갑상샘눈병증에서 갑상샘자극호르몬수용체 자가항체가 망막 및 맥락막혈관에 미치는 영향
Effects of Thyroid-stimulating Hormone Receptor Autoantibody on Retinal and Choroidal Vessels in Thyroid Eye Disease
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목적: 갑상샘눈병증(thyroid eye disease, TED) 환자에서 빛간섭단층촬영혈관조영술(optical coherence tomography angiography, OCTA)을 이용하여 갑상샘자극호르몬수용체 자가항체(thyroid stimulating hormone receptor antibody, TSHR Ab)의 변화와 망막혈관 및 맥락막의 변화의 연관성을 알아보고자 하였다. 대상과 방법: TED로 진단받은 환자 중 TSHR Ab 이상(>1.5 IU/L)을 보인 환자군 23명(우안)을 대상으로 망막의 표층부 무혈관 부위(superficial foveal avascular zone, sFAZ) 및 심층부 무혈관 부위(deep foveal avascular zone, dFAZ) 크기, 황반부중심의 지름1 mm 중심와, 3 mm 중심와부근 영역의 표층모세혈관총밀도(superficial capillary plexus density, sCPD) 및 맥락막두께(choroidal thickness, CT)를 측정하였고 내원 1개월 이후 반복 시행하여 TSHR Ab 변화에 대한 상관관계를 분석하였다. 결과: sFAZ, dFAZ, 1 mm 중심와 sCPD에서 양의 경향성을 보였으나(p=0.465, p=0.759, p=0.224), 3 mm 중심와부근 sCPD와 CT에서는 음의 경향성을 보이며, 모든 변수에 통계적인 유의성은 없었다(p=0.421, p=0.487). 결론: TED 환자에서 1개월 간의 TSHR Ab의 변화량에 따라 망막혈류와 맥락막두께 변화량에는 영향이 없으나, 1 mm 중심와 sCPD에서는 강한 양의 경향성을 가진다.
Abstract
Purpose: We describe the use of optical coherence tomography angiography (OCTA) to investigate the relationship between thyroid-stimulating hormone receptor autoantibody (TSHR Ab) levels and retinal vessel and choroid changes in patients with thyroid eye disease (TED). Methods: We enrolled 23 TED patients with abnormal TSHR Ab levels (>1.5 IU/L; all right eyes). Sex, visual acuity, intraocular pressure and TSHR Ab level were recorded at baseline and after 1 month. We used OCTA to determine the size of the superficial and deep foveal avascular zones (sFAZ and dFAZ, respectively), as well as the 1-mm foveal and 3-mm parafoveal superficial capillary plexus density (sCPD) and choroidal thickness (CT), at baseline and after 1 month later. Results: The mean age of the 23 patients was 43.30 ± 16.16 years and 18 were female (78%). The mean baseline TSHR Ab level was 11.47 ± 11.22 IU/L. The TSHR Ab level showed non-significant correlations with sFAZ and dFAZ size, and with the 1-mm foveal sCPD; the correlation coefficients were 0.173, 0.073, and 0.266, respectively (p = 0.465, p = 0.759, and p = 0.224, respectively). The 3-mm parafoveal sCPD and CT showed non-significant correlations with the TSHR Ab level; the correlation coefficients were -0.185 and -0.16 (p = 0.421, p = 0.487). Conclusions: In TED patients, changes in TSHR Ab level over 1 month do not affect retinal blood flow or CT, but show a non-significant positive association with the 1-mm foveal sCPD.
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