【摘要】 目的观察国产聚乙二醇化重组集成干扰素变异体注射液(Peg IFN-SA)联合利巴韦林(RBV)治疗慢性丙型病毒性肝炎(CHC)患者时甲状腺功能异常(TD)或甲状腺自身抗体(TAs)产生情况及对疗效影响。方法前瞻性观察2013年9月至2015年12月于本中心接受国产Peg IFN-SA联合RBV治疗的CHC病例45例。试验组患者给予Peg IFN-SA皮下注射(1.5μg/kg、1次/周),对照组患者给予聚乙二醇化干扰素α-2a(Peg IFN-α-2a)皮下注射(派罗欣180μg、1次/周),两组患者均联合口服利巴韦林(1 000~1 200 mg/d),HCV基因2、3型患者治疗24周,非HCV基因2、3型患者治疗48周,停药后均随访6个月。在治疗前、治疗后每3个月及停药后6个月监测两组患者甲状腺功能及HCV RNA水平。结果试验组慢性丙型肝炎患者30例,其中男性14例,女性16例,平均年龄为(36.5±12.0)岁(19~56岁),HCV基因2、3型患者6例,HCV非基因2、3型患者24例。治疗结束停药半年后HCV持续应答率为83.3%(25/30),共13例患者出现TD或TAs,其发生率为43.3%(13/30);9例发生TD患者中4例(44.4%)丙型肝炎复发,高于未出现TD者(1/21,4.8%),差异具有统计学意义(P=0.02)。结论国产Peg IFN-SA联合RBV治疗慢性丙型病毒性肝炎患者甲状腺功能异常及抗体阳性较为常见,发生甲状腺功能异常者CHC更易复发。更多还原

【Abstract】 Objective To investigate the incidence and long-term outcomes of thyroid dysfunction(TD) in patients with chronic hepatitis C(CHC) who received pegylated recombinant interferon variant combined with ribavirin(Peg IFN-SA/RBV) treatment. Methods Total of 45 patients with CHC admitted in Wuhan University Zhongnan Hospital during September 2013 and December 2015 were collected. Patients in test group were treated with Peg IFN-SA subcutaneous injection once a week(1.5 μg/kg). Patients in control group were treated with Peg IFN α-2 a for subcutaneous injection once a week(180 μg). All patients were also treated with oral RBV(1 000-1 200 mg/d).The patients with HCV genotype 2/3 were treated for 24 weeks, the other patients with no-genotype 2/3 HCV were treated for 48 weeks, all patients were followed up for 24 weeks after treatment. Thyroid function and HCV RNA were measured at baseline, every 3 months during therapy and 6 months after treatment. Results Among the 30 patients who completed treatment with Peg IFNSA/RBV and 24 weeks follow-up, 14 cases were males and the median age was(36.5 ± 12.0) years old(19-56 years old), 6 cases were with HCV genotype 2/3, 83.3%(25/30) cases achieved sustained virological response(SVR); 13(43.3%, 13/30) patients developed TD/TAs during the Peg IFN-SA/RBV treatment. The relapse rate of HCV was higher in patients with TD than those without TD(44.4% vs. 4.8%, P = 0.02). Conclusions The development of TD/TAs was common in patients with CHC receiving Peg-IFN-SA/RBV treatment. TD is associated with an unfavorable virological response to Peg IFN-SA/RBV.更多还原