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目的研究慢性丙型肝炎患者(CHC)治疗过程中出现甲状腺自身抗体(TA)特点及TA与甲状腺功能预后间关系。方法收集2010年7月~2016年9月解放军第三〇二医院以干扰素α(INF-α)为基础抗病毒治疗的CHC患者115例,随访中根据临床表现及实验室检查结果 ,分成桥本甲状腺炎(HT)组(HT组)、弥漫性甲状腺肿(GD)组(GD组)以及未进展成自身免疫性甲状腺疾病(AITD)组,另选择乙型病毒性肝炎(HBV)感染伴发AITD患者8例为HBV伴发AITD组,无肝炎病毒感染的单纯AITD患者47例为单纯AITD组。比较各组及甲状腺功能不同转归(缓解组、恶化组)CHC患者TA[包括抗甲状腺球蛋白抗体(TG-Ab)、抗过氧化物酶抗体(TPO-Ab)、促甲状腺激素受体抗体(TRAb)]滴度差异情况。结果 (1)115例CHC患者随访过程中24例(20.9%)发生AITD,5例(4.3%)为GD,19例(16.5%)为HT,GD组、HT组、及未进展成AITD组患者TA水平间差异有高度统计学意义(P<0.01)。(2)HBV伴发AITD组及单纯AITD组TA水平与GD组比较,差异有高度统计学意义(P<0.01),与HT组比较差异无统计学意义(P>0.05)。(3)缓解组(15例)患者TPO-Ab、TRAb均值显著低于恶化组(9例)(P<0.05),缓解组TG-Ab均值略低于恶化组(P>0.05)。结论应用INF-α治疗的CHC患者易诱发AITD,并且TA在不同种类AITD患者中存在各自特点,TPO-Ab、TRAb较TG-Ab可能在患者临床调整治疗方案调整和甲状腺功能预后判断方面更加敏感。
Objective To investigate the characteristics of thyroid autoantibodies (TA) and the relationship between TA and thyroid function prognosis in patients with chronic hepatitis C (CHC). Methods From July 2010 to September 2016, 115 cases of CHC patients treated with IFN-α based antiviral therapy at the 302 Hospital of People’s Liberation Army were divided into two groups based on the clinical manifestations and laboratory findings: In the HT group (HT group), the GD group (GD group) and the group that did not progress to the autoimmune thyroid disease (AITD group), another group of patients with hepatitis B virus infection Eight patients with AITD developed HBV-associated AITD and 47 patients without AITD had AITD. To compare TA (including anti-thyroglobulin antibody (TG-Ab), anti-peroxidase antibody (TPO-Ab), thyroid stimulating hormone receptor antibody (TRAb)] titers. Results (1) AITD was found in 24 (20.9%) of 115 patients with CHC, 5 (4.3%) were GD, and 19 (16.5%) were HT, GD, HT and did not progress to AITD There was a statistically significant difference in TA level among patients (P <0.01). (2) There was a significant difference in TA level between HBV-associated AITD group and AITD-only group and GD group (P <0.01). There was no significant difference between HT group and TA group (P> 0.05). (3) The mean values of TPO-Ab and TRAb in remission group (15 cases) were significantly lower than those in exacerbation group (9 cases) (P <0.05), and the mean TG-Ab in remission group was slightly lower than that in exacerbation group (P> 0.05). Conclusions AITD is easily induced in patients with CHC treated with INF-α, and TA has its own characteristics in different types of AITD patients. TPO-Ab and TRAb may be more sensitive than TG-Ab in the adjustment of treatment regimen and prognosis of thyroid function .