CAJ | 학술논문

目的：探讨IFN联合利巴韦林（RBV）治疗CHC致甲状腺功能异常的临床特点。方法回顾性分析78例CHC患者应用干扰素联合RBV治疗过程中出现甲状腺功能异常的临床资料。78例患者随机分为重组人干扰素α2b（IFN-α2b）组58例，聚乙二醇化干扰素α-2a（Peg-IFN-α2a）组20例。结果78例患者中，发生甲状腺功能异常（TD）者17例（21.79%），其中甲状腺功能亢进症5例，甲状腺功能减退症12例。78例患者的性别、基线HCV RNA载量、丙型肝炎病程、病毒应答时间、总疗程与TD发生无显著相关性，年龄、既往TD病史有显著相关性。78例患者中，有15例为一过性TD，仅2例终止干扰素治疗。两组患者导致TD的发生率分别为10%（2/20）和25.80%（15/58）。两组患者的年龄（χ2=4.974，P=0.026，OR=1.073）、既往TD病史（χ2=5.123，P=0.024，OR=16.569）与甲状腺疾病发生呈现正相关。出现TD时间主要集中在干扰素治疗后31～60天。结论TD是干扰素治疗CHC中较常见的不良反应，特别是既往有TD病史者，多数TD为短暂性异常，应在密切监视下完成抗病毒疗程。
목적：탐토IFN연합리파위림（RBV）치료CHC치갑상선공능이상적림상특점。방법회고성분석78례CHC환자응용간우소연합RBV치료과정중출현갑상선공능이상적림상자료。78례환자수궤분위중조인간우소α2b（IFN-α2b）조58례，취을이순화간우소α-2a（Peg-IFN-α2a）조20례。결과78례환자중，발생갑상선공능이상（TD）자17례（21.79%），기중갑상선공능항진증5례，갑상선공능감퇴증12례。78례환자적성별、기선HCV RNA재량、병형간염병정、병독응답시간、총료정여TD발생무현저상관성，년령、기왕TD병사유현저상관성。78례환자중，유15례위일과성TD，부2례종지간우소치료。량조환자도치TD적발생솔분별위10%（2/20）화25.80%（15/58）。량조환자적년령（χ2=4.974，P=0.026，OR=1.073）、기왕TD병사（χ2=5.123，P=0.024，OR=16.569）여갑상선질병발생정현정상관。출현TD시간주요집중재간우소치료후31～60천。결론TD시간우소치료CHC중교상견적불량반응，특별시기왕유TD병사자，다수TD위단잠성이상，응재밀절감시하완성항병독료정。
Objective To explore the clinical characteristics of thyroid dysfunctions (TD) in patients with chronic hepatitis C during interferon combined with ribavirin (RBV) therapy. Methods The clinical data of thyroid dysfunctions in 78 cases of patients with chronic hepatitis C during interferon combined RBV therapy were retrospectively analyzed. There were 58 cases with human recombinant interferon alpha 2 b (IFN-α2b) therapy and 20 cases with polyethylene glycol interferon alpha 2 a (Peg-IFN-α2a) therapy in the 78 cases. Results In the 78 cases of patients, there were 17 cases (21.79%) with thyroid dysfunction, then 5 cases with thyrotoxicosis, and 12 cases with hypothyroidism. Sex, the baseline load of HCV RNA, the duration of HCV infection, the time of virological response and the total course of treatment was no signiifcant correlation with the occurrence of TD. Yet age and previous history of TD was signiifcantly correlated with TD. There were 15 cases of patients with transient TD, only 2 cases had to terminate the treatment of interferon. The incidence of TD in Peg INF α-2a group and INF-α 2b group was 10% (2/20) and 25.80% (15/58), respectively. Age (χ2=4.974, P=0.026, OR=1.073), a history of previous TD (χ2=5.123, P=0.024, OR=16.569) showed a positive correlation with the incidence of thyroid dysfunction. TD occured mainly in 31-60 days after interferon therapy. Conclusions TD is the more common adverse reactions in chronic hepatitis C with interferon combined with RBV therapy, especially those with previous history of TD. Most of TD is a temporary anomaly, so antiviral treatment should be done under close surveillance.