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HIV感染者的甲状腺功能障碍

Authors
Melissa Weinberg, MD
Morris Schambelan, MD
Section Editor
John G Bartlett, MD
Deputy Editor
Allyson Bloom, MD
Translators
赵乃倩, 副主任医师

引言

在获得性免疫缺陷综合征(acquired immune deficiency syndrome, AIDS)流行初期，人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染者的多种内分泌表现更常是机会性感染(opportunistic infection, OI)、肿瘤或并发的全身性疾病的后果。强效抗逆转录病毒治疗(antiretroviral therapy, ART)的广泛应用使得OI和肿瘤所致的腺体浸润的发病率降低，并且人们开始更多地关注HIV治疗所引起的代谢并发症，包括胰岛素抵抗、血脂异常和体脂分布改变。

本专题将介绍HIV/AIDS患者甲状腺疾病的评估和处理。与垂体和肾上腺疾病、胰岛素抵抗、骨和钙疾病以及性激素改变有关的问题将在别处讨论。 (参见“HIV相关脂肪营养不良的的流行病学、临床表现和诊断”和“Treatment of HIV-associated lipodystrophy”和“HIV感染者的骨和钙代谢紊乱”和“Pituitary and adrenal gland dysfunction in HIV-infected patients”)

一般原则

一般而言，HIV感染者甲状腺疾病的诊断和治疗与免疫功能正常个体的并无不同。然而，有一些特殊的考虑。首先，HIV感染可能会引起甲状腺功能的适应性改变，这种改变不需要治疗。此外，甲状腺功能障碍的许多症状和体征具有非特异性，可能与HIV感染者中常见的其他非内分泌疾病相重叠。最后，一些用于治疗HIV感染及其并发症的药物可能会诱发甲状腺功能障碍(表 1)。

甲状腺腺体感染和浸润

由多种微生物所致的感染及HIV相关的恶性肿瘤(即，Kaposi肉瘤和淋巴瘤)已在甲状腺中被检出(表 2)。此类情况曾在广泛引进强效ART之前更加常见，但在未接受ART或存在抗逆转录病毒药物耐药性感染的患者中仍可能会观察到此类情况。

确定诊断一般需要组织学检查。甲状腺细针抽吸活检(fine needle aspiration, FNA)安全、有效且广泛可用。由于有临床意义的甲状腺功能障碍可能伴随腺体感染或浸润，所以也应进行标准的甲状腺功能检测。

     

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Literature review current through: 2017-06 . | This topic last updated: 2015-06-23.
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References
Top
  1. Hommes MJ, Romijn JA, Godfried MH, et al. Increased resting energy expenditure in human immunodeficiency virus-infected men. Metabolism 1990; 39:1186.
  2. Lambert M. Thyroid dysfunction in HIV infection. Baillieres Clin Endocrinol Metab 1994; 8:825.
  3. Madeddu G, Spanu A, Chessa F, et al. Thyroid function in human immunodeficiency virus patients treated with highly active antiretroviral therapy (HAART): a longitudinal study. Clin Endocrinol (Oxf) 2006; 64:375.
  4. Sellmeyer DE, Grunfeld C. Endocrine and metabolic disturbances in human immunodeficiency virus infection and the acquired immune deficiency syndrome. Endocr Rev 1996; 17:518.
  5. Wartofsky L, Burman KD. Alterations in thyroid function in patients with systemic illness: the "euthyroid sick syndrome". Endocr Rev 1982; 3:164.
  6. LoPresti JS, Fried JC, Spencer CA, Nicoloff JT. Unique alterations of thyroid hormone indices in the acquired immunodeficiency syndrome (AIDS). Ann Intern Med 1989; 110:970.
  7. Grunfeld C, Pang M, Doerrler W, et al. Indices of thyroid function and weight loss in human immunodeficiency virus infection and the acquired immunodeficiency syndrome. Metabolism 1993; 42:1270.
  8. Beltran S, Lescure FX, Desailloud R, et al. Increased prevalence of hypothyroidism among human immunodeficiency virus-infected patients: a need for screening. Clin Infect Dis 2003; 37:579.
  9. Nelson M, Powles T, Zeitlin A, et al. Thyroid dysfunction and relationship to antiretroviral therapy in HIV-positive individuals in the HAART era. J Acquir Immune Defic Syndr 2009; 50:113.
  10. Carella C, Mazziotti G, Amato G, et al. Clinical review 169: Interferon-alpha-related thyroid disease: pathophysiological, epidemiological, and clinical aspects. J Clin Endocrinol Metab 2004; 89:3656.
  11. Jubault V, Penfornis A, Schillo F, et al. Sequential occurrence of thyroid autoantibodies and Graves' disease after immune restoration in severely immunocompromised human immunodeficiency virus-1-infected patients. J Clin Endocrinol Metab 2000; 85:4254.
  12. Gilquin J, Viard JP, Jubault V, et al. Delayed occurrence of Graves' disease after immune restoration with HAART. Highly active antiretroviral therapy. Lancet 1998; 352:1907.
  13. Crum NF, Ganesan A, Johns ST, Wallace MR. Graves disease: an increasingly recognized immune reconstitution syndrome. AIDS 2006; 20:466.
  14. Rasul S, Delapenha R, Farhat F, et al. Graves' Disease as a Manifestation of Immune Reconstitution in HIV-Infected Individuals after Initiation of Highly Active Antiretroviral Therapy. AIDS Res Treat 2011; 2011:743597.