Department of Gastroenterology, Centre for Medical Research, Western Australian Institute, Western Australia, Australia.
J Gastroenterol Hepatol. 2009 Jun;24(6):1017-23. doi: 10.1111/j.1440-1746.2008.05690.x. Epub 2009 Dec 1.
Treatment of chronic hepatitis C with interferon is known to be associated with thyroid dysfunction (TD) in 5-14% of patients. We studied the incidence, types, outcome and risk factors predictive of thyroid dysfunction.
A retrospective analysis was performed on all patients treated with interferon alpha (IFN) or pegylated interferon alpha (PEG-IFN) +/- ribavirin (RBV), who developed abnormal thyroid function tests (TFTs). These cases were compared with treatment-matched controls to identify factors predictive of thyroid dysfunction. Statistical methods consisted of: chi(2) test, Fischer's exact test, Welch's t-test, and multivariate analysis.
From a total of 511 patients, 45 cases with TD were identified (8.8%). Pegylated interferon alpha was associated with higher rates of TD than IFN (14.1% vs 6.0%, P = 0.0029). Female sex (OR 5.6, 95% CI 1.1-7) and Asian ethnicity (OR 2.7, 95% CI 1.4-22) were independent predictors of developing TD. Cytology was obtained in 13 patients: benign follicular pattern (8); thyroiditis (3); and normal (2). Thyroid peroxidase (TPO) antibodies (P = 0.004) and earlier onset of dysfunction (P = 0.03) were associated with need for treatment. Sixteen patients had persistent TD by the end of the follow-up period, predicted by female sex, non-Asian ethnicity, prior history of TD and TPO antibodies.
Pegylated interferon alpha, female sex and Asian ethnicity are independent risk factors for TD. Thyroid peroxidase antibodies and earlier TD within the course of IFN are associated with the requirement for treatment. Thyroid function tests should be monitored during and after IFN-based therapy. The most common cytological finding is a benign follicular pattern.
干扰素治疗慢性丙型肝炎已知与 5-14%的患者甲状腺功能障碍（TD）有关。我们研究了甲状腺功能障碍的发生率、类型、结局和预测因素。
对所有接受干扰素α（IFN）或聚乙二醇干扰素α（PEG-IFN）+/-利巴韦林（RBV）治疗且甲状腺功能检测（TFT）异常的患者进行回顾性分析。将这些病例与治疗匹配的对照组进行比较，以确定预测甲状腺功能障碍的因素。统计方法包括：卡方检验、Fisher 确切检验、Welch 检验和多变量分析。
在总共 511 例患者中，发现 45 例甲状腺功能障碍（8.8%）。聚乙二醇干扰素α与 IFN 相比，甲状腺功能障碍发生率更高（14.1% vs 6.0%，P = 0.0029）。女性（OR 5.6，95%CI 1.1-7）和亚洲人种（OR 2.7，95%CI 1.4-22）是发生甲状腺功能障碍的独立预测因素。对 13 例患者进行了细胞学检查：良性滤泡模式（8 例）、甲状腺炎（3 例）和正常（2 例）。甲状腺过氧化物酶（TPO）抗体（P = 0.004）和甲状腺功能障碍早期发作（P = 0.03）与治疗需求相关。在随访结束时，16 例患者持续存在甲状腺功能障碍，这与女性、非亚洲人种、既往甲状腺功能障碍和 TPO 抗体病史有关。
聚乙二醇干扰素α、女性和亚洲人种是甲状腺功能障碍的独立危险因素。TPO 抗体和 IFN 治疗过程中甲状腺功能障碍较早发生与治疗需求相关。在基于 IFN 的治疗期间和之后应监测甲状腺功能检测。最常见的细胞学发现是良性滤泡模式。
