[1]邵毅,廖许琳,陈偲翊.解读“2021欧洲Graves眼病医疗管理指南”[J].眼科新进展,2021,41(11):1001-1005.[doi:10.13389/j.cnki.rao.2021.0211]
　SHAO Yi,LIAO Xulin,CHEN Siyi.Interpretation of “2021 European Guidelines for the Management of Graves’ Ophthalmopathy”[J].Recent Advances in Ophthalmology,2021,41(11):1001-1005.[doi:10.13389/j.cnki.rao.2021.0211]
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
41卷
期数:
2021年11期
页码:
1001-1005
栏目:
述评
出版日期:
2021-11-05

文章信息/Info

Title:
Interpretation of “2021 European Guidelines for the Management of Graves’ Ophthalmopathy”
作者:
邵毅; 廖许琳; 陈偲翊
330006　江西省南昌市，南昌大学第一附属医院眼科（邵毅，陈偲翊）；999077　香港特别行政区，香港中文大学眼科与视觉科学学系（廖许琳）
Author(s):
SHAO Yi1; LIAO Xulin2; CHEN Siyi1
1.Department of Ophthalmology,the First Affiliated Hospital of Nanchang University,Nanchang 330006,Jiangxi Province,China
2.Department of Ophthalmology and Visual Sciences,the Chinese University of Hong Kong,Hong Kong 999077,China
关键词:
Graves眼病; 诊断; 指南解读
Keywords:
Graves’ ophthalmopathy;  diagnosis;  interpretation of Guidelines
分类号:
R771.3
DOI:
10.13389/j.cnki.rao.2021.0211
文献标志码:
A
摘要:
Graves眼病，又称甲状腺相关性眼病，是一种免疫介导的炎症性疾病，常导致眼外肌和眶内脂肪扩张。“2021欧洲Graves眼病医疗管理指南”详细介绍了最新的Graves眼病的管理方法。本文将对该指南进行全面解读，旨在为广大医务工作者进一步提高Graves眼病的诊断和治疗水平，以更好地服务于广大眼病患者提供参考。
Abstract:
Graves’ ophthalmopathy, also called thyroid-associated ophthalmopathy, is an immune-mediated inflammatory disease that often leads to the expansion of extraocular muscles and intraorbital fat. The 2021 European Guidelines for the Management of Graves’ Ophthalmopathy introduces the latest management methods of thyroid-associated ophthalmo-pathy in detail. This article aims to provide a comprehensive interpretation of the Guidelines so that medical staff can increase their diagnosis and treatment levels to better serve patients with eye diseases.

参考文献/References:

［1］　KAHALY G J.Management of Graves thyroidal and extrathyroidal disease:an update［J］.J Clin Endocrinol Metab,2020,105(12):3704-3720.
［2］　PERROS P,ZˇARKOVIC＇ M,AZZOLINI C,AYVAZ G,BALDESCHI L,BARTALENA L,et al.PREGO(presentation of Graves’orbitopathy)study:changes in referral patterns to European Group on Graves’Orbitopathy(EUGOGO)centres over the period from 2000 to 2012［J］.Br J Ophthalmol,2015,99(11):1531-1535.
［3］　BARTALENA L,PIANTANIDA E,GALLO D,LAI A,TANDA M L.Epidemiology,natural history,risk factors,and prevention of Graves’ orbitopathy［J］.Front Endocrinol (Lausanne),2020,11:615993.
［4］　KAHALY G J,PETRAK F,HARDT J,PITZ S,EGLE U T.Psychosocial morbidity of Graves’ orbitopathy［J］.Clin Endocrinol (Oxf),2005,63(4):395-402.
［5］　WIERSINGA W M.Quality of life in Graves’ ophthalmopathy［J］.Best Pract Res Clin Endocrinol Metab,2012,26(3):359-370.
［6］　PONTO K A,HOMMEL G,PITZ S,ELFLEIN H,PFEIFFER N,KAHALY G J.Quality of life in a german Graves orbitopathy population［J］.Am J Ophthalmol,2011,152(3):483-490.
