中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2012年
3期
216-220
,共5页
黄雁翔%陈新月%马丽娜%殷继明%任珊%郭丹丹%郑艳红
黃雁翔%陳新月%馬麗娜%慇繼明%任珊%郭丹丹%鄭豔紅
황안상%진신월%마려나%은계명%임산%곽단단%정염홍
肝炎,丙型,慢性%干扰素%甲状腺%细胞因子
肝炎,丙型,慢性%榦擾素%甲狀腺%細胞因子
간염,병형,만성%간우소%갑상선%세포인자
Hepatitis C,chronic%Interferon%Thyroid%Cytokine
目的 探讨慢性丙型肝炎(CHC)抗病毒治疗患者甲状腺功能异常情况并分析其影响因素. 方法 对194例CHC患者应用聚乙二醇干扰素(Peg-IFN) α-2a联合利巴韦林(RBV)治疗,疗程48周,停药后随访24周.按治疗结束时甲状腺功能分为正常组和异常组.采用病例对照方法,回顾性分析患者治疗前后甲状腺功能异常情况及其影响因素.计数资料采用x2检验,计量资料采用t检验；对有统计学意义的性别、甲状腺自身抗体进行logistic回归分析. 结果 治疗结束时甲状腺功能异常52例,占26.80％,正常142例,占73.20％；其中甲状腺功能亢进症(甲亢)1例,占0.52％,甲状腺功能减退症(甲减)10例,占5.15％)；亚临床甲亢4例,占2.06％),亚临床甲减37例,占19.07％；抗病毒治疗前后甲状腺功能异常率差异有统计学意义(12.37％对比26.80％,x2=12.829,P＜ 0.05).影响甲状腺功能的因素主要有性别(x2=4.038,P＜0.05,95％ CI:1.016 ～ 3.040)和甲状腺自身抗体(P＜0.05,95％ CI:1.681 ～ 36.183)；但抗病毒疗效差异无统计学意义；细胞因子中,正常和异常组白细胞介素6 (IL-6)差异有统计学意义[(27.08±14.90) ng/L对比(11.65±5:46)ng/L,t=3.127,P＜0.05,95％ CI:5.28 ～ 25.58],治疗24周末:2组IL-6差异无统计学意义[(6.30±2.47) ng/L对比(6.81±2.80) ng/L,t=0.352,P＞0.05].甲状腺功能异常组治疗前后IL-6差异无统计学意义[ (11.65±5.46) ng/L对比(6.81±2.80) ng/L,t=1.997,P＞0.05].甲状腺功能正常组治疗前后IL-6差异有统计学意义[(27.08±14.90) ng/L对比(6.30±2.47)ng/L,t=3.632,P＜0.05). 结论 Peg-IFNα-2a联合RBV治疗CHC患者可引起甲状腺功能异常,其中引起甲状腺功能减退症常见.女性,甲状腺自身抗体阳性患者Peg-IFNα-2a联合RBV治疗后容易发生甲状腺功能异常.IL-6可作为预测Peg-IFN α-2a联合RBV治疗引起甲状腺功能异常的辅助诊断参考指标.
目的 探討慢性丙型肝炎(CHC)抗病毒治療患者甲狀腺功能異常情況併分析其影響因素. 方法 對194例CHC患者應用聚乙二醇榦擾素(Peg-IFN) α-2a聯閤利巴韋林(RBV)治療,療程48週,停藥後隨訪24週.按治療結束時甲狀腺功能分為正常組和異常組.採用病例對照方法,迴顧性分析患者治療前後甲狀腺功能異常情況及其影響因素.計數資料採用x2檢驗,計量資料採用t檢驗；對有統計學意義的性彆、甲狀腺自身抗體進行logistic迴歸分析. 結果 治療結束時甲狀腺功能異常52例,佔26.80％,正常142例,佔73.20％；其中甲狀腺功能亢進癥(甲亢)1例,佔0.52％,甲狀腺功能減退癥(甲減)10例,佔5.15％)；亞臨床甲亢4例,佔2.06％),亞臨床甲減37例,佔19.07％；抗病毒治療前後甲狀腺功能異常率差異有統計學意義(12.37％對比26.80％,x2=12.829,P＜ 0.05).影響甲狀腺功能的因素主要有性彆(x2=4.038,P＜0.05,95％ CI:1.016 ～ 3.040)和甲狀腺自身抗體(P＜0.05,95％ CI:1.681 ～ 36.183)；但抗病毒療效差異無統計學意義；細胞因子中,正常和異常組白細胞介素6 (IL-6)差異有統計學意義[(27.08±14.90) ng/L對比(11.65±5:46)ng/L,t=3.127,P＜0.05,95％ CI:5.28 ～ 25.58],治療24週末:2組IL-6差異無統計學意義[(6.30±2.47) ng/L對比(6.81±2.80) ng/L,t=0.352,P＞0.05].甲狀腺功能異常組治療前後IL-6差異無統計學意義[ (11.65±5.46) ng/L對比(6.81±2.80) ng/L,t=1.997,P＞0.05].甲狀腺功能正常組治療前後IL-6差異有統計學意義[(27.08±14.90) ng/L對比(6.30±2.47)ng/L,t=3.632,P＜0.05). 結論 Peg-IFNα-2a聯閤RBV治療CHC患者可引起甲狀腺功能異常,其中引起甲狀腺功能減退癥常見.女性,甲狀腺自身抗體暘性患者Peg-IFNα-2a聯閤RBV治療後容易髮生甲狀腺功能異常.IL-6可作為預測Peg-IFN α-2a聯閤RBV治療引起甲狀腺功能異常的輔助診斷參攷指標.
