Clinical observation of Hashimoto thyroiditis in patients with chronic hepatitis C undergoing pegylated-interferon alpha-2a and ribavirin combination therapy / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the relation of thyroid function with hashimoto thyroiditis (HT, an autoimmune disease of unknown etiology also known as chronic lymphocytic thyroiditis) in patients with chronic hepatitis C (CHC) receiving treatment with pegylated-interferon-alpha (Peg-IFNa) based on the observation that HT is common among individuals undergoing IFN-based therapy.</p><p><b>METHODS</b>One-hundred-and-seven patients with chronic hepatitis C were enrolled for study between January 2008 and December 2010. Thyroid function was assessed by electrochemiluminescence assays to detect serum levels of anti-thyroid peroxidase (A-TPO) antibodies, thyroid stimulating hormone (TSH), and free thyroxine (FT4) prior to initiation of the IFN-based therapy. The treatment strategies (drugs, doses, schedules) were designed according to HT status (CHC with HT, or CHC without HT). Patients were monitored during the 24 weeks of treatment (including measuring serum alanine aminotransferase (ALT), TSH, and FT4 every two to four weeks, and HCV RNA every four weeks) so that the IFNa dose could be adjusted and thyroid medications (levothyroxine sodium or methimazole) added as necessary. The response rate at end of treatment (week 24) was assessed.</p><p><b>RESULTS</b>Twenty-one of the CHC patients were diagnosed with HT, and the incidence of thyroid dysfunction among the CHC patients with HT was 71.4% (15/21); among the CHC patients with no HT, the incidence of thyroid dysfunction was significantly lower (30.2% (26/86), X2 = 12.1995, P less than 0.01). In the CHC patients with HT, 90.5% (19/21) had serum levels of A-TPO antibodies that were more than or equal to 2-times higher than the normal value at the end of treatment. Of the 15 CHC patients with HT and thyroid dysfunction, 73.3% (11/15) continued to show thyroid dysfunction at the end of treatment. Hypothyroidism was the most common form of thyroid dysfunction observed (4/11), and all of those patients responded to levothyroxine sodium treatment. The virological response rates of the two groups (CHC with HT and CHC without HT) were not significantly different at any time point examined (treatment week 4, 12, and 24, P more than 0.05).</p><p><b>CONCLUSION</b>The incidence of thyroid dysfunction is significantly higher among CHC patients with HT than among CHC patients without HT. If suspected, these patients should be carefully monitored because the clinical symptoms of thyroid dysfunction are not obvious and the drug therapy should be carefully adjusted to minimize the thyroid dysfunction while maximizing the antiviral effect.</p>

Role of diffusion weighted magnetic resonance imaging and spectroscopy in the diagnosis and follow-up of hepatolenticular degeneration / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the changes of different brain metabolites during hepatolenticular degeneration using diffusion weighted magnetic resonance imaging (DWI) and magnetic resonance spectroscopy (MRS) in patients with hepatolenticular degeneration and study the correlation of apparent diffusion coefficient(ADC) values and MRS with the different pathological changes.</p><p><b>METHODS</b>Totally 53 patients with hepatolenticular degeneration were enrolled in this study and divided into DWI high-signal group (n=31) and DWI low-signal group (n=22). Magnetic resonance scan, DWI, and spectroscopy were performed before treatment and 4 months after treatment. The changes of ADC value, N-acetyl aspartate (NAA)/creatine (Cr) ratio, and choline (Cho)/Cr ratio were recorded.</p><p><b>RESULTS</b>Before treatment, the NAA/Cr ratio was significantly higher in the DWI high-signal group than in DWI low-signal group (P=0.002), whereas ADC value and NAA/Cr ratio were significantly lower (P=0.004, P=0.014, respectively). After treatment, the NAA/Cr ratio was still significantly higher in the DWI high-signal group (P=0.036), while the differences of ADC value and Cho/Cr ratio showed no statistical deference (P>0.05). In the DWI high-signal group, the ADC value and NAA/Cr ratio were significantly elevated after treatment (P=0.006, P=0.008), whereas the Cho/Cr ratio showed no significant change (P>0.05). In the DWI low signal group, NAA/Cr ratio was significantly increased after treatment (P=0.015), while the ADC value and Cho/Cr ratio showed no significant change (P>0.05).</p><p><b>CONCLUSIONS</b>DWI combined MRS imaging can be used to evaluate the microscopic structure and metabolic changes during copper deposition and thus, compared with the conventional magnetic resonance imaging provide more information on metabolism. Therefore, they can be useful tools in the early diagnosis and efficacy evaluation of hepatolenticular degeneration.</p>