慢性病毒性肝炎合并甲状腺疾病的临床研究

Clinical study on chronic viral hepatitis with thyroid disease

目的研究慢性乙型和丙型肝炎患者在干扰素治疗前及治疗期间出现甲状腺疾病的临床特征。方法对2009年9月至2012年9月首都医科大学附属北京地坛医院住院诊断为慢性病毒性肝炎合并甲状腺疾病的143例患者的临床资料进行回顾性分析并加以归纳总结,对其进行描述性分析,分别监测干扰素治疗前、中、后游离甲状腺素(FT4)及促甲状腺激素(TSH)。结果 143例慢性病毒性肝炎合并甲状腺疾病患者,男性38例,女性105例;其中聚乙二醇化干扰素(PegIFN)α-2a治疗前合并甲状腺疾病85例,23例男性患者中甲状腺功能亢进者13例(56.5%)和甲状腺机能减退者10例(43.5%);62例女性患者中甲状腺功能亢进者23例(37.1%)和甲状腺机能减退者39例(62.9%)。PegIFN-α-2a治疗中出现甲状腺疾病为58例,既往无甲状腺疾病,15例男性患者中甲状腺功能亢进者8例(53.3%)和甲状腺机能减退者7例(46.7%);43例女性患者中甲状腺功能亢进者12例(27.9%)和甲状腺机能减退者31例(72.1%)。PegIFN-α-2a治疗中,甲状腺疾病多出现在治疗的第4～6个月。结论慢性肝炎患者中女性合并甲状腺疾病发病率较男性高,且女性以甲状腺机能减退更常见。

Objective To assess the frequency of thyroid dysfunction before and during interferon-αtherapy in chronic hepatitis B （CHB） and C （CHC） patients. Methods The clinical datas of 143 chronic hepatitis patients with thyroid disease who were admitted in Beijing Ditan Hospital, Capital Medical University from September 2009 to September 2012 were collected and analyzed, retrospectively. Free thyroxine （FT4） and thyrotropin （TSH） levels were measured before, during and after interferon-αtreatment. Results Among the 143 chronic viral hepatitis patients with thyroid diseases, 38 male and 105 female patients. Among the 23 male patients with thyroid disorders before Peg-IFN-α2a treatment, 13 （56.5%） had hyperthyroidism and 10 （43.5%） hypothyroidism. Among the 62 female patients with thyroid disorders before Peg-IFN-α-2a treatment, 23 （37.1%） had hyperthyroidism and 39 （62.9%） had hypothyroidism. There were 58 patients developed thyroid dysfunction during Peg-IFN-α-2a treatment. Among the 15 male patients, 8 （53.3%） had hyperthyroidism and 7 （46.7%） hypothyroidism, and 12 （27.9%） had hyperthyroidism and 31 （72.1%） hypothyroidism among the 43 female patients. During Peg-IFN-α-2a treatment, thyroid disorders happened mostly in the 4 to 6 months after the beginning of treatment. Conclusions The incidence of thyroid disorders is higher in female patients with chronic hepatitis than in male patients, and female with hypothyroidism is more common.