Graves甲亢多种治疗方法对Graves眼病影响的系统评价

目的 通过榆索、分析文献系统评价131I、手术、抗甲状腺药物(ATD)治疗Graves病(GD)对Graves眼病(GO)的影响.方法 检索了MEDIJNE(1966年-2006年3月)、EMBASE(1984-2005年)、The Cochrane Library(2006年第1期)、中国生物医学文献光盘数据库(EBMdisc,1978年1月-2006年4月)和中国学术期刊全文数据库(CNKI,1994-2006年)所收录的有关不同GD治疗方法对GO影响的文献,同时从参考文献中追溯文献.对纳入研究的方法学质量进行评价,根据是否采取预防甲状腺功能低下(简称甲低)发生的措施对纳入研究进行亚组分析,结果采用RevMan4.2软件进行统计学分析.结果 最终纳入随机对照研究5项,非随机对照研究2项,病例对照研究1项,共1625例患者.Meta分析显示:如GD治疗后早期未采取措施预防甲低,131I与手术治疗、131I与ATD治疗GD在诱发或加重GO以及减轻GO症状方面莘异有统计学意义检验值分别为2.31,5.97,3.70,5.55;P均＜0.05];如GD治疗后早期采取措施预防甲低,手术与ATD治疗GD在诱发或加重GO以及减轻GO症状方面差异无统计学意义(检验值分别为0.27,0.99;P均＞0.05),尚无研究涉及131I治疗GD后早期采取甲低预防措施时131I对GO的影响.结论 若未及时采取甲低预防措施,131I较ATD、手术治疗GD更容易诱发或加重GO,减轻GO的症状却不如后两者,对于治疗前已有活动性GO的患者,应慎用131I.

Relationship between the management of Graves' disease and the course of Graves' ophthaimopathy:a systematic review

Objective To perform literature search and review on the controversial relationship between therapies of hyperthyroidism due to Graves'disease(GD)and the course of Graves'ophthalmopathy(CA)).Methods We searched the database of MEDLINE(1966-2006.3),EMBASE(1984-2005),Cochrane Library(2006 No.1),CBMdisc(1978.1-2006.4)and CNKI(1994-2006).The methodological quality of the studies selected for review was assessed according to the quality assessment criteria suggested by the Cochrane systematic review guideline.Meta-analysis was performed by RevMan 4.2 software.Results Eight studies were included in the systematic review.Meta-analysis showed that there was statistically significant difference between 131I and other forms of therapysurgery or antithyroid drugs(ATD)](test value:2.31,5.97,3.70,5.55;all P＜0.05)in aggravation of exophthalmos and symptom improvement in patients without receiving thyroxine during the early stage to prevent hypothyroidism.However,there was no statisti cally significant differenee in the above relationship between surgery and ATD therapy in those patients already receiving thyroxine supplement(test value:0.27,0.99;all P＞0.05).There were not yet any studies on the impact between early prevention of hypothyroidism after 131I therapy and GO.Conclusions Based on meta-analysis on literature data,if early measures are not performed to prevent hypothyroidism after 131I therapy,it may induce or aggravate GO more frequently than ATD or surgical treatment.Symptomatic relief of GO after 131I therapy is also less effective than the other 2 forms of therapy.Therefore.131I therapy should be delivered carefully in those patients with GO.