Testa A, Castaldi P, Fant V, Fiore G F, Grieco V, De Rosa A, Pazardjiklian M G, De Rosa G
Department of Emergency Medicine, A. Gemelli University Hospital, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2006 Jul-Aug;10(4):183-6.
Auto-immune thyroid disease (AITD) has often been reported during interferon-alpha therapy for chronic viral C hepatitis (HCV) or other diseases. Recently, a high AITD prevalence has been reported in HCV independently on alpha-interferon therapy. The aim of our study is to investigate the possible relationship between AITD and HCV and HBV virus infections, and their influence on the thyroid function.
We prospectively studied 112 patients with AITD (94 women and 18 men; mean age: 49.8 +/- 14.9 yrs) and 88 patients with non-toxic goitre (NTG) (73 women and 15 men; mean age: 50.2 +/- 13.5 yrs) as controls. In all patients HCV antibodies, HBsAg and anti-HBs antibodies, TSH, FT3 and FT4 serum levels, circulating anti-thyroid-peroxidase antibodies (TPO-Ab) and anti-thyroglobulin antibodies (TG-Ab) were measured.
HCV antibodies were positive in 11.6% of AITD patients (13/112) and in 2.3% of controls (2/88) (P < 0.05), the prevalence of HCV in the controls being similar to the expected value in the general population (about 2%). HBsAg and anti-HBs were found only in 2.6% of AITD patients (3/112) and 1.1% of controls (1/88) (P = NS), according to the expected value in the general population (about 2.5%). No difference in thyroid function was observed between positive and negative HCV subgroups.
A significant association between HCV infection and AITD was found. This finding confirms that HCV, but not HBV, could be one of the environmental factors responsible for the breakdown of immunological tolerance. Therefore detection of TPO-Ab and TG-Ab in all HCV patients, independently of IFN therapy, is suggested and the utility of a screening for HCV in all AITD patients is stressed.
自身免疫性甲状腺疾病（AITD）在慢性丙型肝炎病毒（HCV）或其他疾病的干扰素-α治疗期间常有报道。最近，有报道称在不进行α干扰素治疗的情况下，HCV患者中AITD患病率也很高。我们研究的目的是调查AITD与HCV和HBV病毒感染之间的可能关系，以及它们对甲状腺功能的影响。
我们前瞻性地研究了112例AITD患者（94例女性和18例男性；平均年龄：49.8±14.9岁）和88例非毒性甲状腺肿（NTG）患者（73例女性和15例男性；平均年龄：50.2±13.5岁）作为对照。检测了所有患者的HCV抗体、HBsAg和抗-HBs抗体、TSH、FT3和FT4血清水平、循环抗甲状腺过氧化物酶抗体（TPO-Ab）和抗甲状腺球蛋白抗体（TG-Ab）。
AITD患者中11.6%（13/112）的HCV抗体呈阳性，对照组中为2.3%（2/88）（P<0.05），对照组中HCV的患病率与一般人群的预期值相似（约2%）。根据一般人群的预期值（约2.5%），仅在2.6%的AITD患者（3/112）和1.1%的对照组（1/88）中发现HBsAg和抗-HBs（P=无显著性差异）。HCV阳性和阴性亚组之间未观察到甲状腺功能差异。
发现HCV感染与AITD之间存在显著关联。这一发现证实，HCV而非HBV可能是导致免疫耐受破坏的环境因素之一。因此，建议在所有HCV患者中检测TPO-Ab和TG-Ab，无论是否进行干扰素治疗，并强调在所有AITD患者中筛查HCV的实用性。
