干扰素治疗慢性丙型肝炎对患者甲状腺功能的影响

Influence of interferon therapy on thyroid functionin patients with chronic hepatitis C

目的分析干扰素治疗慢性丙型肝炎对甲状腺功能的影响。方法收集2014年1月-2016年12月收治的慢性丙型肝炎轻度、中度及早期肝纤维化患者40例作为研究组,选取同期健康体检者30例作为对照组,采用化学发光免疫分析法检测研究组干扰素治疗前、中、后甲状腺激素及抗体水平,并与对照组比较。结果研究组出现甲状腺疾病8例(20.0%),其中甲亢5例,甲减3例。研究组治疗前血清甲状腺球蛋白抗体(TGAb)和抗甲状腺过氧化物酶抗体(TPOAb)的阳性率分别为15.0%(6/40)和12.5%(5/40),对照组TGAb和TPOAb的阳性率分别为0和6.7%(2/30),2组TGAb和TPOAb阳性率比较差异均有统计学意义(P<0.05);且研究组治疗后TGAb和TPOAb的阳性率均低于治疗前(P<0.05)。研究组治疗前甲状腺激素水平均在正常范围,但游离三碘甲状原氨酸(FT3)、游离甲状腺素(FT4)均显著低于对照组(P<0.05)。研究组治疗后FT3、FT4均显著升高,与治疗前比较差异均有统计学意义(P<0.05);研究组治疗过程中TSH较治疗前有明显增高(P<0.05),随着治疗的进展TSH逐渐恢复正常。结论慢性丙型肝炎患者可存在甲状腺功能异常,干扰素治疗中可出现一过性甲状腺激素代谢紊乱,其中TSH的检测更灵敏,TGAb、TPOAb可作为干扰素(IFN)治疗中甲状腺疾病发生发展的预测因素。

Objective To analyse the changes and clinical significance of chronic hepatitis C patients before and after antiviral therapy of thyroid function. Methods 40 patients with mild, moderate and early hepatic fibrosis were enrolled as study group,which were admitted in hospital from January 2014 to December 2016 ,and 30 cases healthy subjects were selected as a control group,thyroid hormone and antibody levels were determined with chemiluminescence immunoassay in study group both before and after antiviral treatments with interferon, and compared with the control group. Results The study group showed thyroid disease in 8 eases（20.0% ） ,of which 5 cases of hyperthyroidism,hypothyroidism in 3 cases. The positive rates of serum TGAb and TPOAb in the study group before treatment were 15.0% （6/40） and 12.5% （5/40） respectively,the posi- tive rates of TGAb and TPOAb in the control group were 0 and 6.7% （2/30） ,the positive rates of TGAb and TPOAb in two groups were significantly different （ P 〈 0.05 ） ; The positive rates of TGAb and TPOAb in the study group were lower than those before treatment（ P 〈 0.05 ）. The thyroid hormone levels of study group before treatment were in the normal range ,the FT3 and FT4 in the study group were significantly lower than those in the control group（P 〈0.05）. After treatment,the FT3 and FT4 in the study group were significantly higher than those before treatment （ P 〈 0.05 ）. The TSH in study group was significantly higher than that before treatment（P 〈0.05） ,TSH gradually returned to normal with the progress of treatment. Conclusion Abnormal thyroid function in patients with chronic hepatitis C can exist;use of interferon anti-viral treatment process had thy- roid hormone metabolism disorder may occur, and TSH detection is more sensitive than other thyroid hormone determination; but with the end of the on of liver function, thyroid hormone gradually restores to normal; TGAb, TPOAb can be the predictive factors of interferon（IFN） treatment of chronic hepatitis C during the development of thyroid disease