Graves眼病患者托珠单抗治疗前后临床指标的变化情况分析

doi:10.3969/j.issn.1006-7795.2025.04.019

首都医科大学学报 ›› 2025, Vol. 46 ›› Issue (4): 710-717.doi: 10.3969/j.issn.1006-7795.2025.04.019

Graves眼病患者托珠单抗治疗前后临床指标的变化情况分析

谢荣荣^1#, 许心语^2#, 宋智慧³, 信中², 华琳^4*,史婷婷^2*

1.北京市糖尿病研究所/糖尿病防治研究北京市重点实验室，北京 100730； 2. 首都医科大学附属北京同仁医院内分泌科，北京 102600； 3. 首都医科大学附属北京同仁医院药剂科，北京 102600； 4.首都医科大学生物医学工程学院智能医学工程学学系，北京 100069

收稿日期:2024-12-23 出版日期:2025-08-21 发布日期:2025-09-01
通讯作者: 华琳,史婷婷 E-mail:hualin7750@ccmu.edu.cn;stingting325@126.com
基金资助:
北京市医管局“培育计划”项目（PX2021006）, 国家自然科学基金项目（82200937）。

Changes of blood clinical parameters in patients with Graves' ophthalmopathy before and after treatment with tocilizumab

Xie Rongrong^1#, Xu Xinyu^2#, Song Zhihui³, Xin Zhong², Hua Lin^4*, Shi Tingting^2*

1.Beijing diabetes Research Institute/Diabetes Prevention and Control Office of Beijing Municipality, Beijing 100730, China; 2.Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing 102600, China; 3. Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing 102600, China; 4. Department of Intelligent Medical Engineering, School of Biomedical Engineering, Capital Medical University, Beijing 100069, China

Received:2024-12-23 Online:2025-08-21 Published:2025-09-01
Supported by:
This study was supported by Beijing Municipal Administration of Hospitals Incubating Program (PX2021006) ，National Natural Science Foundation of China（82200937）.

摘要/Abstract

摘要： 目的分析托珠单抗（Tocilizumab，TCZ）治疗有效的中重度Graves眼病（Graves’ophthalmopathy，GO）患者的临床指标变化包括血白细胞及中性粒细胞、肝肾功能、凝血功能、血脂、甲状腺激素及抗体的浓度变化，并探讨其临床意义。方法纳入经过TCZ治疗有效的中重度活动期GO患者85例，在治疗前及治疗后3个月采集患者清晨空腹血并检验血常规、生化常规、凝血功能、甲状腺激素及抗体浓度，同时收集所有研究对象的性别、年龄、病程、吸烟史、合并疾病及合并药物等基本信息，分析治疗前后患者的临床指标变化并进行相关性分析。结果中重度活动期GO患者经过TCZ治疗后，血白细胞绝对值及中性粒细胞绝对值较治疗前下降，转氨酶如丙氨酸氨基转移酶及天冬氨酸氨基转移酶、肌酐、三酰甘油、胆固醇、高密度脂蛋白及低密度脂蛋白浓度较治疗前均显著升高,凝血酶原时间、活化的部分凝血活酶时间、纤维蛋白原(fibrinogen，FIB)及D-二聚体浓度显著下降，促甲状腺激素浓度较前显著上升，血清促甲状腺素受体抗体(thyrotropin receptor antibody,TRAB)滴度显著下调，并且治疗前血清TRAB滴度浓度与FIB浓度具有显著相关性。结论 TCZ治疗中重度活动期GO患者后甲状腺功能及抗体浓度得到改善，且血白细胞、肝肾功能、血脂及凝血功能较前显著变化。该研究结果证实了TCZ对GO眼病的免疫紊乱的治疗作用，同时提示临床诊治中需要关注其相关的不良反应。

关键词: Graves眼病, 托珠单抗, 白细胞, 凝血功能, 甲状腺激素及抗体, 肝肾功能, 纤维蛋白原

Abstract: Objective To systematically analyze the changes in clinical indicators including blood leukocytes and neutrophils, liver and kidney functions, coagulation function, lipids, and levels of thyroid hormones and antibodies in Graves ophthalmopathy (GO) patients who had undergone effective treatment with tocilizumab (TCZ) and to explore their clinical significance. Methods Eighty-five patients with moderately or severely active GO who were effectively treated with TCZ were enrolled. Early morning fasting blood was collected and tested for routine blood, biochemical routine, coagulation function, thyroid hormone and antibodies, and basic information such as gender, age, duration of the disease, history of smoking, comorbidities, and medications were also collected from all patients, so changes in the clinical indicators before and after the treatment could be analyzed and correlation analyses could be carried out. Results Patients with moderately to severely active GO treated with TCZ showed a significant decrease in absolute blood leukocyte and neutrophil values compared with before, and a significant decrease in liver function (alanine transaminase,aspartate aminotransferase,creatinine), cholesterol ( total cholesterol , high-density lipoprotein and low-density lipoprotein) levels were significantly higher than before, and concentrations of coagulation parameters ［prothrombin time , activated partial thromboplastin time,fibrinogen (FIB) and D-dimer］ were significantly decreased. The concentrations of thyroid hormone and thyroid-stimulating hormone levels increased significantly, and the antibody titer of thyrotropin receptor antibody (TRAB) was significantly down-regulated after treatment. TRAB levels were significantly correlated with FIB before treatment. Conclusion Thyroid function and antibody levels improved after TCZ treatment in patients with moderately to severely active GO, but blood leukocytes, liver function and coagulation function changed significantly compared with before. The results of this study confirm the therapeutic effect of TCZ on immune disorders in GO ophthalmopathy, while underscoring the importance of monitoring potential adverse effects in clinical treatment.

Key words: Graves' ophthalmopathy, tocilizumab, leucocyte, coagulation function, thyroid hormones and antibodies, hepatorenal function, fibrinogen

中图分类号:

谢荣荣, 许心语, 宋智慧, 信中, 华琳, 史婷婷. Graves眼病患者托珠单抗治疗前后临床指标的变化情况分析[J]. 首都医科大学学报, 2025, 46(4): 710-717.

Xie Rongrong, Xu Xinyu, Song Zhihui, Xin Zhong, Hua Lin, Shi Tingting. Changes of blood clinical parameters in patients with Graves' ophthalmopathy before and after treatment with tocilizumab[J]. Journal of Capital Medical University, 2025, 46(4): 710-717.

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[1]	史婷婷, 谢荣荣, 信中, 刘薇, 苏志燕, 杨金奎. Graves眼病患者糖皮质激素治疗前后血清细胞因子的变化[J]. 首都医科大学学报, 2024, 45(3): 399-405.
[2]	谢荣荣, 史婷婷, 信中, 曹曦, 杨金奎. Graves眼病患者血浆细胞因子浓度与临床活动度的相关性分析[J]. 首都医科大学学报, 2023, 44(3): 407-412.

Graves眼病患者托珠单抗治疗前后临床指标的变化情况分析

Changes of blood clinical parameters in patients with Graves' ophthalmopathy before and after treatment with tocilizumab

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