论文部分内容阅读
目的探讨慢性丙型肝炎(chronic hepatitis C,CHC)患者干扰素治疗中合并甲状腺功能异常(thyroid dysfunction,TD)的相关影响因素,为临床抗病毒治疗中合并TD提供预测。方法采用临床前瞻-回顾性研究方法 ,对确诊为CHC的194例患者采用标准治疗方案进行抗病毒治疗,根据治疗中是否出现TD进行分组,回顾性分析其相关影响因素。结果女性合并TD的比例(33.00%,33/100)明显高于男性(20.21%,19/94),差异有统计学意义(P=0.031);甲状腺自身抗体(Tab)阳性者合并TD占64.29%(9/14),明显高于阴性患者的23.89%(43/180),差异有统计学意义(P=0.001);基线IL-4、MIP-1αTD组低于非TD组,而IL-2 TD组高于非TD组,差异均有统计学意义(P=0.037,0.007,0.040)。基线MIP-1α对TD预测的ROC曲线下面积0.767(P=0.001);24周TD组不同于非TD组的变化为IL-1β升高(P=0.045);非TD组不同于TD组的变化为IL-6降低(P<0.01),且这两种细胞因子的变化对TD预测的ROC曲线下面积分别为0.832(P<0.01)、0.828(P<0.01)。结论 CHC患者出现TD的相关危险因素有:女性、Tab阳性;基线IL-2升高,IL-4、MIP-1α降低可能与TD相关,且基线MIP-1α可能对TD有较好的预测价值;治疗24周IL-1β升高、IL-6无明显降低可能与TD相关。
Objective To investigate the related factors of thyroid dysfunction (TD) in interferon therapy in patients with chronic hepatitis C (CHC), and to provide a prediction for the combination of TD in clinical antiviral therapy. Methods A total of 194 patients diagnosed with CHC were treated with antiviral therapy in a prospective retrospective study. According to the presence or absence of TD in the treatment group, the related factors were analyzed retrospectively. Results The proportion of women with TD (33.00%, 33/100) was significantly higher than that of males (20.21%, 19/94) (P = 0.031). The percentage of thyroid autoantibodies with TD was 64.29 % (9/14), which was significantly higher than that of negative patients (23.89%, 43/180), the difference was statistically significant (P = 0.001); baseline IL-4 and MIP-1αTD group was lower than non-TD group, 2 TD group than non-TD group, the difference was statistically significant (P = 0.037,0.007,0.040). The area under the ROC curve of baseline MIP-1α predicted by TD was 0.767 (P = 0.001); the change of TD group at 24 weeks was different from that of non-TD group by the increase of IL-1β (P = 0.045) (P <0.01), and the area under the ROC curve of TD-predicted by these two cytokines were 0.832 (P <0.01) and 0.828 (P <0.01), respectively. Conclusions The risk factors for TD in CHC patients are female and Tab positive. Elevated baseline IL-2, IL-4 and MIP-1α may be related to TD, and baseline MIP-1α may have better predictive value for TD ; 24 weeks after treatment IL-1β increased, no significant reduction of IL-6 may be associated with TD.