Interferon-induced thyroid dysfunction in chronic hepatitis C
Interferon-induced thyroid dysfunction in chronic hepatitis C
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DOI：
10.1111/j.1440-1746.2008.05690.x
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发表时间：
2009-06-01
影响因子：
4.1
通讯作者：
Cheng, Wendy
中科院分区：
文献类型：
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作者：
Jamil, Khaleel M.;Leedman, Peter J.;Cheng, Wendy
已知用干扰素治疗慢性丙型肝炎与5-14%的患者甲状腺功能障碍（TD）有关。我们研究了甲状腺功能障碍的发生率、类型、结局和危险因素。回顾性分析了所有接受干扰素α (IFN)或聚乙二醇化干扰素α (PEG-IFN) +/-利巴韦林（RBV）治疗的甲状腺功能检查（TFTs）异常的患者。将这些病例与治疗匹配的对照组进行比较，以确定预测甲状腺功能障碍的因素。统计方法包括chi(2)检验、Fischer精确检验、Welch t检验和多变量分析。在总共511例患者中，确定了45例TD（8.8%）。与IFN相比，聚乙二醇干扰素α与更高的TD发生率相关（14.1% vs 6.0%, P = 0.0029）。女性（OR 5.6, 95% CI 1.1-7）和亚洲种族（OR 2.7, 95% CI 1.4-22）是发生TD的独立预测因素。13例患者行细胞学检查：良性卵泡型（8例）；甲状腺炎(3);和正常(2)。甲状腺过氧化物酶（TPO）抗体（P = 0.004）和早期功能障碍（P = 0.03）与治疗需求相关。随访结束时，16例患者有持续性TD，由女性、非亚洲种族、既往TD和TPO抗体史预测。聚乙二醇化干扰素α、女性和亚洲种族是TD的独立危险因素。甲状腺过氧化物酶抗体和干扰素治疗过程中的早期TD与治疗需求相关。甲状腺功能测试应监测期间和之后的干扰素为基础的治疗。最常见的细胞学发现是良性滤泡型。
Treatment of chronic hepatitis C with interferon is known to be associated with thyroid dysfunction (TD) in 5-14% of patients. We studied the incidence, types, outcome and risk factors predictive of thyroid dysfunction.A retrospective analysis was performed on all patients treated with interferon alpha (IFN) or pegylated interferon alpha (PEG-IFN) +/- ribavirin (RBV), who developed abnormal thyroid function tests (TFTs). These cases were compared with treatment-matched controls to identify factors predictive of thyroid dysfunction. Statistical methods consisted of: chi(2) test, Fischer's exact test, Welch's t-test, and multivariate analysis.From a total of 511 patients, 45 cases with TD were identified (8.8%). Pegylated interferon alpha was associated with higher rates of TD than IFN (14.1% vs 6.0%, P = 0.0029). Female sex (OR 5.6, 95% CI 1.1-7) and Asian ethnicity (OR 2.7, 95% CI 1.4-22) were independent predictors of developing TD. Cytology was obtained in 13 patients: benign follicular pattern (8); thyroiditis (3); and normal (2). Thyroid peroxidase (TPO) antibodies (P = 0.004) and earlier onset of dysfunction (P = 0.03) were associated with need for treatment. Sixteen patients had persistent TD by the end of the follow-up period, predicted by female sex, non-Asian ethnicity, prior history of TD and TPO antibodies.Pegylated interferon alpha, female sex and Asian ethnicity are independent risk factors for TD. Thyroid peroxidase antibodies and earlier TD within the course of IFN are associated with the requirement for treatment. Thyroid function tests should be monitored during and after IFN-based therapy. The most common cytological finding is a benign follicular pattern.