Analysis Of Prognostic Factors Of Graves Disease Treated With ATD And Construction Of Prediction Model

Objective:The purpose of this study was to explore the influencing factors of prognosis in patients with Graves’ disease(GD)treated with antithyroid drugs(ATD),and to construct a simple and effective predictive model related to the prognosis of Graves disease and evaluate its effectiveness.Methods:From October 2012 and October 2019,first-visit patients with Graves’ disease were enrolled retrospectively from the Affiliated Hospital of Qingdao University.(1)According to the therapeutic cycle and relapse,they were divided into remission group and non-remission group 。 The age,gender,family history,degree of goiter and relevant laboratory indicators,such as thyroid-stimulating hormone(TSH),free triiodothyronin(FT3),free thyroxine(FT4),FT3/FT4,thyrotrophin receptors autoantibody(TRAb)at initial diagnosis,falling rate of TRAb at 6 months(? 4 weeks)of treatment,thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(Tg Ab),To evaluate whether the above indicators have significant differences between the remission group and the non-remission group.(2)Use the unvariate and multivariate logistic regression to screen risk factors and construct prediction model.Use the receiver operating characteristic(ROC)curve to compare the test efficacy of different indicators for prognosis by comparing the area under the curve(AUC),and further evaluate the test efficacy of the prediction model(3)Select patients with complete TRAb data at 6 and 12 months(±4 weeks),12 and18 months(±4 weeks)of treatment,and form subgroups of TRAb at 6 to 12 months and12 to 18 months.Compare the falling rate of TRAb in the remission and non-remission groups of the two subgroups.Results:(1)Compared to remission group,the age of the non-remission group was lower[(35.56 ± 1.45)years vs(40.25 ± 1.26)years ],levels of TRAb at first-visit and 6 months treatment were higher [10.73(6.59,21.29)IU/L vs 8.85(4.59,16.92)IU/L,6.98(2.56,12.86)IU/L vs 2.45(1.05,5.01)IU/L)],and the falling rate of TRAb was lower [0.45(0.20,0.69)vs 0.65(0.49,0.84)].The difference between the two groups was statistically significant(all P<0.05).(2)Univariate logistic regression analysis showed that age,TRAb at first-visit and 6months of treatment,and falling rate of TRAb were prognostic risk factors for prognosis(All P < 0.05).Multivariate logistic regression analysis showed that age,TRAb at first-visit,and the falling rate of TRAb were independent prognostic risk factors after ATD treatment(all P<0.05).The predictive model constructed with above three indicators is as follows: logit(P)=2.388-0.045 ×age+0.032 × TRAb at first-visit-2.718 × the falling rate of TRAb,where P represents the probability of non-remission.ROC curve analysis showed that the area under the curve(AUC)of the prognosis of Graves disease with the falling rate of TRAb was 0.693,95% confidence interval(0.616,0.768),which was significantly larger than the age and TRAb at first-visit [0.597(0.516,0.679),0.592(0.512,0.673)],and was the most valuable prognostic indicator among the single factors.The AUC of the predictive model was 0.749,95% confidence interval(0.681,0.808),which is higher than the individual indicator of various indicators.(3)In the two subgroups,there was no statistically significant difference in the falling rate of TRAb between the non-remission group and the remission group at 6-12 months and 12-18 months(both P>0.05).Conclusion:1.Age,the falling rate of TRAb and TRAb at first-visit are independent risk factors for poor prognosis.The older the age,the higher the falling rate of TRAb,the easier it is to achieve clinical remission.the higher the TRAb at first-visit,the worse the prognosis。2.Compared with age and TRAb at first-visit,the falling rate of TRAb has better prognostic value,but the predictive efficacy of single factor in prognosis is not quite ideal.3.The predictive model constructed by age,TRAb at first-visit and TRAb falling rate:logit(P)=2.388-0.045 ×age+0.032 × TRAb at first-visit-2.718 × the falling rate of TRAb has good predictive value for prognosis,,and may be a new evaluation standard for clinical evaluation of the prognosis of patients with Graves disease after ATD treatment,and provide more appropriate clinical treatment plan for patients.