免疫重建治疗后甲状腺功能障碍

G. Melnichenko, A. Glibka, Olga Y. Demicheva
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摘要

药物对免疫系统的影响常常导致自身免疫性疾病等不良事件的发生。甲状腺是一个器官,其胚胎发育的特点是易受各种自身免疫作用的自发和诱导病变的影响。细胞分裂素诱导的甲状腺炎(在5070%的病例中发展为破坏性甲状腺炎),免疫检查点抑制剂后甲状腺功能障碍(使用CTLA-4 + PD-1/PD-L1联合治疗可导致甲状腺功能减退率增加高达20%)。一些研究人员认为,锂治疗后可能会出现甲状腺功能障碍。作者强调,自身免疫机制对甲状腺疾病的易感性也有双相情感障碍和丙型肝炎的干扰素- α治疗。对于许多这些临床情况,国家和国际协会采纳了临床建议,并向医生介绍了在危险人群中纠正治疗的最佳筛选算法。免疫康复疗法(IRT)被广泛应用于多种疾病的治疗中。这些药物对甲状腺的影响在多发性硬化症、HIV感染和骨髓移植中得到了最充分的描述。IRT制剂对甲状腺的非特异性作用的特殊性可导致短暂性疾病或在IRT完成后的后期长期表现出来。这使得对一系列疾病的有针对性的诊断变得复杂,这意味着它增加了并发症发生和发展的风险,恶化了患者的生活质量和预后。在本文中,我们根据2019年发布的IRT,为读者回顾了欧洲甲状腺功能障碍临床指南。这些建议不仅适用于内分泌学家,也适用于风湿病学家、传染病专家、移植学家、全科医生和许多其他专业。早些时候,《临床与实验甲状腺学杂志》(Journal of Clinical and Experimental Thyroidology)已经对免疫介导的内分泌疾病进行了描述,该疾病在使用免疫反应控制点抑制剂治疗癌症患者中发展起来。这些内分泌疾病有其独特的特点,是研究甲状腺不良事件的兴趣所在。它们反映在临床建议中,并为内分泌学家关于现代药物对甲状腺的影响开辟了新的方面。
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Thyroid dysfunction following immune reconstitution therapy
Medication effects on the immune system often lead to the development of adverse events such as autoimmune diseases. The thyroid gland is organ whose embryonic development features are predisposed spontaneous and induced lesions with various autoimmune effects. Cytokinin-induced thyroiditis (in 5070% of cases proceeds as a destructive thyroiditis), thyroid dysfunction following immune checkpoint inhibitors (using the combined treatment CTLA-4 + PD-1/PD-L1 leads to an increase hypothyroidism rates up to 20%). Some researchers presume that can develop thyroid dysfunction following treatment lithium. Authors emphasize that predisposition to autoimmune mechanisms thyroid diseases also has bipolar affective disorder and treatment with interferon-alfa in hepatitis C. For many of these clinical situations, national and international associations adopted clinical recommendations and physicians have been introduced to optimal screening algorithm of correcting treatment in risk groups. Immune rehabilitation therapy (IRT) is actively used in the treatment of many diseases. The effect of these drugs on the thyroid gland is most fully described for multiple sclerosis, HIV infection and bone marrow transplantation. The peculiarity of the non-specific effect of IRT preparations on the thyroid gland can lead to transient disorders or manifest in the late long-term period after completion of the IRT. This complicates the targeted diagnosis of a whole range of diseases, which means it increases the risk of development and progression of complications, worsens the patients quality of life and prognosis. In this article we reviewed for our readers European clinical guidelines for thyroid dysfunction, following IRT, published in 2019. The recommendations are relevant not only for Endocrinologists, but also for Rheumatologists, Infectious disease specialists, Transplantologists, GP and many other specialties. Earlier, in the Journal of Clinical and Experimental Thyroidology a description was already made for immuno-mediated endocrinopathies, developing in the treatment of cancer patients with inhibitors of immune response control points. These endocrinopathies have their own distinctive features and are of interest in the study of adverse events from the thyroid gland. They are reflected in clinical recommendations and open up new aspects for the Endocrinologists about the effect of modern drugs on the thyroid gland.
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