慢性丙型肝炎患者干扰素治疗中合并甲状腺功能异常影响因素分析

Chronic hepatitis C patients combined with thyroid dysfunction in interferon antiviral treatment

目的探讨慢性丙型肝炎(chronic hepatitis C,CHC)患者干扰素治疗中合并甲状腺功能异常(thyroid dysfunction,TD)的相关影响因素,为临床抗病毒治疗中合并TD提供预测。方法采用临床前瞻-回顾性研究方法 ,对确诊为CHC的194例患者采用标准治疗方案进行抗病毒治疗,根据治疗中是否出现TD进行分组,回顾性分析其相关影响因素。结果女性合并TD的比例(33.00%,33/100)明显高于男性(20.21%,19/94),差异有统计学意义(P=0.031);甲状腺自身抗体(Tab)阳性者合并TD占64.29%(9/14),明显高于阴性患者的23.89%(43/180),差异有统计学意义(P=0.001);基线IL-4、MIP-1αTD组低于非TD组,而IL-2 TD组高于非TD组,差异均有统计学意义(P=0.037,0.007,0.040)。基线MIP-1α对TD预测的ROC曲线下面积0.767(P=0.001);24周TD组不同于非TD组的变化为IL-1β升高(P=0.045);非TD组不同于TD组的变化为IL-6降低(P<0.01),且这两种细胞因子的变化对TD预测的ROC曲线下面积分别为0.832(P<0.01)、0.828(P<0.01)。结论 CHC患者出现TD的相关危险因素有:女性、Tab阳性;基线IL-2升高,IL-4、MIP-1α降低可能与TD相关,且基线MIP-1α可能对TD有较好的预测价值;治疗24周IL-1β升高、IL-6无明显降低可能与TD相关。

Objective To study factors affecting chronic hepatitis C （CHC） patients with thyroid dysfunction （TD） in clinical antiviral treatment. Methods Perspective-retrospective study was conducted and 194 CHC patients undergoing standard antiviral treatment were enrolled in the study. Results Thirty three out of 100 （33.00 %） female C HC patients combined TD, which is significantly higher than that in male patients （19/94, 20.21%） （P=0. 031）; 64.29%（9/14） of Tab-positive patients combined TD, which is markedly higher than that in Tab-negative ones （43/180, 23.89%） （P= 0. 001） . The baseline levels of cytokines, IL-4, MIP-1α were lower in TD group than that in non-TD group, while IL-2 is higher in TD group than non-TD group （P=0. 037, 0. 007, 0. 040, respectively） . The baseline area of MIP 1α under the ROC curve was 0. 767 （P= 0. 001） ; TD group and non-TD group showed inconsistent cytokine changes. TD group differed from the non-TD group in elevated IL-1 beta （P=0. 045）, and the non-TD group differed from the TD group in reduced IL-6 （P 〈 0.01）. The area under the ROC curve for the two cytokines to predict TD were 0. 832 and 0. 828, respectively. Conclusions Risk factors for combined TD in （＇HC patients including female and Tab positive, baseline elevated IL-2 and reduced IL-4, M1P lc~ may associate with TD as well. MIP-1 alpha could be a good predictive factor for TD. At the 24-week time point, increased ILl beta may re- late to TD and can predict TD. A significantly lower of IL-6 can be a predictive factor for non-TD.