目的:已报道特发性眼眶炎症(IOI)的高复发率。本研究旨在确定IOI复发的现有预测因素。
方法:这是一项为期11年的回顾性研究,随访至少12个月。观察了2006年至2017年间在我们三级医院收治的50例经活检证实的IOI患者。我们比较了临床特征,组织病理学特征,和生物标志物表达(肥大细胞,免疫球蛋白G4,肿瘤坏死因子-α,和转化生长因子-β)16例复发患者(I组)和34例无复发患者(II组)。进行统计学比较和多变量分析以建立预测因素。
结果:我们发现了五个复发预测因素:眼球突出的表现(比值比[OR]4.96,95%置信区间[CI]1.36-18.03),视力障碍(OR15,95%CI1.58-142.72),眼外肌(EOM)限制(OR3.86,95%CI1.07-13.94),非眼前受累(OR7.94,95%CI1.88-33.5),和皮质类固醇(CS)单独治疗(OR7.20,95%CI1.87-27.8)。在多变量分析中,非眼前受累和CS单独治疗被验证为预测因素(曲线下面积=0.807[95%CI0.69-0.92]).组织病理学特征和生物标志物表达与复发无关。然而,仅接受CS治疗的肉芽肿型患者的复发风险高22倍.
结论:与提到的五个临床特征不同,组织病理学和生物标志物变量均与复发无关.非前部受累或肉芽肿型患者的CS单独治疗被证明会增加复发风险。因此,对于这组患者,我们建议在未与其他治疗方式联合治疗的情况下,不给予CS治疗.
OBJECTIVE: The high recurrence rate of idiopathic orbital inflammation (IOI) has been reported. This study aims to determine existing predictive factors for the recurrence of IOI.
METHODS: This was an 11-year retrospective study with at least a 12-month follow-up. Fifty patients with biopsy-proven IOI admitted between 2006 and 2017 at our tertiary hospital were observed. We compared the clinical characteristics, histopathological profile, and biomarker expressions (mast cell, immunoglobulin G4, tumor necrosis factor-alpha, and transforming growth factor-beta) of 16 patients with recurrence (Group I) and 34 patients with no recurrence (Group II). Statistical comparison and multivariate analysis were performed to establish the predictive factors.
RESULTS: We discovered five recurrence predictive factors: presentation of proptosis (odds ratio [OR] 4.96, 95% confidence interval [CI] 1.36-18.03), visual impairment (OR 15, 95% CI 1.58-142.72), extraocular muscle (EOM) restriction (OR 3.86, 95% CI 1.07-13.94), nonanterior involvement (OR 7.94, 95% CI 1.88-33.5), and corticosteroid (CS) alone treatment (OR 7.20, 95% CI 1.87-27.8). On multivariate analysis, nonanterior involvement and CS alone treatment were validated as predictive factors (area under the curve = 0.807 [95% CI 0.69-0.92]). Histopathological profile and biomarker expressions were not associated with recurrence. However, there was a 22-fold higher recurrence risk for granulomatous-type patients given CS alone treatment.
CONCLUSIONS: Unlike the five clinical characteristics mentioned, both histopathology and biomarker variables were not associated with recurrence. CS alone treatment for patients with nonanterior involvement or granulomatous type is proven to increase the risk of recurrence. Therefore, we suggest not giving CS without any combination treatment with other modalities for this group of patients.