硒治疗自身免疫性甲状腺炎的系统评价

目的系统评价补硒治疗自身免疫性甲状腺炎（AITD）的效果和安全性。方法采用Cochrane系统评价法,检索Cochrane图书馆、Medline、EMbase及中国生物医学文献数据库、中国知网、维普中文科技期刊数据库、万方数据库等中文科技期刊数据库,纳入硒治疗AITD的随机对照试验（RCT）。应用RevMan5.0软件对数据进行Meta分析。结果纳入硒治疗AITD的7个RCT,共513例患者。Meta分析结果显示,与使用安慰剂的对照组比较,硒治疗组AITD患者血清抗甲状腺过氧化物酶抗体（TPOAb）阳性率显著降低加权均数差（WMD）=-342.67,95%CI：-433.33～-242.02,P〈0.00001],患者健康状态改善明显（RR=2.79,95%CI：1.21～6.47,P=0.02）。患者经补硒治疗后的不良反应少且轻微。结论本组资料的Meta分析表明补硒是治疗AITD的一种安全且有效的方法。由于本次纳入试验的质量和样本量的局限性,有待设计严格的大样本多中心随机双盲试验的纳入以提供更高质量的循证医学证据。

Systematic evaluation of selenium in treatment of autoimmune thyroiditis

Objective To systematically evaluate the efficacy and safety of selenium in treatment of autoimmune thyroiditis (AITD). Methods Based on the principle and methods of Cochrane systematic review, the Cochrane Library, Medline, Embase, Chinese Biomedicine Database, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals and Wanfang Data were searched, and the randomized controlled trials (RTC) of selenium in treatment of AITD were included. Meta analysis was conducted for the data using RevMan 5.0 software. Results Seven RCT involved with selenium in treatment of AITD were included, and there were 513 patients in all. Meta analysis revealed that the positive rate of serum anti thyroid peroxidase antibody (TPOAb) in selenium treatment group was significantly lower than that in control group treated with placebo weighted mean difference (WMD)=-342.67, 95%CI: -433.33 to -242.02, P<0.000 01], and the healthy status of the former was better than the latter (RR=2.79, 95%CI: 1.21 to 6.47, P=0.02). The adverse effects were less and moderate after selenium treatment. Conclusion Meta analysis of this study indicates that selenium therapy for AITD is effective and safe. However, the evidence is not powerful enough due to the low quality of trials and limitation of sample number. The rigorously designed, multicenter, randomized and double blinded trials with large samples are needed for further research.