［7］　PONTO K A,MERKESDAL S,HOMMEL G,PITZ S,PFEIFFER N,KAHALY G J.Public health relevance of Graves’ orbitopathy［J］.J Clin Endocrinol Metab,2013,98(1):145-152.
［8］　ROSS D S,BURCH H B,COOPER D S,GREENLEE M C,LAURBERG P,MAIA A L,et al.2016 American thyroid association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis［J］.Thyroid,2016,26(10):1343-1421.
［9］　WANG Y Q,LI H.Progression of pathogenesis of Graves’ ophthalmopathy［J］.Int J Ophthalmol,2012,12(1):65-68.
［10］　NASELLI A,MORETTI D,REGALBUTO C,ARPI M L,LO GIUDICE F,FRASCA F,et al.Evidence that baseline levels of low-density lipoproteins cholesterol affect the clinical response of Graves’ophthalmopathy to parenteral corticosteroids［J］.Front Endocrinol (Lausanne),2020,11:609895.
［11］　PERROS P,DAYAN C M,DICKINSON A J,EZRA D,ESTCOURT S,FOLEY P,et al.Management of patients with Graves’ orbitopathy:initial assessment,management outside specialised centres and referral pathways［J］.Clin Med (Lond),2015,15(2):173-178.
［12］　钱江.逐步规范甲状腺相关眼病的临床诊疗工作［J］.中华眼科杂志,2017,53 (6):404-407.
QIAN J.The stepwise establishment of standardized treatment for the thyroid eye disease［J］.Chin J Ophthalmol,2017,53(6):404-407.
［13］　WIERSINGA W M.Smoking and thyroid［J］.Clin Endocrinol (Oxf),2013,79(2):14551.
［14］　KHONG J J,FINCH S,DE SILVA C,RYLANDER S,CRAIG J E,SELVA D,et al.Risk factors for Graves’ orbitopathy; the Australian Thyroid-Associated Orbitopathy Research (ATOR) study［J］.J Clin Endocrinol Metab,2016,101(7):2711-2720.
［15］　TRISK F,TALLSTEDT L,ABRAHAM-NORDLING M,ANDERSSON T,BERG G,CALISSENDORFF J,et al.Thyroid-associated ophthalmopathy after treatment for Graves’ hyperthyroidism with antithyroid drugs or iodine-131［J］.J Clin Endocrinol Metab,2009,94(10):3700-3707.
［16］　BARTALENA L,MARCOCCI C,BOGAZZI F,PANICUCCI M,LEPRI A,PINCHERA A.Use of corticosteroids to prevent progression of Graves’ ophthalmopathy after radioiodine therapy for hyperthyroidism［J］.N Engl J Med,1989,321(20):1349-1352.
［17］　TALLSTEDT L,LUNDELL G,TRRING O,WALLIN G,LJUNGGREN J G,BLOMGREN H.Occurrence of ophthalmopathy after treatment for Graves’ hyperthyroidism［J］.N Engl J Med,1992,326(26):1733-1738.
［18］　BARTALENA L,MARCOCCI C,BOGAZZI F,MANETTI L,TANDA M L,DELL’UNTO E,et al.Relation between therapy for hyperthyroidism and the course of Graves’ ophthalmopathy［J］.N Engl J Med,1998,338(2):73-78.
［19］　PONTO K A,ZANG S,KAHALY G J.The tale of radioiodine and Graves’ orbitopathy［J］.Thyroid,2010,20(7):785-793.
［20］　BARTALENA L,VANNUCCHI G,COVELLI D,CAMPI I,CURR N,DAZZI D,et al.Prevention of orbitopathy by oral or intravenous steroid prophylaxis in short duration Graves’ disease patients undergoing radioiodine ablation:a prospective randomized control trial study［J］.Thyroid,2019,29(12):1828-1833.
