Thyroid dysfunction in chinese patients with chronic hepatitis C treated with interferon alpha: incidence, long-term outcome and predictive factors.
Thyroid dysfunction in chinese patients with chronic hepatitis C treated with interferon alpha: incidence, long-term outcome and predictive factors.
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DOI：
10.5812/hepatmon.6390
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发表时间：
2012-09
影响因子：
0.6
通讯作者：
Wang Y
中科院分区：
文献类型：
--
作者：
Yan Z;Fan K;Fan Y;Wang X;Mao Q;Deng G;Wang Y
甲状腺功能障碍(TD)是慢性丙型肝炎(CHC)的肝外表现，也可能是干扰素-α治疗的副作用。然而，先前的研究表明，慢性丙型肝炎患者中TD的发生率有很大的差异。此外，在接受干扰素-α治疗的患者中，TD的长期结果和预测因素仍未得到充分研究。这项研究的目的是描述接受干扰素-α治疗的中国慢性丙型肝炎患者TD的发生率和长期结局。我们还旨在确定与这类治疗相关的TD的预测因素。对连续接受干扰素-α治疗、基础甲状腺功能正常的592例慢性丙型肝炎患者进行了回顾性病例系列研究。在治疗前、治疗期间每三个月以及停止治疗后的随访中评估甲状腺功能。观察TD的发生率和远期疗效。在性别和年龄匹配的嵌套病例对照研究中检测治疗前甲状腺过氧化物酶抗体(TPOAb)的患病率。采用多元逐步回归分析探讨基线因素对TD发病率的独立影响。在干扰素-α治疗结束时，68例(11.5%)患者发生TD，58例(85.3%)患者出现亚临床TD，仅10例(14.7%)患者发生显性甲状腺炎。46例(67.8%)患者在随访6个月后甲状腺功能自然恢复正常，仅3例(4.4%)患者在随访24个月后仍有明显的甲状腺功能障碍症状。多因素逐步回归分析显示，性别和治疗前TPOAb是TD发病的独立影响因素。女性患者(OR4.31；95%CI2.0 6~7.31；P=1.2 6×10-4)和治疗前TPOAb阳性者(OR=3.9，95%CI1.72~8.5 4，P=0.008)均增加TD发生的危险性。在中国慢性丙型肝炎患者中，干扰素-α治疗期间TD的发生率为11.5%，其中大部分是亚临床的，而只有一小部分人有长期的显性TD需要持续的药物治疗。女性和治疗前TPOAb阳性是干扰素-α治疗中TD发生的危险因素。
Thyroid dysfunction (TD) represents an extra-hepatic manifestation of chronic hepatitis C (CHC) and it may also be a side effect of interferon-alpha (IFN-α) based treatment. However, previous studies have shown a wide variation in the incidence of TD in patients with CHC. Furthermore, the long-term outcomes and the predictive factors of TD in patients who receive IFN-α based treatment have still not been fully studied. The purpose of this study was to describe the incidence and long-term outcomes of TD in Chinese patients with CHC receiving IFN-αbased treatment. We also aimed to identify the predictive factors of TD associated with this type of therapy. A retrospective case-series study of 592 consecutive CHC patients with normal baseline thyroid functions, who received IFN-αbased therapy, was performed. Thyroid function was assessed at baseline and every three months during treatment, as well as in the follow-up after cessation of therapy. The incidence and long-term outcomes of TD were observed. The prevalence of pretreatment thyroid peroxidase antibodies (TPOAb) were assayed in a sex- and age-matched nested case-control study. Multivariable stepwise regression analysis was used to explore the independent effects of the baseline factors, on the incidence of TD. At the end of the IFN-αbased therapy, 68 patients (11.5%) in the study had developed TD, 58 patients (85.3%) presented with subclinical TD, and only 10 patients (14.7%) developed overt thyroiditis. The thyroid function of 46 patients (67.8%) spontaneously returned to normal in the six months of follow-up and only three patients (4.4%) had persistent overt TD symptoms after the 24 month follow-up period. Multivariate stepwise analysis suggested that gender and pretreatment TPOAb were the independent factors related to the incidence of TD. Both female patients (OR, 4.31; 95%CI, 2.06–7.31; P = 1.26×10-4) and participants with a positive pretreatment TPOAb (OR = 3.9, 95%CI, 1.72–8.54, P = 0.008) had an increased risk for the development of TD. The incidence of TD in Chinese patients with CHC during IFN-αbased therapy was 11.5%, the majority of which was subclinical, while only a very small group had long-term overt TD requiring ongoing medical therapy. Female gender and pretreatment TPOAb positivity are risk factors for the development of TD during IFN-αbased therapy.
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