Saglietti G, Ferrari V, Luraschi A, Ripamonti G, Gioria A, Fedeli P, Bersi M
Divisione di Medicina Generale, USL 14, Ospedale, Omegna.
Recenti Prog Med. 1996 Jul-Aug;87(7-8):342-5.
In recent years recombinant alpha interferon (IFN) has been widely used in the treatment of neoplastic and infectious diseases. Induced autoimmune disorders and thyroid impairment are getting increasing relevance in the field of side-effects complicating long-term alpha-interferon courses. We monitored thyroid function in 35 patients receiving alpha-IFN therapy for different diseases (chronic hepatitis, essential thrombocytemia, multiple myeloma, chronic myeloid leukemia, essential polycytemia, essential crioglobulinemia and hairy-cell leukemia). All of them were euthyroid and negative for anti-thyroid serum antibodies before treatment. Six months later, 6 patients (17%) developed primary hypothyroidism with elevated antithyroid antibodies in 5 cases; 1 continuing to be negative. None of our patients developed hyperthyroidism. Overall, "indirect-autoimmune" and "direct non autoimmune" mechanisms are considered possible and/or combined pathogenetic moments of thyroid disfunction during alpha-IFN therapy. Thyroid complications mainly occur when latent impairment of immune system exists. Thyroid circulating hormones levels and autoimmunity screening should be performed in all patients before starting and during long-term alpha-IFN treatment.
近年来，重组α干扰素（IFN）已广泛应用于肿瘤和感染性疾病的治疗。在长期使用α干扰素治疗的并发症领域，诱发的自身免疫性疾病和甲状腺损害正变得越来越重要。我们监测了35例因不同疾病（慢性肝炎、原发性血小板增多症、多发性骨髓瘤、慢性髓性白血病、原发性红细胞增多症、原发性冷球蛋白血症和毛细胞白血病）接受α干扰素治疗的患者的甲状腺功能。所有患者在治疗前甲状腺功能正常且抗甲状腺血清抗体阴性。6个月后，6例患者（17%）发生原发性甲状腺功能减退，其中5例抗甲状腺抗体升高，1例仍为阴性。我们的患者均未发生甲状腺功能亢进。总体而言，“间接自身免疫”和“直接非自身免疫”机制被认为是α干扰素治疗期间甲状腺功能障碍可能的和/或联合的发病机制。甲状腺并发症主要发生在存在免疫系统潜在损害时。所有患者在开始长期α干扰素治疗前和治疗期间都应进行甲状腺循环激素水平和自身免疫筛查。
