干扰素α治疗病毒性肝炎引起的甲状腺疾病

Thyroid diseases associated with interferon α treatment for viral hepatitis

干扰素α用于治疗病毒性肝炎的过程中极易发生不良反应，其中甲状腺疾病是最常见的内分泌方面的不良反应。干扰素诱发的甲状腺炎引起了临床医生的普遍关注。这类疾病有很多易感因素，如：遗传、性别、丙型肝炎病毒感染等。发病机制可能是干扰素α的免疫调节作用或干扰素α对甲状腺的直接作用，可分为自身免疫型和非自身免疫型。前者表现为3种形式：Graves病、桥本甲状腺炎，以及出现甲状腺抗体而没有临床症状。后者有两种形式：破坏性的甲状腺炎和非自身免疫性甲状腺功能减退。在干扰素治疗的前、中、后期，均需要监测促甲状腺激素水平和甲状腺抗体水平，并及时进行规范的诊断和治疗。

There are many complications during the interferon alpha （IFNα） treatment for viral hep- atitis, and thyroid disease is the most common side-effect in endocrine aspects. Thus, clinicians are drawing much attention to the interferon induced thyroiditis （IIT）. Though the etiology is not clear,some factors may contribute to the susceptibility to IIT, such as genetic predisposition, gender, and hepatitis C virus （HCV） infection. The pathogenesis may be secondary to immune modulation by IFN-α and/or by its direct effects on the thyroid. Autoimmune IIT may manifest as Graves＇ disease, Hashimoto＇s thyroiditis and the development of thyroid antibodies without clinical symptoms. Non-autoimmune IIT can manifest as destructive thyroiditis or hypothyroidism with negative thyroid antibodies. Screening for autoantibodies and serum thyroid-stimulating hormone（TSH） is recommended before, during and after IFN-α treatment. Early detection and therapy of these conditions is important.