Labbadia Giancarlo, Martocchia Antonio, Mammarella Antonio, Paoletti Vincenzo, Rocco Antonio, Benvenuto Rosalba, Antonella Proietti, Rosaria D'Urso, Trabace Simonetta, Musca Antonino, Falaschi Paolo
Department of Medical Therapy, Faculty of Medicine, University of Rome La Sapienza, Italy.
Neuro Endocrinol Lett. 2005 Apr;26(2):109-12.
The interferon-alpha (IFN-alpha) therapy for HCV hepatitis may exacerbate or induce underlying thyroid disorders. Besides viral factors, the human leukocyte antigen (HLA) may be an independent risk factor.
We evaluated fifteen patients with HCV chronic hepatitis during a period of 40 months. At the enrollment, all the patients were negative for thyroid disorders, excluding one patient with subclinical hypothyroidism. Eleven patients received IFN-alpha therapy. The HLA system was examined in every patient, evaluating antigens (n=40) of locus A, B and Cw and alleles (n=19) of locus DRB1* and DQB1*. The HLA system was also examined in healthy subjects (n=107) as a control group.
The HCV genotype distribution in patients was: 1b=20%, 2a=60%, 3a=20%. Four IFN-treated patients presented clinical thyroid disorders, including autoimmune hypothyroidism (n=2), transient thyrotoxicosis (n=1) and subacute thyroiditis (n=1). The HLA susceptibility to thyroid disorders (antigen/allele frequency) in the whole group of patients was not different in respect to controls and normal Italian population. The patients with HCV chronic hepatitis that developed thyroid diseases after IFN- treatment had a double and specific association with the HLA system (Mantel-Haenszel X(c)(2)=4.706, p<0.05).
This case report suggests that HLA system examination is an important and promising diagnostic aspect that may be considered in order to evaluate the appearance of thyroid disorders during the IFN-alpha treatment for HCV-related chronic hepatitis.
丙型肝炎病毒（HCV）肝炎的α干扰素（IFN-α）治疗可能会加重或诱发潜在的甲状腺疾病。除病毒因素外，人类白细胞抗原（HLA）可能是一个独立的危险因素。
我们在40个月的时间里评估了15例HCV慢性肝炎患者。入组时，所有患者甲状腺疾病检查均为阴性，但有1例亚临床甲状腺功能减退患者除外。11例患者接受了IFN-α治疗。对每位患者的HLA系统进行检查，评估A、B和Cw位点的抗原（n = 40）以及DRB1和DQB1位点的等位基因（n = 19）。还对107名健康受试者作为对照组进行了HLA系统检查。
患者的HCV基因型分布为：1b型 = 20%，2a型 = 60%，3a型 = 20%。4例接受IFN治疗的患者出现临床甲状腺疾病，包括自身免疫性甲状腺功能减退（n = 2）、短暂性甲状腺毒症（n = 1）和亚急性甲状腺炎（n = 1）。患者组中HLA对甲状腺疾病的易感性（抗原/等位基因频率）与对照组和正常意大利人群相比无差异。IFN治疗后发生甲状腺疾病的HCV慢性肝炎患者与HLA系统存在双重且特异性的关联（Mantel-Haenszel X(c)(2)=4.706，p<0.05）。
本病例报告表明，HLA系统检查是一个重要且有前景的诊断方面，在评估IFN-α治疗HCV相关慢性肝炎期间甲状腺疾病的出现时可予以考虑。
