| Objective：The purpose of this study was to estimate the prevalence， features of thyroiddysfunction （TD） among patients with chronic hepatitis C virus （HCV） before, duringand after treatment with conventional interferon (IFN) in association with ribavirin(RBV),possible risk factors as well as the evolution of the thyroid function were also studied.Materials and methods:We achieve292eligible patients by screening from epidemiological investigation in thefirst hospital of JiLin university from2009to2010.the research object needs to conformthe following two conditions:(1) has been proved to have a virological and serologicalchronic HCV infection (2) the HCV with HBV or (and) HIV infection patients, pregnancy,after the treatment of patients with TD, alcohol abuse, application of radioactive drugs,others influenced the results were excluded. Our patients will be divided into two groupsaccording to that thyroid function at baseline is normal or not,in order to convenienceness onresearch, Patients with normal thyroid function at baseline are divided into5groupsaccording to the severity of changes in thyroid function during the follow-up: continuousnormal group, subclinical hypothyroidism group, hypothyroidism group, andhyperthyroidism group.The usage of IFN-α was5million IU at a time,three times every week, subcutaneousinjection.The dose of RBV was1000mg/day (body weight,≤75kg) or1200mg/day(body weight,>75kg). Duration of treatment was48weeks，including genotype2a,genotype1b, genotype1b/2a,and no genotype patients. All patients were evaluated clinicallyaccording to the need, demographic (sex,age,body mass index, gene polymorphism of IL28Brs12979860, rs6051702, rs1127354) and clinical biochemically characteristics [liverfunction,thyroid stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine(FT3)] virological characteristics Serum HCV-RNA levels，HCV genotype) Results:(1)Out of292patients who suffered from chronic hepatitis C included in thestudy,204(70%) of the men and88(30%) of the women.we verified euthyroid individualsprior to the use of IFN in243(83.2%)，and thyroid dysfunction in49(16.8%);6(2.1%) ofthem presented primary hypothyroidism,28(9.6%), subclinical hypothyroidism and otherdysfunctions (5.1%),and,after treatment, euthyroid individuals in144(62.1%), thyroiddysfunction in88(37.9%),21(9.1%) of them presented hypothyroidism, subclinicalhypothyroidism in38(16.4%), hyperthyroidism in6(2.6%).we found the differences ingenetic polymorphisms of interleuk in28Brs6051702(p=0.042), mean level of TSH（p=1.83x10-19）,AST (p=0.002),ALT (p=3.15x10-4)and NE%(p=0.036)before the initiationof treatment between euthyroidics and dysthyroidics with chronic HCV infection in ourstudy population.(2) During treatment, the new prevalence of developing TD graduallyreduced for243euthyroid individuals at baseline,secquently20.6%，16.7%，9.4%and7.2%.(3)During the whole following-up, we verified hypothyroidism developed once at leastin26(10.7%), Similarly,subclinical hypothyroidism in66(27.2%) and hyperthyroidism in18(7.4) and other dysfunctions in79(32.5%) for euthyroid individuals at baseline.(4) Foreuthyroid individuals at baseline,the total prevalence of developing TD gradually increasedas treatment,respectively,20.6%，26.1%，28.7%，31.4%.2.5For euthyroid patients at baseline.The change model of thyroid function was described categorically,9(3.7%)patientsdeveloped not only hyperthyroidism but also hypothyroidism or subclinical hypothyroidism.（5）In general,we verified sustained euthyroid individuals after treatment in112(46.1%)，and thyroid dysfunction in131(53.9%);19(7.8%) of them presented primaryhypothyroidism,forty-six, subclinical hypothyroidism (18.9%),9(3.7%) hyperthyroidismand57other dysfunctions(5.1%).（6） Nineteen patients who suffered from subclinicalhypothyroidism before treatment whereas remained subclinical hypothyroidism until end oftreatment.Among19patients,6(21.4%) were diagnosed with sustained hypothyroidism andonly one (3.6%) with subclinical hypothyroidism, which later converted to hypothyroidism.8（28.6%）patients recovered.（7）There were6cases of hypothyroidism at baseline, twocases(33.3%) did not spontaneously reverse after treatment were discontinued.2（33.3%） patients recovered.（8）Six cases(40.0%) whose thyroid function is mild change recoveredultimately.2(13.4%) cases convertedto subclinical hypothyroidism,and2(13.4%) casesconverted to hyperthyroidism.（9）We also found that sex distribution was different in the2groups (p=0.006) with more females in the hypothyroidism(57.9%)or subclinicalhypothyroidism group (37%), than sunstained euthyroid group (21.4%). Moreover, we foundthe difference in age distribution after the initiation of treatment (p=0.047) in4groups,mean age of hyperthyroidism group was lower than others.（10）we found differencein genotype, age distribution (p=0.195) before the initiation of treatment betweeneuthyroidics and dysthyroidics with chronic HCV infection.（11）we found mean level ofHGB was litter higher in sunstained euthyroid group (160g/L) than hypothyroidism (153g/L)or subclinical hypothyroidism group (153g/L),mean level of neutrophils count was litterhigher in sunstained euthyroid group (3.6x109/L) than hypothyroidism (2.9x109/L) orsubclinical hypothyroidism group(3.1x109/L)（.12）Mean level of GGT was much lower inhypothyroidism or hyperthyroidism group than sunstained euthyroid group or subclinicalhypothyroidism group (p=0.006)（.13）For243euthyroid individuals at baseline,we observedthe relationship of change form of thyroid function after treatment to curative effect,wefound that, the ratio of achieving RVR and EVR was higher in subclinical hypothyroidismgroup than sunstained euthyroid group.（14）At the same time, we also assessed curativeeffect of antiviral therapy among patients with TD at baseline,and made a comparison to243euthyroid individuals at baseline,then we found there was not any difference between twogroup.（15）Further, we compared the patients with euthyroid at baseline who developed TDafter treatment with ones with TD at baseline,then we found there were not statisticaldifferencesConclusion:1.Antiviral treatment with IFN-α and RBV increases the total prevalence of thyroiddysfunction,therefore,decreases the prevalence of newly developing it.2.Genotype2a virus was associated with a higher risk for developing hyper thyroidism.3. Women appear to be more vulnerable to hypothyroidism or subclinical hypothyroidism than men;The younger patients,the more easily develop hyper thyroidismduring antiviral treatment.4. HCV, itself, and the immune reaction induced by stimulating the body may directlyor indirectly have an affect on thyroid function, liver cell damage is more serious in patientsof hypothyroidism.That HCV play a role on thyroid dysfunction still need to further clarify.5.Genetic polymorphisms of interleukin28in the sites: rs12979860，rs6051702，rs1127354is not related to thyroid dysfunction after treatment,but these patients withrs6051702AA may be more vulnerable to subclinical hypothyroidism.6. The patients who develop subclinical hypothyroidism achieve easily RVR andEVT,compared with ones who always keep thyroid function normal during treatment.7.There was no need to interrupt or to change HCV treatment,unless clinical symptomsare obvious,or it will greatly reduce the effectiveness of antiviral therapy.Most of euthyroidindividuals at baseline may recover, however, most of patient with thyroid dysfunction atbaseline remain unrecovered after treatment (at the60th or72th week follow-up). |
PDF Full Text Request