慢性丙型肝炎患者抗病毒治疗后甲状腺功能动态变化和转归及其影响因素

摘要

Objective To investigate the dynamic changes and prognosis of thyroid function in the patients with chronic hepatitis C (CHC)after antiviral treatment,and to clarify the influence of baseline factors in the changes of thyroid function.Methods 243 CHC patients with normal baseline thyroid function were enrolled. All patients were treated with IFN-alpha-2b(IFN-α2b)combined with ribavirin for 48 weeks.The thyroid function and serum HCV RNA level were assessed at 12,24,36,48,60 and 72 weeks.According to the changes in thyroid function after treatment,the patients were divided into continued normal,subclinical hypothyroidism,hypothyroidism and hyperthyroidism groups.The regularity of the changes of thyroid function of the patients in various groups were observed.Results Among 243 CHC patients,82(33.7%)patients had thyroid dysfunction.The prevalence of subclinical hypothyroidism,hypothyroidism and hyperthyroidism were 20.9%(51/243),5.3%(13/243)and 7.4%(18/243),respectively. At the end of 72 weeks,there were 32 (39.0%)patients suffering from subclinical hypothyroidism,12 (14.6%) patients with hypothyroidism and 7 (8.5%) patients with hyperthyroidism rehabilitated.6(7.3%)patients suffering from hypothyroidism turned to subclinical hypothyroidism,and 3(3.7%) patients suffering from hyperthyroidism turned to subclinical hypothyroidism.19(23.2%)patients had no significant change,they performed for continued subclinical hypothyroidism (1,1.2%),hypothyroidism (13,15.9%)and hyperthyroidism (5 , 6.1%).In addition, 3 (3.7%)patients with hyperthyroidism turned to hypothyroidism.An increased risk for hypothyroidism was found in female patients compared with males (P<0.05);the average age of the patients with hyperthyroidism was lower than those of the patients with hypothyroidism, subclinical hypothyroidism and continued normal (P<0.05);the baseline levels of GGT in the patients with hyperthyroidism and hypothyroidism were lower than those of the patients with subclinical hypothyroidism and continued normal(P<0.05).The ratio of the patients with HCV 2a to the patients with hypertyroidism was higher than those of the patients with hypothyroidism,subclinical hypothyroidism and continued normal(P<0.05).Conclusion Thyroid function in the CHC patients can be affected by antiviral treatment. Gender, age, liver function, genotype of HCV are influencing factors for the changes of thyroid function.%目的：探讨慢性丙型肝炎（C H C）患者抗病毒治疗后甲状腺功能动态变化和转归，阐明基线因素对甲状腺功能改变的影响。方法：取基线甲状腺功能正常的CHC患者243例，均给予干扰素-α2b联合利巴韦林抗病毒治疗48周，分别在12、24、36、48、60和72周时对甲状腺功能和 HCV RNA定量等进行检测，根据治疗后甲状腺功能变化情况分为持续正常组、亚临床甲状腺功能减退（亚甲减）组、甲状腺功能减退（甲减）组和甲状腺功能亢进（甲亢）组，观察各组患者甲状腺功能变化的规律。结果：82例（33.7％）患者发生甲状腺功能改变，其中亚甲减51例（20.9％），甲减13例（5.3％），甲亢18例（7.4％）。随访至72周时，亚甲减、甲减、甲亢患者恢复正常的分别为32例（39.0％）、12例（14.6％）和7例（8.5％），甲减转变为亚甲减的为6例（7.3％），甲亢转变为亚甲减的为3例（3.7％）；19例（23.2％）患者病情无明显改善，1例（1.2％）表现为持续亚甲减，13例（15.9％）持续甲减，5例（6.1％）持续甲亢；3例（3.7％）患者由甲亢转变为甲减。女性甲减发生率高于男性（P＜0.05）；发生甲亢患者平均年龄低于甲减、亚甲减及持续正常患者（P＜0.05）；发生甲亢和甲减患者基线γ-谷氨酰转肽酶水平低于亚甲减和持续正常者（P ＜0.05）；发生甲亢患者中 HCV 2a型患者所占比例明显高于发生甲减、亚甲减及持续正常者（P ＜0.05）。结论：CHC患者抗病毒治疗可使甲状腺功能发生改变，性别、年龄、肝功能和基因型对甲状腺功能改变具有预测意义。