［21］　SHIBER S,STIEBEL-KALISH H,SHIMON I,GROSSMAN A,ROBENSHTOK E.Glucocorticoid regimens for prevention of Graves’ ophthalmopathy progression following radioiodine treatment:systematic review and meta-analysis［J］.Thyroid,2014,24(10):1515-1523.
［22］　BARTALENA L,WIERSINGA W M.Proposal for standardization of primary and secondary outcomes in patients with active,moderate-to-severe Graves’ orbitopathy［J］.Eur Thyroid J,2020,9(Suppl 1):3-16.
［23］　European Group on Graves’ Orbitopathy (EUGOGO),WIERSINGA W M,PERROS P,KAHALY G J,MOURITS M P,BALDESCHI L,et al.Clinical assessment of patients with Graves’ orbitopathy:the European Group on Graves’ Orbitopathy recommendations to generalists,specialists and clinical researchers［J］.Eur J Endocrinol,2006,155(3):387-389.
［24］　GRDAL C,SARA O,GEN I,KIRIMLIOGˇLU H,TAKMAZ T,CAN I.Ocular surface and dry eye in Graves’ disease［J］.Curr Eye Res,2011,36(1):8-13.
［25］　GUPTA A,SADEGHI P B,AKPEK E K.Occult thyroid eye disease in patients presenting with dry eye symptoms［J］.Am J Ophthalmol,2009,147(5):919-923.
［26］　MATHEIS N,GRUS F H,BREITENFELD M,KNYCH I,FUNKE S,PITZ S,et al.Proteomics differentiate between thyroid-associated orbitopathy and dry eye syndrome［J］.Invest Ophthalmol Vis Sci,2015,56(4):2649-2656.
［27］　SELTER J H,GIRE A I,SIKDER S.The relationship between Graves’ ophthalmopathy and dry eye syndrome［J］.Clin Ophthalmol,2015,9:57-62.
［28］　ISMAILOVA D S,FEDOROV A A,GRUSHA Y O.Ocular surface changes in thyroid eye disease［J］.Orbit,2013,32(2):87-90.
［29］　ECKSTEIN A K,FINKENRATH A,HEILIGENHAUS A,RENZING-KHLER K,ESSER J,KRGER C,et al.Dry eye syndrome in thyroid-associated ophthalmopathy:lacrimal expression of TSH receptor suggests involvement of TSHR-specific autoantibodies［J］.Acta Ophthalmol Scand,2004,82(3 Pt 1):291-297.
［30］　HU S Z,CHEN Z,DONG W J.Clinical efficacy of orbital decompression in patients with Graves ophthalmopathy［J］.Int J Ophthalmol,2017,17(10):1963-1965.
［31］　何晓婕,姜发纲,王兴华,雷澄.纤维细胞和前列腺素 E2在 Graves 眼病发病机制中的作用研究［J］.中华眼科医学杂志（电子版），2014,4(4):201-205.
HE X J,JIANG F G,WANG X H,LEI C.The role of fibrocytes and prostaglandin E2 in the pathogenesis Graves’ ophthalmopathy［J］.Chin J Ophthalmol Med (Electr Edit),2014,4(4):201-205.
［32］　SALVI M,VANNUCCHI G,CURR N,CAMPI I,COVELLI D,DAZZI D,et al.Efficacy of B-cell targeted therapy with rituximab in patients with active moderate to severe Graves’ orbitopathy:a randomized controlled study［J］.J Clin Endocrinol Metab,2015,100(2):422-431.
［33］　STAN M N,GARRITY J A,CARRANZA LEON B G,PRABIN T,BRADLEY E A,BAHN R S.Randomized controlled trial of rituximab in patients with Graves’ orbitopathy［J］.J Clin Endocrinol Metab,2015,100(2):432-441.
［34］　MARCOCCI C,BARTALENA L,BOGAZZI F,BRUNO-BOSSIO G,LEPRI A,PINCHERA A.Orbital radiotherapy combined with high dose systemic glucocorticoids for Graves’ ophthalmopathy is more effective than radiotherapy alone:results of a prospective randomized study［J］.J Endocrinol Invest,1991,14(10):853-860.
