Department of Radiology, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
Department of Medical Research, Tainan Municipal Hospital (managed by Show Chwan Medical Care Corporation), Tainan, Taiwan.
BMC Endocr Disord. 2019 Apr 5;19(1):36. doi: 10.1186/s12902-019-0362-7.
This study aimed to investigate the occurrence and risk factors of thyroid dysfunction (TD) in patients with chronic hepatitis C (CHC) infection in Taiwan.
The data in this study were obtained from the Taiwan National Health Insurance Research (Taiwan NHIR) database between 2001 and 2013. CHC patients treated with pegylated interferon/ribavirin (PEG-IFN/RBV) were enrolled as case patients, and nontreated CHC patients were enrolled as controls and were matched at a control:case ratio of 3:1 by index date, age (± 3 years), and sex. We compared the cumulative incidence of TD between the cohorts at follow-up until 2013.
During the study period, 3810 cases and 9393 controls were included in the study. Among the study subjects, 173 (4.5%) case patients and 244 (2.6%) controls were diagnosed with TD during the follow-up period. The types of TD were hypothyroidism (42.9%), hyperthyroidism (31.2%), and thyroiditis (25.9%). Compared to controls during the 13-year follow-up, patients treated with PEG-IFN/RBV had a higher incidence rate of TD (P < 0.0001), as determined using the Kaplan-Meier method. Cox proportional hazards regression analysis showed that female sex (adjusted hazard ratio (HR): 1.49; 95% confidence interval (CI): 1.23-1.75; P < 0.001), treatment with PEG-IFN/RBV (HR: 1.68; 95% CI: 1.38-2.06; P < 0.001), hyperlipidemia (HR: 1.38; 95% CI: 1.12-1.71; P < 0.001), and past history of goiter (HR: 6.40; 95% CI: 5.00-8.18; P < 0.001) were independent predictors for the development of TD.
PEG-IFN/RBV treatment may be an independent risk factor for thyroid dysfunction among patients with hepatitis C virus (HCV) infection. Monitoring thyroid function keenly during PEG-IFN/RBV therapy in patients with chronic HCV infection is recommended for clinicians, especially for female patients and for patients with a history of hyperlipidemia and goiter.
本研究旨在探讨台湾地区慢性丙型肝炎（CHC）感染患者甲状腺功能障碍（TD）的发生和危险因素。
本研究数据来源于 2001 年至 2013 年期间的台湾全民健康保险研究（Taiwan NHIR）数据库。接受聚乙二醇干扰素/利巴韦林（PEG-IFN/RBV）治疗的 CHC 患者被纳入病例组，未接受治疗的 CHC 患者被纳入对照组，并按指数日期、年龄（±3 岁）和性别进行 3:1 匹配。我们比较了两组在随访至 2013 年期间 TD 的累积发生率。
在研究期间，纳入了 3810 例病例和 9393 例对照组。在研究对象中，173 例（4.5%）病例组和 244 例（2.6%）对照组在随访期间被诊断为 TD。TD 的类型为甲状腺功能减退症（42.9%）、甲状腺功能亢进症（31.2%）和甲状腺炎（25.9%）。与 13 年随访期间的对照组相比，接受 PEG-IFN/RBV 治疗的患者 TD 发生率更高（P<0.0001），采用 Kaplan-Meier 法确定。Cox 比例风险回归分析显示，女性（校正风险比（HR）：1.49；95%置信区间（CI）：1.23-1.75；P<0.001）、PEG-IFN/RBV 治疗（HR：1.68；95%CI：1.38-2.06；P<0.001）、高脂血症（HR：1.38；95%CI：1.12-1.71；P<0.001）和既往甲状腺肿史（HR：6.40；95%CI：5.00-8.18；P<0.001）是 TD 发生的独立预测因素。
PEG-IFN/RBV 治疗可能是丙型肝炎病毒（HCV）感染患者甲状腺功能障碍的独立危险因素。建议临床医生在慢性 HCV 感染患者接受 PEG-IFN/RBV 治疗期间密切监测甲状腺功能，特别是女性患者以及有高脂血症和甲状腺肿病史的患者。
