干扰素治疗慢性乙型肝炎患者发生甲状腺功能异常的相关因素分析.pdf

重庆医学201年5月第43卷第14期
1721
论著?临床研究
干扰素治疗慢性乙型肝炎患者发生甲状腺功能异常的相关因素分析
陈郁梅,黄明寿,赖绮云
(广州市番禺区中心医院感染科511400)
摘要:目的研究慢性乙型肝炎患者使用千扰素(INF)治疗后发生甲状腺功能异常的情况及其相关因素的分析。方法
回颀性分析213例应用INF治疗慢性乙型肝炎的患者,治疗48周,停药后随访48周,观察治疗前后甲状腺功能的异常慵汎及其
彩响因索,并经 Logistic回归分析发生甲状腺功能异常的危险因素。结果213例接受INF治疗的恵者中,有38例发生甲状腺
功能异常,包括甲状腺功能减退有9例,其中6例桥本甲状腺炎、3例非自身免疫性甲状腺功能减退,甲状腺功能亢进有6例,其
中3例 raves病,3例破坏性甲状腺炎;亚临床甲状腺功能亢进5例;亚临床甲状腺功能减退18例。治疗结束后随访48周,所有
患者的甲状腺功能均恢复正常。多元 Logistic回归分析显示,女性(OR=3.696)、同期两型肝炎病毒(HCV)感染(OR=3.675)
体内预存抗甲状腺自身抗体(OR=2.008)是慢性乙型肝炎患者使用INF治疗后诱发甲状腺疾病的独立危险因素。结论对慢性
乙型肝炎病毒患者使用INF治疗时,尤其是体内预存大量抗甲状腺过氧化物酶抗体,合并丙型肝炎病毒感染的女性,要监测甲状
腺功能相关指标,定期复查,预防甲状腺疾鵷的发生。
关键词:千扰肃类;肝突乙型,慢性;甲状腺疾病;危险因素
doi:10.3969/j.issn.1671-8348.2014.14.014
文献标识码:A
文章编号:1671-8348(2014)11-1721-03
An related factors analysis of thyroid disease induced by interferon in patients with chronic hepatitis B
Chen Yumei, Huang Mingshou, Lai Qiyun
Department of Infectious Disease, entral Hos pital of Panyu, District Guangzhou, Guangdong 511400, China
Abstract: Objective To investigate and anal ze the related factors about the occurrence of thyroid diseases induced by interfer
on in treating the chronic hepatitis B. Methods A retrospective analysis and following up of 213 interferon-treated patients with
chronic hepatitis B were performed. They were treated for 48 weeks and Logistic regression analysis was performed to evaluate the
risk factors of thyroid dysfuncion Patients were followed up for 48 weeks after drug withdrawal. Results In 213 patients received
interferon therapy, there were 38 cases suffered thyroid dysfunction, nine of which were hypothyroidism including six cases of
Hashimotos disease and 3 cases of nor-autoimmune thyroid dysfunction, six of which were hyperthyroidism including 3 cases of
Grave disease and 3 cases of destructive thyroiditis, five of which were subclinical hyperthyroidism and 18 of which were subclinical
hypothyroidism. Until 48 weeks of following-up after treatment, all patients with thyroid function was normal. Logistic regression a
nalysis showed that the risk factors of female(or-3. 696), hepatitis C virus infection over the same period(OR=3.675)and pre-
stored anti-thyroid peroxidase antibody(or-2.008) were correlated independently with the suffering of interferon induced thyri
diseases in the chronic hepatitis B patients. Conclusion For patients with chronic hepatitis B virus using interferon therapy, espe
ially the woman who pre-stored anti-thyroid peroxidase antibody in a large number and infected with hepatitis C virus. the clinical
therapy should monitor the related index of thyroid function regularly to prevent the happening of thyroid diseases.
Key words: interferons hepatitis B, chronic; thyroid disease; risk factors
干扰素( interferon,IFN)是治疗慢性乙型肝炎的一种常用型肝炎与甲状腺疾病的诊断符合2005年《慢性乙型肝炎防治
药,其具有抗病毒和免疫调节作用门,但治疗过程中会引起多指南》、《中国甲状腺疾病诊治指南》诊断标准?。排除标准:
种不良反应,12%的患者会由于较严重的并发症而停止INF(1)自身免疫性肝病、遗传性肝病者。(2)存在除了慢性肝炎和
治疗,38%的患者的用药需减量2。甲状腺疾病足应用INF甲状腺疾病外其他重大基础疾病者。
治疗时最易出现的内分泌系统疾病,可对虑者造成持续性损1.2方法
害?。本研究通过回顾分析木院38例慢性乙型肝炎忠者使用1.2.1INF使用方法患者使用的INF为聚乙二醇IFNa-2a
INF治疗后岀现甲状腺功能异常的情况,分析其危险因素,为(派罗欣,上海罗氏公司生产)180/135g,每周1次,皮下注
正确处理INF治疗慢性乙型肝炎患者过程中出现的不良反应射,或普通IFNa(运德素,北京三元基因公司生产)500万U,
提供指导,为临床医师治疗慢性乙型肝炎病毒提供用药建议,隔天1次,皮下注射,总疗程48周。记录患者的一般资料,包
以期减少INF诱发的甲状腺疾病的发生。
括性别、年龄、是否合并丙型肝炎病毒感染及病毒基因分型,所
资料与方法
用的INF