慢性丙型肝炎患者干扰素-α治疗后诱发甲状腺功能异常观察

摘要

目的：探讨丙型肝炎患者行以干扰素-α(interferon-alpha，IFN-α)为基础的抗病毒治疗后诱发甲状腺功能异常(thyroid dysfunction，TD)的临床特点及影响因素。方法以2013年10月-2014年4月我院收治的432例经以干扰素-α为基础抗病毒治疗的慢性丙型肝炎(chronic hepatitis C，CHC)患者为研究对象，男性259例(60.0%)，女性173例(40.0%)，平均年龄(43.5±32.7)岁。分别采用化学发光法、酶法、荧光定量PCR技术等检测患者抗病毒治疗前和治疗后3个月、6个月、9个月、12个月甲状腺功能、抗甲状腺过氧化物酶抗体(TPOAb)、抗甲状腺球蛋白抗体(TGAb)、肝功能、HCV RNA和HCV RNA分型等指标。结果经以干扰素-α为基础抗病毒治疗后，67例(15.5%)发展为TD，其中甲状腺功能减退症占58.2%。男女发病比例1∶3.8。32例(47.8%)为治疗后3个月内发生，58例(86.6%)在6个月内出现。停止抗病毒治疗后，63例(94.0%)12个月内自发或经药物治疗后甲状腺功能恢复正常，仅4例(6.0%)发展为持续性TD。多元逐步回归分析表明，性别和治疗前甲状腺自身抗体TPOAb、TGAb是TD发生的独立风险因素。结论 CHC患者行以干扰素-α为基础抗病毒治疗后，15.5%患者发展为TD，以女性为主。女性和治疗前TPOAb及TGAb阳性是发展为TD的危险因素。%Objective To investigate clinical characteristics and predictive factors of thyroid dysfunction (TD) in patients with chronic hepatitis C (CHC) receiving IFN-α based treatment.Methods Four hundred and thirty-two consecutive CHC patients with normal baseline thyroid functions who received IFN-α based therapy in our hospital from October 2013 to April 2014 were enrolled in this study. There were 259 males (60.0%) and 173 females (40.0%) with an average age of (43.5±32.7) years. Thyroid and liver function, TPOAb, TGAb, HCV RNA and HCV RNA types before and 3, 6, 9, 12 months after treatment were detected by Chemiluminescence, enzymatic andfluorescent quantitative PCR technology, respectively.Results At the end of IFN-α based therapy, 67 patients (15.5%) in this study had developed with TD while the hypothyroidism patients took the most. The percentage of hypothyroid ism accounted for 58.2%. The incidence of this disease in female was higher than male with male to female ratio of 3.8∶1.The cumulative incidence at three, six months after ini tiation of IFN-αbased HCV treatment was 47.8% (32 patients) and 86.6% (58 patients), respectively. The thyroid function of 63 patients (74.6%) spontaneously returned to nor mal in the follow-up period of 12 months and only 4 patients (6%) had persistent overt TD symptoms. Multivariate stepwise analysis suggested that gender and pretreatment TPOAb, TGAb were the independent factors related to the incidence of TD.Conclusion The incidence of TD in patients with CHC during IFN-αbased therapy is 15.5%, taking female as the main. Female gender, pretreatment TPOAb and TGAb positiv ity are risk factors for the development of TD during IFN-αbased therapy.