慢性丙型肝炎患者干扰素联合利巴韦林治疗诱发甲状腺疾病的临床转归  

The outcome of thyroid disease induced by interferon plus ribavirin in patients with chronic hepatitis C

作　　者：刘俊平[1] 曹永革[1] 李宽[1] 宁会彬 刘翠平[1] 毛重山[1] 康谊[1] 尚佳[1] 

机构地区：[1]河南省人民医院感染性疾病科,郑州450003

出　　处：《中华传染病杂志》2016年第7期410-414,共5页Chinese Journal of Infectious Diseases

基　　金：河南省医学科技攻关计划项目（201303149）;河南省医学科技攻关计划省部共建项目（20140101015）

摘　　要：目的研究慢性丙型肝炎在长效干扰素联合利巴韦林（PR方案）抗病毒治疗中发生甲状腺疾病的长期临床转归。方法收集自2009年1月至2012年12月在河南省人民医院就诊使用PR方法进行抗病毒治疗的慢性丙型肝炎患者，分别于治疗前、治疗12、24、48和72周，治疗结束后24、48、96和144周进行甲状腺功能检查，根据患者具体甲状腺功能情况增加检测次数，并登记用药情况。计量资料采用t检验，计数资料采用卡方检验或Fisher确切概率法。结果共纳入358例慢性丙型肝炎患者，年龄18～65岁，平均年龄（43±12）岁，其中男200例，女158例。基因1型患者300例（83．8％），基因2型56例（15．6％），基因3型2例（0．6％）。358例患者中有80例（22．3％）患者发生了甲状腺疾病，71例（88．75％）为自身免疫性甲状腺炎，9例（11．25％）为非免疫性甲状腺炎。治疗后并随访144周，自身免疫性甲状腺炎中有21例（29．6％）完全恢复正常，9例非自身免疫性甲状腺炎完全恢复，两组比较差异均有统计学意义（F=16．69，P=0．00）。将患者分为无甲状腺疾病组和甲状腺疾病组，两组间基线的病毒载量、基因分型、转氨酶水平、年龄差异均无统计学意义（均P〉0．05）；两组间性别、基线甲状腺过氧化物酶抗体（TPOAb）水平、甲状腺球蛋白抗体（TgAb）水平和治疗后比较差异均有统计学意义（均P〈0．05）。结论干扰素诱发自身免疫性甲状腺炎不能完全逆转，部分患者转化为慢性甲状腺炎，需要长期药物治疗。干扰素诱发TPOAb和TgAb阳性的患者在随访过程中有转换为桥本甲状腺炎和弥漫性毒性甲状腺肿（Graves病）的风险。及时治疗干扰素诱发的甲状腺疾病，并不影响抗病毒治疗。临床医师在抗病毒治疗中以及停药后应密切观察患者甲状腺功能。Objective To explore the long-term outcome of thyroid disease occurred during and after peg-interferon plus ribavirin therapy （PR therapy） in patients with chronic hepatitis C （CHC）. Methods CHC patients admitted to Henan People＇s Hospital during January 2009 to December 2012 treated with peg-interferon plus ribavirin were included in this study. The thyroid functions were tested before treatment, at week 12, week 24, week 48, week 72 of treatment, and at week 24, week 48, week 96, week 144 after end of treatment. Thyroid function test frequency was increased according to the patientsr test results and medication was registered. Measurement data was analyzed using t test and count data was compared using chi square test or Fisher exact probability test. Results A total of 358 patients was included with mean age of （434-12） years （range 18 to 65 years） , of whom 200 were male and 158 were female. There are 300 cases （83.8%） with HCV genotype-1 infection, 56 cases （15.60/00） with genotype- 2 infection and 2 cases （0.6%） with genotype 3 infection. Eighty out of 358 patients （22.3%） developed thyroid disease, among whom 71 cases （88.75%） were diagnosed with autoimmune thyroiditis and 9 cases （11.25 % ） were non-autoimmune thyroiditis. At week 144 after end of treatment, 21 （29.6%） cases with autoimmune thyroiditis completely recovered and 9 cases with non-autoimmune thyroiditis fully restored. The comparison between two groups had statistical significance （F=16. 69, P=0.00）. Patients were divided into non-thyroid disease and thyroid disease groups. The were no significant differences of baseline viral load, HCV genotype, transaminase levels and age between the two group （all P~ 0. 05）. The differences of gender, baseline levels of thyroid peroxidase antibody （TPOAb）, thyroglobulin antibody （TgAb） and treatment outcome were statistically significant （all P〈0. 05）. Conclusions Interferon induced autoimmune thyroiditis could not be completely reversed.

关 键 词：肝炎 丙型 慢性 甲状腺疾病 干扰素 甲状腺抗体 

分 类 号：R512.63[医药卫生—内科学]