干扰素治疗慢性病毒性肝炎发生甲状腺功能异常的临床特征和危险因素  

Characteristics and risk factors of thyroid dysfunction following interferon therapy in patients with chronic viral hepatitis

作　　者：桂红莲[1] 吴彦文[1] 周惠娟[1] 庄焱[1] 郭斯敏[1] 安宝燕[1] 王晖[1] 谢青[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院感染科,200025

出　　处：《中华传染病杂志》2013年第2期87-92,共6页Chinese Journal of Infectious Diseases

基　　金：中国肝炎基金会光辉基金资助项目（GHF2010201）;十二五重大专项基金资助项目（2012ZX10002004-003.2012ZX10002007）

摘　　要：目的探讨IFN治疗慢性病毒性肝炎患者发生甲状腺功能异常的临床特征，并结合生物化学、病毒学等因素分析其危险因素。方法选择2007年1月至2010年3月间采用IFN治疗的慢性乙型和丙型肝炎患者385例，在抗病毒治疗前2周内及治疗中每4～12周检测血常规、肝功能和病毒载量，并观察甲状腺功能的血清学指标和甲状腺自身抗体变化，治疗结束后继续随访48周。Logistic分析甲状腺功能异常发生的危险因素。结果IFN治疗后发生甲状腺功能异常者共32例，发生率为8．3％，其中甲状腺功能亢进及减退各占一半，依次为桥本甲状腺炎10例，Graves病和破坏性甲状腺炎各8例，非自身免疫性甲状腺功能减退6例。10例甲状腺功能异常者有明显临床症状；9例进行内分泌治疗，3例停用IFN。发生甲状腺功能异常的中位时间为治疗第7个月（最早于治疗第2个月，最迟于治疗结束后7个月），甲状腺功能异常持续时间中位数为4个月（1～11个月）。治疗结束后随访1年，所有患者甲状腺功能均恢复正常。女性（OR=3．656）和预存的抗甲状腺过氧化物酶抗体（OR=1．006）是发生甲状腺功能异常的独立危险因素。结论Graves病、桥本甲状腺炎、破坏性甲状腺炎和非自身免疫性甲状腺功能减退是IFN致甲状腺功能异常的主要类型，前两者通常伴有明显症状，可能需停用IFN并予内分泌治疗。接受IFN治疗的慢性病毒性肝炎患者在治疗前、中及后均应密切监测甲状腺功能和甲状腺自身抗体，尤其是女性及有预存甲状腺自身抗体者。Objective To find out the clinical characteristics of thyroid dysfunction during interferon （IFN） therapy in patients with chronic viral hepatitis, and to analyze its risk factors based on biochemical and virological results of these patients. Methods Between January 2007 and March 2010, 385 patients with chronic hepatitis B （CHB） or chronic hepatitis C （CHC） who received IFN therapy for 48 weeks were chosen. Blood routine, liver function, viral load were tested within 2 weeks before therapy, and every 4 to 12 weeks during therapy. Serological tests of thyroid function as well as thyroid autoantibodies were also monitored during the treatment and followed-up till 48 weeks after end of treatment. Logistic regression analysis was performed to evaluate risk factors of thyroid dysfunction. Results Among the 385 cases, 32 developed thyroid dysfunction after IFN therapy, theincidence was 8.3 %. Hyperthyroidism and hypothyroidism each accounted for half of the 32 patients. There were 10 cases of Hashimotors thyroiditis, 8 cases of Gravesr disease, 8 cases of destructive thyroiditis, and 6 cases of non-autoimmune hypothyroidism. Overt symptoms occurred in 10 patients. Nine symptomatic patients received endocrine therapy, and 3 patients stopped IFN therapy. The median time to develope thyroid dysfunction was 7 month during treatment （range from 2 month during treatment to 7 months after end of treatment）. The median duration of thyroid dysfunction was 4 months （range 1 to 11 months）. All patients regained normal thyroid function during 1-year follow up after end of treatment. Multivariate logistic regression analysis revealed that prestored anti-thyroid peroxidase antibody （OR = 1. 006） and female gender （OR- 3. 656） were independent risk factors of IFN induced thyoid dysfunction. Conclusions Autoimmune hypothyroidism （ Hashimoto＇s thyroiditis）, autoimmune thyrotoxicosis （Graves＇ disease）, destructive thyroiditis and hypothyroidism with negative thyroid antibodies are the main types

关 键 词：慢性病毒性肝炎 干扰素 甲状腺功能异常 危险因素 

分 类 号：R51[医药卫生—内科学] R5[医药卫生—临床医学]