thyroid related antibodies such as TRAb and TPOAb and immunoglobulin such as total IgG and IgA in both groups were significantly decreased after treatment(P<0.01).The percentage of CD3+T cells of both groups was significantly decreased(P<0.05).The percentage of CD3+CD4+T cells and ratio of CD4/CD8 were significantly decreased in the moderate to severe groups(P<0.05),while there was no significant change in the very severe group.In both groups,there was no significant change in the percentage of CD8+T cells(P>0.05).Orbital MRI showed that most of the parameters in the baseline values of the longest transverse diameter,the shortest transverse diameter and the cross-sectional area of the 8 extraocular muscles were significantly greater in the extremely severe group than in the moderate-to-severe group(P<0.05).After treatment,only the parameters related to the external rectus of the left eye were significantly decreased in the moderate-to-severe group(P<0.01),while the parameters related to the external rectus of the left eye were significantly decreased in the extremely severe group(P<0.05).The comparison between the two groups showed that the variation of the related parameters of the left lateral rectus in the very severe group was significantly greater than that in the moderate-to-severe group(P<0.001).Conclusion Methylprednisolone may play a therapeutic role by regulating both humoral and cellular immunity as well as reducing serum immunoglobulin concentration directly.Methylprednisolone 4-week pulse therapy may have a better effect than 12-week pulse therapy on reducing extraocular swelling.