131I联合糖皮质激素治疗Graves眼病疗效的Meta分析

目的 对131I+糖皮质激素（GC）治疗Graves眼病（GO）进展的有效性和安全性进行系统评价。 方法 检索PubMed、Embase、Cochrane Library和中国知网、万方数据知识服务平台中关于131I+GC治疗GO的相关研究，检索时间从建库至2021年7月20日。根据纳入和排除标准筛选文献、提取数据。应用Stata 15.0软件进行Meta分析，比较131I+GC治疗与单纯131I治疗对不同时期 Graves 甲状腺功能亢进症（GH）合并GO患者的疗效，并分析静脉注射与口服GC 2种用药方式对GO治疗及其并发症发生情况的影响。采用χ2检验的P值和 I2对文献进行异质性评价，GO病情进展情况用相对危险度（RR）表示，采用Egger法和剪补法对纳入文献的发表偏倚和敏感性进行分析，采用Z检验分析2种用药方式的治疗效能。 结果 最终纳入22篇文献，其中15篇文献为随机对照试验类，7篇文献为队列研究类。131I+GC治疗较131I治疗对GH合并GO患者的疗效更佳，差异有统计学意义（Z=3.18，RR=0.37，95%CI:0.20~0.68，P=0.004）；标准剂量GC（0.3~0.5 mg/kg）较低剂量GC（0.2~0.3 mg/kg）能更好地预防GO的进展。不同的用药方式对预防GO进展的影响不大。 结论 131I+GC治疗对预防GH合并GO患者的病情进展是有效的，特别是活动期的GO患者；标准剂量GC较低剂量GC能更好地控制GO的进展，但同时产生更多的并发症；静脉注射与口服GC 2种用药方式对131I治疗后的GO患者疗效相当。

Efficacy of 131I combined with glucocorticoid in the treatment of Graves' ophthalmopathy: a Meta-analysis

Objective To systematically evaluate the efficacy and safety of 131I+glucocorticoid (GC) in the treatment of Graves' ophthalmopathy (GO). Methods PubMed, Embase, Cochrane Library, China National Knowledge Internet, and Wanfang data Knowledge Service Platform were searched for relevant studies on the use of 131I+GC treatment GO. The search time was from database establishment to July 20, 2021. They selected the literature and extracted the data according to the inclusion and exclusion criteria. Meta-analysis was performed with Stata 15.0 software to compare the efficacy of 131I+GC and 131I for treating Graves' hyperthyroidism (GH) complicated with GO in different periods, as well as to analyze the effects of intravenous injection and oral GC administration on the treatment of GO and its complications. The heterogeneity of an article was evaluated using P values of χ2 test and I2. The progression of GO was expressed by relative risk (RR). The publication bias and sensitivity of the included literature were analyzed by the Egger and clipping methods, and the therapeutic efficacy of the two methods was analyzed by the Z test. Results Finally, a total of 22 articles were included, among which 15 were randomized controlled trials and 7 were cohort studies. The curative effect of 131I+GC was better than that of 131I in patients with GH complicated with GO, and the difference was statistically significant (Z=3.18, RR=0.37, 95%CI: 0.20–0.68, P=0.004). A standard dose of GC (0.3–0.5 mg/kg) can better prevent the progression of GO than a low-dose one (0.2–0.3 mg/kg). Different ways of drug use had little effect on the progress of GO prevention. Conclusions 131I+GC treatment was effective in preventing the progression of GH complicated with GO, especially in active GO patients. A standard dose of GC can better control the progression of GO than a low-dose one, but at the same time produces more complications. Intravenous injection and oral administration of GC had the same effect on patients with GO after 131I treatment.