| Background and Objective:Graves’ ophthalmopathy(GO)is an inflammatory disease that affects the crippling and destructive appearance of the orbit and appendages.Studies have shown that statins can reduce the risk of developing GO in patients with Graves’ disease(GD),improve the outcome of Graves orbital disease in patients with moderate and severe active ophthalmopathy with hypercholesterolemia,and protect GO to a certain extent,but the mechanism is still controversial.By studying the effect of atorvastatin calcium tablets on serum cytokines in patients with GO,to analyze whether statins play a protective role by affecting serum cytokines in GO patients,to increase the possible molecular mechanism of statins’ protective effect on GO,and to increase evidence on whether statins are needed in different stages of GO patients.Methods:This study collected 60 GO patients with dyslipidemia who were treated or hospitalized in the Department of Endocrinology,the first affiliated Hospital of Nanchang University from August 1,2022 to March 1,2023,including long course group(GO > 2 years,n = 30)and short course group(GO < 2 years,n = 30).The basic clinical data such as sex,age,height,weight,medical history,medication,radioactive iodine therapy,drug taboo,smoking and so on were collected.The changes of thyroid function,thyrotropin receptor antibody,liver function,fasting blood glucose,blood lipid,cytokines(tumor necrosis factor-α and interleukin-10),exophthalmos,CAS score and adverse drug reactions were observed and analyzed in two groups of GO patients before and 2 months after taking atorvastatin calcium tablets.Results:1.There was no significant difference in age,sex and BMI between the two groups(P > 0.05).There was no significant difference in FT3,TSH,TRAb,TC,HDL-C,LDL-C and exophthalmos between the long course group and the short course group before taking medication(P > 0.05),while there was significant difference in FT4 and TG between the two groups(P < 0.05).There was no correlation between TNF-α and FT4,TG between the two groups before taking medicine(P > 0.05).Before taking medicine,the mean value of TNF-α in the long course group was lower than the upper limit of normal value(ULN),while the mean value of TNF-α in the short course group was significantly higher than the upper limit of normal value,and there was significant difference in TNF-α between the two groups(P < 0.05).2.There was no statistical significance in FT3,FT4,TSH,TRAb,exophthalmos and TNF-α in the long course group before and after medication(P > 0.05),while TC,TG,HDL-C and LDL-C decreased after medication compared with that before medication,with statistical significance(P < 0.05).There was no statistical significance in FT3,TSH,TRAb,TG,HDL-C and exophthalmos in the short course group before and after medication(P > 0.05),while FT4,TC,LDL-C and TNF-αwere all decreased significantly compared with those before medication(P < 0.05).Because the IL-10 of long course group and short course group was < 5 before and after treatment,there was no specific numerical expression,so the data analysis was not carried out.3.The CAS scores of the patients collected were all less than 3.In the short course group,there were 2 patients with bilateral eyelid swelling improved,1 patient with conjunctival congestion improved and CAS score decreased,while the other patients had no change in CAS score before treatment.There was no significant change in the CAS score of patients with long course of disease after treatment.4.There was no statistical significance in antithyroid drugs between the two groups(P > 0.05).There was no significant difference in the dosage of antithyroid drugs between the long course group and the short course group(P > 0.05).The mean values of ALT and AST in long and short course groups were lower than those in ULN before treatment,and there was no significant difference between the two groups(P > 0.05).In the long course group,the mean values of ALT and AST after treatment were lower than those of ULN,but significantly higher than those before treatment(P < 0.05).The mean values of ALT and AST in the short course group were lower than those in ULN after treatment,but there was no significant difference before and after treatment(P > 0.05).The proportion of asymptomatic transaminase elevation in the long course group was higher than that in the short course group,with 5 cases of long course(16.7%,5/30)and only 1 case of short course(3.3%,1/30).The mean value of FBG in long and short course groups was lower than that in ULN before treatment,and there was no significant difference between the two groups(P > 0.05).The mean value of FBG in the two groups after taking medicine was lower than that in ULN,but there was no significant difference before and after taking medicine(P > 0.05).None of the 60 patients had muscle aches or muscle symptoms of myalgia,weakness,stiffness,or spasm.Conclusions:1.Serum pro-inflammatory cytokine TNF-α was increased in patients with Graves’ ophthalmopathy in the early stage of the disease(course < 2 years).Atorvastatin calcium tablets can significantly reduce the level of serum TNF-α in patients with short course Graves’ ophthalmopathy.Some patients may have a decrease in CAS score,but the improvement of exophthalmos is not significant.2.There was no significant change in serum TNF-α in patients with Graves’ ophthalmopathy with a long course of disease(course > 2 years).Atorvastatin calcium tablets did not significantly improve the exophthalmos and CAS score of Graves’ ophthalmopathy patients whose CAS score was lower than 3.3.The level of transaminase in patients with long course Graves’ ophthalmopathy is slightly higher than that before treatment.The transaminase level of short-term atorvastatin calcium tablets in patients with Graves’ ophthalmopathy was asymptomatic,the incidence of stain-associated muscle symptoms was lower,and had no significant effect on fasting blood glucose. |
