CAJ | 학술논문

目的了解慢性丙型肝炎患者在干扰素和利巴韦林的联合治疗过程中甲状腺疾病的发生率及临床特点. 方法慢性丙型肝炎患者82例,给予聚乙二醇干扰素α-2a 180 μg,每周一次,联合利巴韦林15 mg.kg-1.d-1,治疗48周.分别于治疗前、治疗24周、治疗结束(48周)和随访24周(72周)检测患者甲状腺功能、甲状腺抗体、自身抗体谱、免疫球蛋白等指标,分析甲状腺疾病的发生率和临床特点.用SPSS11.5软件对资料进行统计分析.符合正态分布的计量资料组间比较用t检验.计数资料组间比较采用x2检验/精确概率检验. 结果 82例慢性丙型肝炎患者中,抗病毒治疗48周时发生甲状腺功能低下者11例,占13.4％；甲状腺功能亢进3例,占3.7％；甲状腺球蛋白抗体阳性17例,占20.7％；甲状腺过氧化物酶抗体阳性18例,占22.0％.抗病毒治疗前、后IgG值甲状腺正常组分别为(12.95±3.32) g/L和(14.84±2.61) g/L、补体C4分别为(0.22±0.08) g/L和(0.26±0.09) g/L,治疗后IgG、C4显著升高,F值为10.458和6.835,P值为0.002和0.011;IgM分别为(1.00±0.42) g/L和(0.86±0.48) g/L,治疗后显著降低,F=9.106,P=0.003.甲状腺功能异常组治疗前、后IgG分别为(14.75±5.18) g/L和(16.19±5.14) g/L、补体C4分别为(0.22±0.08) g/L和(0.26±0.09) g/L,差异无统计学意义.基线以及抗病毒治疗48周时甲状腺正常组和异常组免疫球蛋白以及补体水平差异无统计学意义.甲状腺异常组和正常组病毒学应答差异无统计学意义.结论聚乙二醇干扰素联合利巴韦林48周初治慢性丙型肝炎患者引起的甲状腺疾病以甲状腺功能减退和甲状腺自身抗体异常为主,甲状腺疾病的发生与否与自身抗体和免疫球蛋白水平无明显相关性.
목적 료해만성병형간염환자재간우소화리파위림적연합치료과정중갑상선질병적발생솔급림상특점. 방법 만성병형간염환자82례,급여취을이순간우소α-2a 180 μg,매주일차,연합리파위림15 mg.kg-1.d-1,치료48주.분별우치료전、치료24주、치료결속(48주)화수방24주(72주)검측환자갑상선공능、갑상선항체、자신항체보、면역구단백등지표,분석갑상선질병적발생솔화림상특점.용SPSS11.5연건대자료진행통계분석.부합정태분포적계량자료조간비교용t검험.계수자료조간비교채용x2검험/정학개솔검험. 결과 82례만성병형간염환자중,항병독치료48주시발생갑상선공능저하자11례,점13.4％；갑상선공능항진3례,점3.7％；갑상선구단백항체양성17례,점20.7％；갑상선과양화물매항체양성18례,점22.0％.항병독치료전、후IgG치갑상선정상조분별위(12.95±3.32) g/L화(14.84±2.61) g/L、보체C4분별위(0.22±0.08) g/L화(0.26±0.09) g/L,치료후IgG、C4현저승고,F치위10.458화6.835,P치위0.002화0.011;IgM분별위(1.00±0.42) g/L화(0.86±0.48) g/L,치료후현저강저,F=9.106,P=0.003.갑상선공능이상조치료전、후IgG분별위(14.75±5.18) g/L화(16.19±5.14) g/L、보체C4분별위(0.22±0.08) g/L화(0.26±0.09) g/L,차이무통계학의의.기선이급항병독치료48주시갑상선정상조화이상조면역구단백이급보체수평차이무통계학의의.갑상선이상조화정상조병독학응답차이무통계학의의.결론 취을이순간우소연합리파위림48주초치만성병형간염환자인기적갑상선질병이갑상선공능감퇴화갑상선자신항체이상위주,갑상선질병적발생여부여자신항체화면역구단백수평무명현상관성.
Objective To investigate the clinical features of thyroid disease occurring in response to antiviral therapy in patients with chronic hepatitis C (CHC).Methods Eighty-two patients diagnosed with CHC were recruited for study from our hospital between 2009 and 2010.All patients were given a 48-week course of antiviral combination therapy with pegylated-interferon (Peg-IFN; 180 μg qw ih) and ribavirin (RBV;15 mg/kg bw).Patient sera was collected prior to treatment (baseline),at treatment weeks 24 and 48,and posttreatment week 24,and used to detect changes in levels of thyroid function markers,thyroid-specific and other autoantibodies,complement factors,and immunoglobulins (Igs).Differential expression of biomarkers was assessed between patients who developed thyroid disorder and those who did not.Results At treatment week 48,13.4％ (11/82) of cases developed hypothyroidism,3.7％ (3/82) developed hyperthyroidism,20.7％ (17/82) tested positive for thyroglobulin antibody,and 22.0％ (18/82) tested positive for thyroid peroxidase antibody.The patients who did not develop thyroid disease had significantly higher post-treatment levels (vs.baseline) of IgG (14.84 ± 2.61 vs.12.95 ± 3.32 g/L,F =10.458,P=0.002) and C4 (0.26 ± 0.09 vs.0.22 ± 0.08 g/L,F =6.835,P =0.011) and significantly lower IgM (0.86 ± 0.48 vs.1.00 ± 0.42 g/L,F=9.106,P =0.003).The patients who developed thyroid disease showed no significant differences in the baseline and post-treatment levels of IgG,C4,or IgM.When the two groups of patients who did or did not develop thyroid disease were compared,there was no difference in the amount of patients who achieved sustained virological response.Conclusion Antiviralinduced thyroid disease in patients with refractory hepatitis C manifests as clinically-detectable abnormalities in serum levels of thyroid autoantibody and markers of hypothyroidism.Levels of other autoantibodies and Igs do not correlate with the development of thyroid disease in these patients,and thyroid disease does not appear to affect the efficacy of Peg-IFN + RBV antiviral therapy.