131I联合碳酸锂与131I单用治疗甲状腺功能亢进症的系统评价

Systematic review of131I combined with lithium carbonate and 131I alone in the treatment of hyperthyroidism

摘要:

目的： 评价¹³¹I联合碳酸锂治疗甲状腺功能亢进症（甲亢）是否优于¹³¹I单用。方法： 检索PubMed、Web of Science、the Cochrane Library、CNKI、CBM、万方数据库中2020年4月之前发表的文献。查找¹³¹I联合碳酸锂与¹³¹I单用治疗甲亢的随机对照试验（randomized controlled trial，RCT）。采用Cochrane系统评价手册推荐的风险偏倚评价工具对纳入文献的质量进行评价，运用Review Manager 5.3对提取的数据进行Meta分析，不能合并者采取描述性分析。结果： 本研究共纳入14个RCT，共纳入1 567名患者，其中试验组808人，对照组759人。数据合并结果表明，¹³¹I联合碳酸锂与¹³¹I单用治疗甲亢相比，在随访第3个月（RR=1.24，95% CI=1.09~1.41，P=0.001）和第12个月（RR=1.18，95% CI=1.04~1.34，P=0.010），甲亢治愈率差异有统计学意义。在随访第3个月，甲亢复发率差异有统计学意义（RR=0.39，95% CI=0.18~0.85，P=0.02）。在随访第1个月，甲减发生率差异有统计学意义（RR=1.39，95% CI=1.06~1.84，P=0.02）。在随访第3个月（RR=1.02，95% CI=0.97~1.08，P=0.48）和第6个月（RR=1.06，95% CI=0.86~1.30，P=0.60），甲亢治疗总有效率差异无统计学意义。在治疗第1个月，甲状腺大小差异无统计学意义（SMD=-0.26，95% CI=-0.61~0.09，P=0.15）。结论： 系统评价结果显示，¹³¹I联合碳酸锂治疗甲亢，随访第3、第12个月的甲亢治愈率，随访第3个月的甲亢复发率，随访第12个月的甲减发生率优于¹³¹I单用，而甲亢治疗总有效率、甲状腺大小与¹³¹I单用均无统计学差异。但由于纳入文献的质量偏低，其结论仍需要更多大样本、多中心、试验设计规范的RCT验证。

Abstract:

Objective: To evaluate whether¹³¹I combined with lithium carbonate is better than¹³¹I alone in the treatment of hyperthyroidism. Methods: The literature published before April 2020 in PubMed, Web of Science, the Cochrane Library, CNKI, CBM and Wanfang databases was retrieved. Randomized controlled trials (RCTs) of¹³¹I combined with lithium carbonate and¹³¹I alone in the treatment of hyperthyroidism were searched. The risk bias evaluation tool recommended by Cochrane system evaluation manual was used to evaluate the quality of the included literature, and Review Manager 5.3 was used to perform Meta-analysis on the extracted data, while descriptive analysis was used for those that could not be combined. Results: This study included 14 RCTs for analysis, including 1 567 patients, 808 in the experimental group and 759 in the control group. The results showed that there was significant difference in the cure rate of hyperthyroidism between¹³¹I combined with lithium carbonate and¹³¹I alone at the third month (RR=1.24, 95% CI=1.09-1.41, P=0.001) and 12th month (RR=1.18, 95% CI=1.04-1.34, P=0.010). There was significant difference in the recurrence rate of hyperthyroidism at the third month (RR=0.39, 95% CI=0.18-0.85, P=0.02), and the incidence of hypothyroidism in one month (RR=1.39, 95% CI=1.06-1.84, P=0.02), and no significant difference in the total effective rate of hyperthyroidism treatment at the third month (RR=1.02, 95% CI=0.97-1.08, P=0.48) and sixth month (RR=1.06, 95% CI=0.86-1.30, P=0.60). There was no significant difference in thyroid size at 1 month (SMD=-0.26, 95% CI=-0.61-0.09, P=0.15). Conclusion: The results of systematic review show that¹³¹I combined with lithium carbonate in the treatment of hyperthyroidism, the cure rate, recurrence rate of hyperthyroidism in the third and 12th month and the incidence of hypothyroidism in the 12th month are better than those of¹³¹I alone, but there is no significant difference in the total effectiverateandthyroidsizeof hyperthyroidism treatment. However, due to the low quality of the included literature, its results and conclusions still need to be verified by more RCTs with large samples, multi centers, and test design specifications.