CAJ | 학술논문

目的观察干扰素α对慢性丙型肝炎合并慢性淋巴细胞性甲状腺炎患者的抗病毒疗效和对甲状腺功能的影响. 方法对21例治疗前及治疗中抗甲状腺过氧化物酶抗体(A-TPO)升高,并诊断为慢性淋巴细胞性甲状腺炎的慢性丙型肝炎患者,初始给予普通干扰素.α-1b 200万单位,隔日1次,肌肉注射2～3次后改为400万单位,隔日1次,肌肉注射2～3次后皮下注射聚乙二醇干扰素α-2a 135 ～ 180 μg,每周1次,直至疗程结束,所有患者服用利巴韦林为0.9 ～ 1.2 g/d,分3次口服.观察治疗过程中及治疗结束后24周患者甲状腺功能的变化及抗病毒治疗的效果.应用PEMS3.1统计软件,计量资料采用t检验或q检验,计数资料采用x2检验或Fisher精确概率法.结果在抗病毒治疗中甲状腺功能异常发生率:慢性丙型肝炎合并慢性淋巴细胞性甲状腺炎的患者为71.4％(15/21),未合并慢性淋巴细胞性甲状腺炎的慢性丙型肝炎患者为30.2％(26/86),二组比较,x2=12.1995,P＜0.01,差异有统计学意义.慢性丙型肝炎合并慢性淋巴细胞性甲状腺炎患者治疗结束24周,仍有90.5％(19/21)的患者A-TPO高于正常值上限2倍以上,73.3％(11/15)的患者甲状腺功能异常.甲状腺功能异常者以甲状腺功能减退表现为主,并且均对左甲状腺素钠敏感.两组患者抗病毒治疗4、12周,治疗结束后24周病毒学应答率比较,差异无统计学意义.结论干扰素α治疗慢性丙型肝炎合并慢性淋巴细胞性甲状腺炎患者,其甲状腺功能异常的发生率明显增高,在严密监测下可完成抗病毒疗程,可与慢性丙型肝炎患者获同样的抗病毒疗效.
목적 관찰간우소α대만성병형간염합병만성림파세포성갑상선염환자적항병독료효화대갑상선공능적영향. 방법 대21례치료전급치료중항갑상선과양화물매항체(A-TPO)승고,병진단위만성림파세포성갑상선염적만성병형간염환자,초시급여보통간우소.α-1b 200만단위,격일1차,기육주사2～3차후개위400만단위,격일1차,기육주사2～3차후피하주사취을이순간우소α-2a 135 ～ 180 μg,매주1차,직지료정결속,소유환자복용리파위림위0.9 ～ 1.2 g/d,분3차구복.관찰치료과정중급치료결속후24주환자갑상선공능적변화급항병독치료적효과.응용PEMS3.1통계연건,계량자료채용t검험혹q검험,계수자료채용x2검험혹Fisher정학개솔법.결과 재항병독치료중갑상선공능이상발생솔:만성병형간염합병만성림파세포성갑상선염적환자위71.4％(15/21),미합병만성림파세포성갑상선염적만성병형간염환자위30.2％(26/86),이조비교,x2=12.1995,P＜0.01,차이유통계학의의.만성병형간염합병만성림파세포성갑상선염환자치료결속24주,잉유90.5％(19/21)적환자A-TPO고우정상치상한2배이상,73.3％(11/15)적환자갑상선공능이상.갑상선공능이상자이갑상선공능감퇴표현위주,병차균대좌갑상선소납민감.량조환자항병독치료4、12주,치료결속후24주병독학응답솔비교,차이무통계학의의.결론 간우소α치료만성병형간염합병만성림파세포성갑상선염환자,기갑상선공능이상적발생솔명현증고,재엄밀감측하가완성항병독료정,가여만성병형간염환자획동양적항병독료효.
Objective To investigate the relation of thyroid function with hashimoto thyroiditis(HT,an autoimmune disease of unknown etiology also known as chronic lymphocytic thyroiditis)in patients with chronic hepatitis C(CHC)receiving treatment with pegylated-interferon-alpha(Peg-IFNαt)based on the observation that HT is common among individuals undergoing IFN-based therapy.Methods One-hundred-and-seven patients with chronic hepatitis C were enrolled for study between January 2008 and December 2010.Thyroid function was assessed by electrochemiluminescence assays to detect serum levels of antithyroid peroxidase(A-TPO)antibodies,thyroid stimulating hormore(TSH),and free thyroxine(FT4)prior to initiation of the IFN-based therapy.The treatment strategies(drugs,doses,schedules)were designed according to HT status(CHC with HT,or CHC without HT).Patients were monitored during the 24 weeks of treatment(including measuring serum alanine aminotransferae(ALT),TSH,and FT4 every two to four weeks,and HCV RNA every four weeks)so that the IFNα dose could be adjusted and thryoid medications (levothyroxine sodium or methimazole)added as necessary.The response rate at end of treatment(week 24)was assessed.Results Twenty-one of the CHC patients were diagnosed with HT,and the incidence of thyroid dysfunction among the CHC patients with HT was 71.4％(15/21);among the CHC patients with no HT,the incidence of thyroid dysfunction was significantly lower(30.2％(26/86),x2 =12.1995,P ＜ 0.01).In the CHC patients with HT,90.5％(19/21)had serum levels of A-TPO antibodies that were ≥ 2-times higher than the normal value at the end of treatment.Of the 15 CHC patients with HT and thyroid dysfunction,73.3％(11/15)continued to show thyroid dysfunction at the end of treatment.Hypothyroidism was the most common form of thyroid dysfunction observed(4/11),and all of those patients responded to levothyroxine sodium treatment.The virological response rates of the two groups(CHC with HT and CHC without HT)were not significantly different at any time point examined(treatment week 4,12,and 24,P ＞ 0.05).Conclusion The incidence of thyroid dysfunction is significantly higher among CHC patients with HT than among CHC patients without HT.If suspected,these patients should be carefully monitored because the clinical symptoms of thyroid dysfunction are not obvious and the drug therapy should be carefully adjusted to minimize the thyroid dysfunction while maximizing the antiviral effect.