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目的评价~(131)Ⅰ与抗甲状腺药物(ATD)治疗儿童及青少年Graves病的疗效和安全性的差异。方法计算机检索MEDLINE(1966～2005)、Cochrane图书馆临床对照试验资料库(2006年第2期)、EMBASE(1984～2004)、CBMDISK(1978～2005)、CNKI(1994～2006),同时手工检索“同位素”(1989～2004)“、”放射学实践“(1986～2005)、”中华内分泌代谢杂志“(1985～2004)以及Endocrinology and Metabolism Clinics of North America(1988～2001)。纳入对比分析~(131)Ⅰ与ATD治疗儿童及青少年Graves病的临床对照研究,对纳入研究的方法学质量进行评价(随机方法,分配隐藏,盲法),并应用Revman4.2软件进行统计分析。结果未检索到随机对照试验,检索到前瞻性非随机同期对照研究1篇,回顾性队列研究4篇,包括538例患者。Meta分析结果显示,与ATD相比,~(131)Ⅰ提高了儿童及青少年Graves病的治愈率、降低了复发率及不良反应发生率,但治疗后的甲状腺功能减退症发生率升高(各指标统计值均P<0.05)。结论~(131)Ⅰ是治疗儿童及青少年Graves病安全、有效的方法,其综合疗效优于ATD (基于纳入的5个研究),但对比分析~(131)Ⅰ与ATD治疗儿童及青少年Graves病效果的研究缺乏随机对照试验,临床对照研究在随机、盲法、随访及统计分析等方面均存在不足,仍需要更多高质量的随机对照试验。
Objective To evaluate the efficacy and safety of ~ (131) Ⅰ and antithyroid drugs (ATD) in the treatment of Graves’ disease in children and adolescents. Methods The data of MEDLINE (1966 ~ 2005), Cochrane Central Register of Controlled Trials (2006), EMBASE (1984 ~ 2004), CBMDISK (1978 ~ 2005) and CNKI (1994 ~ 2006) Endocrinology and Metabolism Clinics of North America (1988 ~ 2004), ”Journal of Endocrinology and Metabolism" (1989 ~ 2004), Radiology Practice (1986 ~ 2005) 2001) .A comparative study of ~ (131) Ⅰ and ATD in the treatment of Graves’ disease in children and adolescents was included in this study, and the methodology of the included studies was evaluated (randomized, assigned and blind, blinded) and Revman 4.2 software Results: No randomized controlled trials were found, one prospective non-randomized controlled study and one retrospective cohort study were included, including 538 patients.Meta analysis showed that compared with ATD, ~ (131) Ⅰ increased the cure rate of Graves’ disease in children and adolescents, and reduced the relapse rate and the incidence of adverse reactions, but the incidence of hypothyroidism after treatment increased (all the statistic values were P <0.05) .Conclusion ~ (131) Ⅰ is to treat children and adolescents with Graves disease , And its effective method is superior to ATD (based on 5 included studies), but there is no randomized controlled trial comparing ~ (131) Ⅰ with ATD in the treatment of Graves’ disease in children and adolescents. The controlled trials in randomized, Blindness, follow-up and statistical analysis, there are still deficiencies, still need more high-quality randomized controlled trials.