Department of Endocrinology, Metabolic Diseases and Internal Diseases, Pomeranian Medical University, Szczecin, Poland.
Endokrynol Pol. 2011;62(6):517-22.
Different forms of interferon alpha (IFN-α) have been used for several years in the treatment of chronic viral hepatitis type C (CVHC). Currently, pegylated forms of interferon alpha (PegIFN-α) in combination with ribavirin is the standard treatment. During therapy with IFN-α, side-effects occur, including thyroid diseases. The aim of this study was an evaluation of administered interferon's impact on the frequency of autoimmune thyroiditis (ATI) occurrence among patients with CVH type C treated with INF-α and an assessment as to whether the type of interferon used is significant in ATI development.
149 patients aged 18-70 (mean 43.9 ± 2.3 years) with CVH type C participated in the study. The serum concentrations of thyrotrophin (TSH), free tyrosine (FT4), triiodothyronine (FT3), thyreoglobulin (Tg), antithyroid antibodies: antiperoxidase (TPOAb) and antithyreoglobulin (TgAb) were evaluated before, and after six and 12 months of treatment. Additionally, the thyroid echostructure was evaluated with ultrasonography. Sixty out of 149 patients received Peg-INF-α, and 89 patients were treated with recombinant IFN-α.
ATI was confirmed in nine patients (6.04%) with CVH type C before the introduction of interferon. Seven of them underwent an exacerbation of hypothyroidsm during therapy with interferon. In 24 patients (17.14%), who did not have the signs of ATI at baseline, an elevated concentration of antithyroid antibodies was detected during therapy with interferon. The mean concentrations of TPOAb before, and after six and 12 months of treatment were, respectively: 12.4; 310.4 and 141.3 IU/ml, and the mean concentrations of TgAb were, respectively: 17.40; 108.0; and 125.6 IU/ml. After six months of treatment in this group of patients, 11 had hypothyroidsm and six had hyperthyroidsm. After 12 months of therapy, four patients had hypertthyroidsm and four showed signs and symptoms of hypothyroidsm; the remaining patients were in a euthyroid state. In ultrasound examination, reduction of echogenicity among patients with ATI before treatment was revealed in 75% of cases at baseline, in 83.3% after six months and in 100% after 12 months of treatment. In the group of patients presenting with ATI during IFN-α therapy, in which no disorders were found in initial examination, after six months of treatment a reduction of echogenicity was found in 69.2%, and after 12 months in 75%, of patients.
Among patients treated with interferon due to CVH type C, there is a risk of the development of ATI or the exacerbation of an existing one. There is no significant difference in ATI presentation in relation to the type of IFN-α used for treatment.
不同形式的干扰素 α（IFN-α）已用于治疗慢性丙型病毒性肝炎（CVHC）多年。目前，聚乙二醇化干扰素 α（PegIFN-α）联合利巴韦林是标准治疗方法。在使用 IFN-α 治疗期间，会出现副作用，包括甲状腺疾病。本研究的目的是评估干扰素对接受 IFN-α 治疗的丙型肝炎患者自身免疫性甲状腺炎（ATI）发生频率的影响，并评估使用的干扰素类型对 ATI 发展的影响。
149 名年龄在 18-70 岁（平均 43.9 ± 2.3 岁）的 CVHC 患者参与了本研究。在治疗前、治疗 6 个月和 12 个月时，评估了血清促甲状腺激素（TSH）、游离酪氨酸（FT4）、三碘甲状腺原氨酸（FT3）、甲状腺球蛋白（Tg）、抗甲状腺抗体：抗过氧化物酶（TPOAb）和抗甲状腺球蛋白（TgAb）的浓度。此外，还使用超声检查评估了甲状腺的超声结构。60 名患者接受 Peg-INF-α治疗，89 名患者接受重组 IFN-α治疗。
在开始使用干扰素之前，9 名丙型肝炎患者（6.04%）被确诊为 ATI。其中 7 名患者在干扰素治疗期间出现甲状腺功能减退症恶化。在 24 名（17.14%）基线时没有 ATI 迹象的患者中，在干扰素治疗期间检测到抗甲状腺抗体浓度升高。治疗前、治疗 6 个月和 12 个月时的 TPOAb 平均浓度分别为 12.4、310.4 和 141.3 IU/ml，TgAb 平均浓度分别为 17.40、108.0 和 125.6 IU/ml。在这组患者中，治疗 6 个月后，11 人出现甲状腺功能减退症，6 人出现甲状腺功能亢进症。治疗 12 个月后，4 人出现甲状腺功能亢进症，4 人出现甲状腺功能减退症症状，其余人处于甲状腺功能正常状态。在超声检查中，在基线时，治疗前有 ATI 的患者中有 75%显示回声降低，治疗 6 个月后有 83.3%，治疗 12 个月后有 100%。在接受 IFN-α 治疗期间出现 ATI 的患者中，在初始检查中未发现异常，治疗 6 个月后有 69.2%的患者回声降低，治疗 12 个月后有 75%的患者回声降低。
在因丙型肝炎接受干扰素治疗的患者中，存在发生 ATI 或原有 ATI 恶化的风险。使用的 IFN-α 类型与 ATI 表现无显著差异。
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