［35］　BARTALENA L,MARCOCCI C,CHIOVATO L,LADDAGA M,LEPRI G,ANDREANI D,et al.Orbital cobalt irradiation combined with systemic corticosteroids for Graves’ ophthalmopathy:comparison with systemic corticosteroids alone［J］.J Clin Endocrinol Metab,1983,56(6):1139-1144.
［36］　KAHALY G J,RSLER H P,PITZ S,HOMMEL G.Low- versus high-dose radiotherapy for Graves’ ophthalmopathy:a randomized,single blind trial［J］.J Clin Endocrinol Metab,2000,85(1):102-108.
［37］　SUDAN,ZHAO S X.The development of radiotherapy for thyroid associated ophthalmopathy［J］.Int J Rad Med Nucl Med,2014,38(2):126-129.
［38］　LIMONE P P,MELLANO M,RUO REDDA M G,MACERA A,FERRERO V,SELLARI FRANCESCHINI S,et al.Graves’ orbitopathy:a multidisciplinary approach［J］.Q J Nucl Med Mol Imaging,2021,65(2):157-171.
［39］　DIANA T,UNGERER M,WSTER C,FASSBENDER J,LI Z,REIMANN A,et al.A cyclic peptide significantly improves thyroid function,thyrotropin-receptor antibodies and orbital mucine/collagen content in a long-term Graves’disease mouse model［J］.J Autoimmun,2021,122:102666.
［40］　HAI Y P,LEE A,FROMMER L,DIANA T,KAHALY G J.Immunohistochemical analysis of human orbital tissue in Graves’ orbitopathy［J］.J Endocrinol Invest,2020,43(2):123-137.
［41］　BARTALENA L,BALDESCHI L,DICKINSON A,ECKSTEIN A,KENDALL-TAYLOR P,MARCOCCI C,et al.Consensus statement of the European Group on Graves’orbitopathy(EUGOGO)on management of GO［J］.Eur J Endocrinol,2008,158(3):273-285.
［42］　KAHALY G J,DIANA T,KANITZ M,FROMMER L,OLIVO P D.Prospective trial of functional thyrotropin receptor antibodies in Graves disease［J］.J Clin Endocrinol Metab,2020,105(4):e1006-e1014.
［43］　ZANG S,KAHALY G J.Steroids and the immune response in Graves’ orbitopathy［J］.Immunol Endocr Metab Agents Med Chem,2011,11(2):90-98.
［44］　LANGERICHT J,KRAMER I,KAHALY G J.Glucocorticoids in Graves’ orbitopathy:mechanisms of action and clinical application［J］.Ther Adv Endocrinol Metab,2020,11:2042018820958335.
［45］　MARCOCCI C,BARTALENA L,TANDA M L,MANETTI L,DELL’UNTO E,ROCCHI R,et al.Comparison of the effectiveness and tolerability of intravenous or oral glucocorticoids associated with orbital radiotherapy in the management of severe Graves’ ophthalmopathy:results of a prospective,single-blind,randomized study［J］.J Clin Endocrinol Metab,2001,86(8):3562-3567.
［46］　KAHALY G J,PITZ S,HOMMEL G,DITTMAR M.Randomized,single blind trial of intravenous versus oral steroid monotherapy in Graves’ orbitopathy［J］.J Clin Endocrinol Metab,2005,90(9):5234-5240.
［47］　EBNER R,DEVOTO M H,WEIL D,BORDABERRY M,MIR C,MARTINEZ H,et al.Treatment of thyroid associated ophthalmopathy with periocular injections of triamcinolone［J］.Br J Ophthalmol,2004,88(11):1380-1386.