목적 탐토만성병형간염(CHC)항병독치료환자갑상선공능이상정황병분석기영향인소. 방법 대194례CHC환자응용취을이순간우소(Peg-IFN) α-2a연합리파위림(RBV)치료,료정48주,정약후수방24주.안치료결속시갑상선공능분위정상조화이상조.채용병례대조방법,회고성분석환자치료전후갑상선공능이상정황급기영향인소.계수자료채용x2검험,계량자료채용t검험；대유통계학의의적성별、갑상선자신항체진행logistic회귀분석. 결과 치료결속시갑상선공능이상52례,점26.80％,정상142례,점73.20％；기중갑상선공능항진증(갑항)1례,점0.52％,갑상선공능감퇴증(갑감)10례,점5.15％)；아림상갑항4례,점2.06％),아림상갑감37례,점19.07％；항병독치료전후갑상선공능이상솔차이유통계학의의(12.37％대비26.80％,x2=12.829,P＜ 0.05).영향갑상선공능적인소주요유성별(x2=4.038,P＜0.05,95％ CI:1.016 ～ 3.040)화갑상선자신항체(P＜0.05,95％ CI:1.681 ～ 36.183)；단항병독료효차이무통계학의의；세포인자중,정상화이상조백세포개소6 (IL-6)차이유통계학의의[(27.08±14.90) ng/L대비(11.65±5:46)ng/L,t=3.127,P＜0.05,95％ CI:5.28 ～ 25.58],치료24주말:2조IL-6차이무통계학의의[(6.30±2.47) ng/L대비(6.81±2.80) ng/L,t=0.352,P＞0.05].갑상선공능이상조치료전후IL-6차이무통계학의의[ (11.65±5.46) ng/L대비(6.81±2.80) ng/L,t=1.997,P＞0.05].갑상선공능정상조치료전후IL-6차이유통계학의의[(27.08±14.90) ng/L대비(6.30±2.47)ng/L,t=3.632,P＜0.05). 결론 Peg-IFNα-2a연합RBV치료CHC환자가인기갑상선공능이상,기중인기갑상선공능감퇴증상견.녀성,갑상선자신항체양성환자Peg-IFNα-2a연합RBV치료후용역발생갑상선공능이상.IL-6가작위예측Peg-IFN α-2a연합RBV치료인기갑상선공능이상적보조진단삼고지표.
Objective To analyze the frequency of thyroid dysfunction and determine its influencing factors in chronic hepatitis C (CHC) patients treated with pegylated-interferon alpha (peg-IFNα)-2a and ribavirin (RBV) combination therapy.Methods A total of 194 CHC patients were treated with peg-IFNα-2a and RBV for 48 weeks.Development of thryoid dysfunction was recorded.Clinical and biological factors from pre-treatment (baseline) to post-treatment were statistically analyzed to determine correlation with thyroid dysfunction in this patient population.Results Fifty-two (26.80％) of 194 peg-IFNβ-2a/RBV-treated patients developed thyroid dysfunction.Dysfunction severity ranged from hyperthyroidism (n =1,0.52％) and hypothyroidism (n =10,5.15％) to subclinical hyperthyroidism (n =4,2.06％) and subclinical hypothyroidism (n =37,19.07％).The dysfunction rate was significantly higher after peg-IFNα-2a/RBV treatment (26.80％ vs.12.37％ at baseline,x2 =12.829,P ＜ 0.05,odds ratio (OR) =0.386,95％ confidence interval (CI):0.226-0.657),in females (33.00％ vs.20.21％ in males,P ＜ 0.05,95％ CI:1.016-3.040),and in thyroid auto-antibody positive patients (64.29％ vs.23.89％ in negative patients,P ＜ 0.05,95％ CI:1.681-36.183).Early virological response did not have any significant effect on dysfunction rate (23.00％ vs.30.85％no early virological response,x2 =1.522,P ＞ 0.05) nor did end of treatment response (27.19％ vs.26.25％ no response at end of treatment,x2 =0.021,P ＞ 0.05).Patients who developed thyroid dysfunction had higher interleukin (IL)-6 at baseline (i.e.before peg-IFNα-2a/RBV treatement) (27.08 ± 14.90 vs.11.65 ± 5.46 in patients who maintained normal thyroid function,t =3.127,P ＜ 0.05,95％ CI:5.28-25.58).IL-6 levels were not significantly different between the two groups at 24 weeks (6.30 ± 2.47 vs.6.81 ± 2.80,t =0.352,P ＞ 0.05).IL-6 levels before and after 48 weeks of treatment in normal thyroid function patients were 27.08 ± 14.90 and 6.30 ± 2.47,t =3.632,P ＜ 0.05,and in thyroid dysfunction patients were 11.65 ± 5.46 and 6.81 ± 2.80,t =1.997,P ＞ 0.05.Conclusion Peg-IFNα-2a/RBV combination therapy may cause thyroid dysfunction,especially hypothyroidism,in CHC patients.Female sex and thyroid auto-antibody positivity may put CHC patients at higher risk of developing thyroi.d dysfunction during peg-IFNα-2a/RBV therapy.Elevated IL-6 may be a predictive marker of peg-IFNα-2a/RBV-induced thyroid dysfunction.
