Kozielewicz Dorota, Wietlicka-Piszcz Magdalena, Halota Waldemar
Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
Department of Theoretical Foundations of Biomedical Sciences and Medical Computer Science, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
Przegl Epidemiol. 2017;71(4):555-569.
Thyroid dysfunctions (TDs) are associated with pegylated interferon and ribavirin (PegIFN-α/RBV) therapy in patients with chronic hepatitis C (CHC) and are considered as possible extrahepatic manifestation of HCV infection
This study aimed to assess the long-term outcomes of TDs in patients with CHC treated with PegIFN-α/RBV
A total of 1,047 treatment-naïve patients with CHC were treated with PegIFN-α/RBV. TSH and FT4 were assessed at baseline, every 3 months during therapy and 6, 12 and 24 months after the end of therapy. Analysis was performed for two groups of patients depending on the absence (group A, n=77) or presence (group B, n=39) of TDs at baseline
At baseline, TDs’ prevalence was 3.7%; 53.8% hypothyroidism, 38.5% goiters, and 7.7% hyperthyroidism. 77 (7.4%) out of 1,008 euthyroid patients developed TDs; 45.5% hypothyroidism, 33.8% hyperthyroidism, 19.5% destructive thyroiditis, and 1.3% goiters. TDs’ remission (TDR) was achieved in 59/116 (50.9%) of treated patients; 64.9% in group A and 23.1% in group B (p<0.001). Hyperthyroidism as compared to hypothyroidism increases the odds of TDR (OR=4.87 (1.65-14.35), p=0.004), whereas preexisting TDs and higher baseline viral load tend to decrease the probability of TDR (OR=0.21 (0.07-0.58), p=0.003 and OR=0.4 (0.22-0.73), p=0.003, respectively)
The prevalence of TDs was low but over one-third of patients in whom TDs developed under PegIFN-α/RBV therapy did not recover. In one-fourth of patients with preexisting TDs remissions were observed. Treatment with PegIFN-α in the past must be taken into account as a potential cause of TDs
甲状腺功能障碍（TDs）与慢性丙型肝炎（CHC）患者接受聚乙二醇干扰素和利巴韦林（PegIFN-α/RBV）治疗相关，被认为是HCV感染可能的肝外表现。
本研究旨在评估接受PegIFN-α/RBV治疗的CHC患者中TDs的长期结局。
共有1047例初治CHC患者接受PegIFN-α/RBV治疗。在基线、治疗期间每3个月以及治疗结束后6、12和24个月评估促甲状腺激素（TSH）和游离甲状腺素（FT4）。根据基线时是否存在TDs将患者分为两组进行分析（A组，n = 77；B组，n = 39）。
基线时，TDs的患病率为3.7%；其中甲状腺功能减退占53.8%，甲状腺肿占38.5%，甲状腺功能亢进占7.7%。1008例甲状腺功能正常的患者中有77例（7.4%）发生了TDs；其中甲状腺功能减退占45.5%，甲状腺功能亢进占33.8%，破坏性甲状腺炎占19.5%，甲状腺肿占1.3%。116例接受治疗的患者中有59例（50.9%）实现了TDs缓解（TDR）；A组为64.9%，B组为23.1%（p<0.001）。与甲状腺功能减退相比，甲状腺功能亢进增加了TDR的几率（OR = 4.87（1.65 - 14.35），p = 0.004），而既往存在TDs和较高的基线病毒载量往往会降低TDR的概率（分别为OR = 0.21（0.07 - 0.58），p = 0.003和OR = 0.4（0.22 - 0.73），p = 0.003）。
TDs的患病率较低，但在接受PegIFN-α/RBV治疗过程中发生TDs的患者中有超过三分之一未恢复。在四分之一既往存在TDs的患者中观察到了缓解情况。过去接受PegIFN-α治疗必须被视为TDs的一个潜在原因。
