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目的综合评价碘放射性同位素131I与抗甲状腺药物(ATD)治疗甲状腺功能亢进症(简称甲亢)的效果。方法全面检索MEDLINE、EMBASE、Cochrane、CNKI、万方、维普数据库,主要入选标准包括:(1)随机对照研究;(2)所有受试者明确诊断为甲亢;(3)治疗组及对照组分别给予131I治疗或ATD;(4)随访时间至少为18个月。结果入选16篇文献,其中131I组2666例,抗甲状腺药物组2556例。与ATD相比,131I治疗可以明显提高甲亢的治愈率(合并OR=4.25,95%置信区间为2.59~6.97;P<0.000 01),但是甲状腺功能减退(简称甲减)的发生率也明显升高(合并OR=2.65,95%置信区间为1.91~3.66;P<0.000 01)。此外,针对治疗前已有突眼的患者,虽然两种治疗方式对突眼的影响差异无显著性(合并OR=1.35,95%置信区间为0.93~1.96;P=0.12),但是,治疗后新发生突眼患者数131I组高于ATD组(合并OR=1.61,95%置信区间为1.33~1.95;P<0.000 01)。结论与ATD相比,131I治疗甲亢更有效,但是其甲减及突眼的发生率更高。
Objective To evaluate the effects of iodine radioisotope 131 I and antithyroid drugs (ATD) in the treatment of hyperthyroidism (Hyperthyroidism). Methods A total of MEDLINE, EMBASE, Cochrane, CNKI, Wanfang and VIP databases were searched. The main inclusion criteria included: (1) randomized controlled study; (2) all subjects were diagnosed as hyperthyroidism; (3) Given 131I treatment or ATD; (4) the follow-up time of at least 18 months. Results Sixteen articles were included, of which 2666 were in 131I group and 2556 in antithyroid drug group. Compared with ATD, 131I treatment can significantly improve the cure rate of hyperthyroidism (OR = 4.25, 95% confidence interval 2.59 ~ 6.97; P <0.000 01), but the incidence of hypothyroidism (hypothyroidism) also significantly increased High (OR = 2.65, 95% confidence interval 1.91-3.66; P <0.000 01). In addition, although there was no significant difference in the effect of the two treatments on exophthalmos (OR = 1.35, 95% confidence interval 0.93 to 1.96; P = 0.12) for patients with exophthalmos before treatment, The number of newly diagnosed patients with exophthalmos was higher in the 131I group than in the ATD group (OR = 1.61, 95% confidence interval 1.33 to 1.95; P <0.000 01). Conclusion Compared with ATD, 131I is more effective in treating hyperthyroidism, but the incidence of hypothyroidism and exophthalmos is higher.