Murdolo G, Francisci D, Forini F, Baldelli F, Angeletti G, Stagni G, Santeusanio F, Calcinaro F, Falorni A
Department of Internal Medicine, Section of Internal Medicine and Endocrine and Metabolic Sciences (DI.M.I.S.E.M.), University of Perugia, Perugia, Italy.
J Endocrinol Invest. 2002 Dec;25(11):938-46. doi: 10.1007/BF03344065.
Interferon-alpha (IFN-alpha) treatment for chronic hepatitis C (CHC) has been associated with thyroid autoimmunity and/or dysfunction. Only a few data concerning the prevalence of islet-cell or adrenal cortex autoantibodies in IFN-alpha-treated subjects are currently available. The aims of our study were to evaluate in CHC, 1) the prevalence and association of thyroid, islet-cell and adrenal autoantibodies, and 2) the appearance of endocrine dysfunction, before and after a 6 month IFN-alpha treatment. We analyzed serum samples from 203 adult patients at the time of clinical diagnosis of CHC and showed that the prevalence of thyroperoxidase (TPOAb), thyroglobulin (TGAb), TSH-receptor (TRAb), glutamic acid decarboxylase (GAD65Ab), IA-2/ICA512 (IA-2/ICA512Ab) and 21-hydroxylase (21OHAb) autoantibodies was similar to that observed among healthy control subjects of similar age and sex distribution. Among 99 patients with follow-up serum samples, 83 accepted and 16 refused IFN-alpha treatment. The IFN-alpha treatment was associated with increase of TPOAb levels in 3 subjects already positive at baseline, with progression to overt hypothyroidism in 2 of them. The de novo appearance of autoantibodies was observed in 5/80 (6%) cases for TPOAb, 1/81 (1.2%) for GAD65Ab and 2/81 (2.5%) for IA-2/ICA512Ab. Clinical or subclinical signs of either hyperthyroidism or hypothyroidism were demonstrated in 3/5 cases with de novo appearance of TPOAb. Four subjects, initially positive for either GAD65Ab or IA2/ICA512Ab, were all found negative after IFN-alpha-treatment. No subjects showed positivity for 21OHAb either at baseline or after the follow-up period. Our study suggests that, in CHC untreated patients, the prevalence of endocrine autoantibodies is similar to that observed in the general population. Furthermore, we demonstrate that IFN-alpha treatment is associated with the induction or enhancement of thyroid, but not of islet-cell or adrenal cortex autoimmunity.
干扰素-α（IFN-α）治疗慢性丙型肝炎（CHC）与甲状腺自身免疫和/或功能障碍有关。目前仅有少量关于接受IFN-α治疗的患者中胰岛细胞或肾上腺皮质自身抗体患病率的数据。我们研究的目的是在CHC患者中评估：1）甲状腺、胰岛细胞和肾上腺自身抗体的患病率及相关性；2）在6个月IFN-α治疗前后内分泌功能障碍的出现情况。我们分析了203例成年CHC患者临床诊断时的血清样本，结果显示甲状腺过氧化物酶（TPOAb）、甲状腺球蛋白（TGAb）、促甲状腺激素受体（TRAb）、谷氨酸脱羧酶（GAD65Ab）、IA-2/胰岛细胞抗原512（IA-2/ICA512Ab）和21-羟化酶（21OHAb）自身抗体的患病率与年龄和性别分布相似的健康对照者中观察到的患病率相似。在99例有随访血清样本的患者中，83例接受了IFN-α治疗，16例拒绝。IFN-α治疗使3例基线时已呈阳性的患者TPOAb水平升高，其中2例进展为明显的甲状腺功能减退。TPOAb在5/80（6%）的病例中出现了新的自身抗体，GAD65Ab在1/81（1.2%）的病例中出现，IA-2/ICA512Ab在2/81（2.5%）的病例中出现。在5例出现新的TPOAb的病例中，3例出现了临床或亚临床甲状腺功能亢进或减退的体征。4例最初GAD65Ab或IA2/ICA512Ab呈阳性的患者在IFN-α治疗后均转为阴性。在基线期或随访期后，没有患者21OHAb呈阳性。我们的研究表明，在未治疗的CHC患者中，内分泌自身抗体的患病率与普通人群中观察到的相似。此外，我们证明IFN-α治疗与甲状腺自身免疫的诱导或增强有关，但与胰岛细胞或肾上腺皮质自身免疫无关。
