| TSH抑制治疗分化型甲状腺癌对骨密度影响的Meta分析 |
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| 引用本文： | 周菱,杨玲,蔡亮,张蜀茂,陈跃. TSH抑制治疗分化型甲状腺癌对骨密度影响的Meta分析[J]. 国际放射医学核医学杂志, 2019, 43(1): 53-60. DOI: 10.3760/cma.j.issn.1673-4114.2019.01.010 |
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| 作者姓名： | 周菱 杨玲 蔡亮 张蜀茂 陈跃 |
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| 作者单位： | 西南医科大学附属医院核医学科，泸州 646000 |
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| 摘 要： | 目的通过Meta分析的方法评价促甲状腺激素（TSH）抑制治疗分化型甲状腺癌（DTC）对骨密度的影响。方法检索PubMed、Medline、万方数据库、中文科技期刊数据库（VIP）、中国学术期刊全文数据库、中国生物医学文献数据库，收集2017年10月前所有TSH抑制治疗DTC的横断面研究、队列研究、前瞻性对照研究、病例对照研究，分析TSH抑制治疗对腰椎骨密度、股骨颈骨密度、股骨大转子骨密度、Ward三角区骨密度的影响。由2位研究者独立提取资料后，采用RevMan 5.3软件进行系统评价。计数资料以比值比（OR）表示，计量资料以加权均数差或标准化均数差（SMD）表示。根据研究的异质性，利用固定效应模型和随机效应模型进行综合分析。结果共纳入14项研究，合计588例DTC患者。Meta分析结果显示，TSH抑制治疗组与对照组相比，腰椎骨密度[SMD=−0.00，95%CI（−0.26, 0.26），P=0.98]、股骨颈骨密度[SMD=−0.00，95%CI（−0.15, 0.14），P=0.96]的差异均无统计学意义，股骨大转子骨密度[SMD=−0.30，95%CI（−0.53, −0.06），P=0.01]、Ward三角区骨密度[SMD=−0.35，95%CI（−0.63, −0.08），P=0.01]的差异均有统计学意义。结论TSH抑制治疗主要降低DTC患者股骨近端骨密度，在长期随访中应注意定期检测骨密度。
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| 关 键 词： | 促甲状腺素 甲状腺肿瘤 骨密度 Meta分析 抑制治疗 |
| 收稿时间： | 2018-06-04 |
Impact of TSH-suppressive therapy on bone mineral density in patients with differentiated thyroid carcinoma: a Meta-analysis |
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| Ling Zhou,Ling Yang,Liang Cai,Shumao Zhang,Yue Chen. Impact of TSH-suppressive therapy on bone mineral density in patients with differentiated thyroid carcinoma: a Meta-analysis[J]. International Journal of Radiation Medicine and Nuclear Medicine, 2019, 43(1): 53-60. DOI: 10.3760/cma.j.issn.1673-4114.2019.01.010 |
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| Authors: | Ling Zhou Ling Yang Liang Cai Shumao Zhang Yue Chen |
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| Affiliation: | Department of Nuclear Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China |
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| Abstract: | ObjectiveTo evaluate the effect of TSH-suppressive therapy on bone mineral density(BMD) in patients with differentiated thyroid carcinoma(DTC).MethodsThe cross-sectional, cohort, prospective controlled, and case-control studies on the BMD change in patients with DTC after TSH-suppressive therapy from databases were searched, including PubMed, Medline, Wanfang Database, VIP, China National Knowledge Infrastructure, and CBM. The effect of TSH-suppressive therapy on the BMD of lumbar, femoral neck, femoral greater trochanter, and Ward triangle were analyzed. Data from the date of database establishment to October 2017 were all reviewed. Meta-analysis was performed with RevMan 5.3 software after two reviewers independently screened the date. The categorical variables were expressed as odds ratios, and numerical variables were expressed as weighted mean or standardized mean differences. Based on the heterogeneity of the study, a comprehensive analysis was performed by using fixed or random effect models.ResultsA total of 14 studies involving 588 patients with differentiated thyroid cancer were included. No significant difference in the BMD of lumbar indications between the experimental and control groups was observed: SMD=−0.00, 95%CI [−0.26, 0.26],P=0.98. The BMD of femoral neck indications: SMD=−0.00, 95%CI [−0.15, 0.14],P=0.96. A significant difference between the experimental and control groups in the BMD of femoral trochanter indications was observed: SMD=−0.30, 95%CI [−0.53, −0.06],P=0.01. The BMD of Ward's triangle indications: SMD=−0.35, 95%CI [−0.63, −0.08],P=0.01.ConclusionsTSH-suppressive therapy in patients with DTC mainly reduces proximal femur BMD, and BMD must be followed-up regularly. |
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| Keywords: | Thyrotropin Thyroid neoplasms Bone density Meta-analysis Suppressive therapy |
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