慢性丙型肝炎合并甲状腺功能异常患者转归情况及抗病毒疗效分析

The outcome of chronic hepatitis C patients complicated with thyroid dysfunction during antiviral treatment and the efficacy of the antiviral treatment

目的 探讨慢性丙型肝炎（chronic hepatitis C,CHC）合并甲状腺功能异常（thyroid dysfunction,TD）患者的抗病毒疗效及TD转归。方法 采用前瞻性研究方法,对2008年8月至2011年3月收治的符合纳入标准的CHC患者采用标准抗病毒治疗方案[聚乙二醇干扰素α-2a 180μg/周,联合利巴韦林10.6~15.0 mg/（kg·d）],疗程48周,停药后随访至24周。于基线治疗第12、24、48周及停药后24周复查丙肝病毒（HCV）RNA、甲状腺功能,分析抗病毒治疗效果及TD转归。结果 194例患者完成48周的抗病毒治疗。随访24周,TD组脱落2例,非TD组脱落1例。TD组50例患者中共17例甲状腺功能复常,占34.0%,其中基线TD、治疗中新出现TD患者分别有17.4%（4/23）与48.1%（13/27）出现甲状腺功能复常,后者明显高于前者,差异有统计学意义（掊2=5.202,P=0.037）。TD组12周早期病毒学应答（EVR）率为44.2%（23/52）,非TD组为54.2%（77/142）;TD组治疗结束时病毒学应答（ETVR）率为59.6%（31/52）,非TD组为58.5%（83/142）;TD组治疗结束后随访24周持续病毒学应答（SVR）率为60.0%（30/50）,非TD组为54.6%（77/141）。两组EVR、ETVR、SVR的差异均无统计学意义（P〉0.05）。结论 TD不影响干扰素的抗病毒治疗效果。完成治疗后随访24周,部分TD可复常,干扰素治疗后合并TD者其临床转归明显优于基线合并TD者。

Objective To explore the antiviral treatment efficacy of chronic hepatitis C （CHC） patients with thyroid dysfunction （TD）and the outcome of TD. Methods This was a prospective study. The CHC patients during Aug 2008 to March 2011 were enrolled into the study. They were treated with standard antiviral treatment[Peg-IFNα-2a 180μg/w, RBV 10.6~15.0 mg/（kg·d）], the total course of treatment was 48 weeks, the follow-up period was 24 weeks. The level of HCV RNA and thyroid function were examined at the point of 12, 24, 48 weeks of the treatment and 24 weeks of the follow-up. Results One hundred and ninety-six patients complete the treatment, 3 patients dropped in the follow-up. There were 24 patients with TD before treatment, 52 patients with TD at the end of treatment. Followed-up for 24 weeks, 34.0%（17/50） of the patients in the TD group whose thyroid function returned to normal, included 17.4%（4/23） of the baseline TD patients and 48.1%（13/27） of the new TD patients （P = 0.037）. The early virological response （EVR） rate in the TD group was 44.2%（23/52） and that of the non-TD group was 54.2%（77/142）. The end treated virologic response （ETVR） rate in the TD group was 59.6%（31/52）, and the non-TD group was 58.5%（83/142）. After 24 weeks follow-up, the sustained virological response （SVR） rate in the TD group and the non-TD group was 60.0%（30/50） and 54.6%（77/141）, respectively. All the differences were not statistically significant （P 〉 0.05）. Conchlsion TD can not reduce the SVR rate. After 24 weeks follow-up, thyroid function in part of the TD patients returns to normal, and the clinical outcomes are better in the newly emerged TD patients than in the baseline TD cases.