131I去除分化型甲状腺癌术后残留甲状腺组织疗效的meta分析

目的：用meta分析方法评价不同剂量131I去除分化型甲状腺癌（DTC）术后残留甲状腺组织（简称清甲）的疗效。方法检索Cochrane图书馆、MEDLINE、OVID、Embase、EBSCO、SpringerLink 等数据库，初筛1980年1月至2013年8月有关高剂量（3700 MBq）与低剂量（1110 MBq）131I清甲治疗疗效的随机对照试验（RCT）文献。采用改良的Jadad量表对入选文献进行质量评价，用RveMan 5．1软件进行统计学分析。结果按照纳入及排除标准，共入选12篇RCT文献，共2290例患者。其中，高剂量组1069例、低剂量组1221例。按各文献报道的DTC患者术后131I清甲治疗成功标准，高剂量组与低剂量组首次清甲成功率之间的差异无统计学意义（Z=1．80，P＞0．05）；低、高剂量组分别采用重组人促甲状腺激素法（311例vs．288例）与激素撤退法（314例vs．284例）两种131I治疗准备方法时，两种方法首次清甲成功率之间的差异也无统计学意义（Z=0．98和0．33，P＞0．05）。采用SF-36量表法分析DTC患者术后首次清甲治疗期间患者生活质量，两剂量组间差异也无统计学意义（Z=0．37，P＞0．05），但高剂量组不良反应发生率明显高于低剂量组（Z=5．15，P＜0．01），且所需隔离时间短。结论131I高剂量组与低剂量组以及两种不同准备方法的清甲治疗疗效基本一致，两剂量组治疗期间患者生存质量也无明显差别，但低剂量组较高剂量组的严重不良反应的发生率小。研究提示，对低风险DTC患者使用低剂量131I治疗可获得与高剂量131I治疗一致的清甲效果，同时可减少不良反应的发生。

A meta-analysis of efficacy of iodine-131 for post-thyroidectomy ablation of remnants in patients with differentiated thyroid carcinoma

Objective To assess the effects of two different doses of 131I（3700 MBq vs. 1110 MBq） for ablation of thyroid remnant in patients with differentiated thyroid carcinoma （ DTC ） by using meta analysis. Methods Collected the eligible trials by searching the Cochrane Library, MEDLINE, OVID, EMBASE, EBSCO and SpringerLink from January 1980 to August 2013. All relevant studies were screened according to inclusion and exclusion criteria. A modified Jadad scale was used for quality evaluation of se-lected literatures. RveMan 5.1 software was used for statistical analysis. Results Twelve randomized con-trolled trails involving 2290 patients were included in accordance with the inclusion and exclusion criteria. According to the criteria of successful thyroid remnant ablation reported in each literature, no statistical difference was noted in the rate of successful remnant ablation between low-and high-dose 131I group （Z=1.80, P〉0.05）. Both the low- or high-dose of 131I ablation showed no significant difference in the rate of successful remnant ablation between the two methods （recombinant human thyrotropin vs. steroid with-drawal） of preparing therapy（Z=0.98 and 0.33, P〉0.05）. Also, no significant differences existed in qual-ity-of-life scores on the SF-36 between different 131I-dose groups （Z=0.37, P〉0.05）. The low-dose group showed lower incidence of adverse events（Z=5.15, P〈0.01） and shorter hospital isolation time than that in high-dose 131I group. Conclusions Two different doses of 131I treatment and two different preparation methods have similar efficacy in ablation of residual thyroid tissue in patients with low risk DTC, but the＆amp;nbsp;incidence of adverse effects in low-dose 131I group is less.