［48］　LEE S J,RIM T H,JANG S Y,KIM C Y,SHIN D Y,LEE E J,et al.Treatment of upper eyelid retraction related to thyroid-associated ophthalmopathy using subconjunctival triamcinolone injections［J］.Graefes Arch Clin Exp Ophthalmol,2013,251(1):261-270.
［49］　GUPTA O P,BOYNTON J R,SABINI P,MARKOWITCH W J,QUATELA V C.Proptosis after retrobulbar corticosteroid injections［J］.Ophthalmology,2003,110(2):443-447.
［50］　HUEBERT I,HEINICKE N,KOOK D,BOOST K A,MILLER C V,MAYER W J,et al.Dual platelet inhibition in cases of severe retrobulbar hemorrhage following retrobulbar and peribulbar anesthesia［J］.J Cataract Refract Surg,2015,41(10):2092-2101.
［51］　ALLISON A C,EUGUI E M.Mycophenolate mofetil and its mechanisms of action［J］.Immunopharmacology,2000,47(2/3):85-118.
［52］　YE X,BO X,HU X,CUI H,LU B,SHAO J,et al.Efficacy and safety of mycophenolate mofetil in patients with active moderate-to-severe Graves’ orbitopathy［J］.Clin Endocrinol (Oxf),2017,86(2):247-255.
［53］　PERROS P,WEIGHTMAN D R,CROMBIE A L,KENDALL-TAYLOR P.Azathioprine in the treatment of thyroid-associated ophthalmopathy［J］.Acta Endocrinol (Copenh),1990,122(1):8-12.
［54］ CHALVATZIS N T,TZAMALIS A K,KALANTZIS G K,EL-HINDY N,DIMITRAKOS S A,POTTS M J.Safety and efficacy of combined immunosuppression and orbital radiotherapy in thyroid-related restrictive myopathy:two-center experience［J］.Eur J Ophthalmol,2014,24(6):953-959.
［55］　KALEVA N N,PEHLIVANOVA N I,MISHEVA Z P,SHABANOVA T D,BALABANOVA A V.Contemporary diagnostic and therapeutic abilities in childhood thyroid-associated ophthalmopathy with a clinical case description［J］.Folia Med (Plovdiv),2010,52(2):57-63.
［56］　ZANG S,PONTO K A,PITZ S,KAHALY G J.Dose of intravenous steroids and therapy outcome in Graves’ orbitopathy［J］.J Endocrinol Invest,2011,34(11):876-880.
［57］　MIS＇KIEWICZ P,JANKOWSKA A,BRODZIN＇SKA K,MILCZAREK B J,AMBROZIAK U.Influence of methylprednisolone pulse therapy on liver function in patients with Graves’orbitopathy［J］.Int J Endocrinol,2018,2018:1978590.
［58］　BARTALENA L,CHIOVATO L,MARCOCCI C,VITTI P,PIANTANIDA E,TANDA M L.Management of Graves’hyperthyroidism and orbitopathy in time of COVID-19 pandemic［J］.J Endocrinol Invest,2020,43(8):1149-1151.
［59］　PUIG-DOMINGO M,MARAZUELA M,GIUSTINA A.COVID-19 and endocrine diseases.A statement from the European Society of Endocrinology［J］.Endocrine,2020,68(1):2-5.
［60］　WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group,STERNE J,MURTHY S,DIAZ J V,SLUTSKY A S,VILLAR J,et al.Association between administration of systemic corticosteroids and mortality among critically ill patients with COVID-19:a meta-analysis［J］.JAMA,2020,324(13):1330-1341.
［61］　ALEXAKI V I,HENNEICKE H.The role of glucocorticoids in the management of COVID-19［J］.Horm Metab Res,2021,53(1):9-15.

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备注/Memo

备注/Memo:
国家自然科学基金（编号:82160195）；中央引导地方科技发展资金（编号:20211ZDG02003）；江西省重点研发项目（编号:20181BBG70004,20203BBG73059）；江西省杰出青年人才计划（编号:20192BCBL23020）
更新日期/Last Update: 2021-11-05