大骨节病与碘暴露碘代谢关系的系统评价

The relationship between the exposure and metabolism of iodine and Kaschin-Beck disease:a systematic review

目的评价大骨节病与外环境碘和体内碘代谢的关系。方法检索中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊全文数据库、万方数据库、PubMed、Cochrane图书馆、EMBASE和ISI Web of knowledge数据库,检索时间均为建库至2013年4月,纳入大骨节病病区与非病区的水、土壤和粮食中碘水平比较,大骨节病患儿与健康人群、病区与非病区健康人群血碘、尿碘、发碘、T3、T4和TSH水平比较的文献。采用RevMan5.10软件进行Meta分析。结果 6篇文献进入分析。①Meta分析结果显示,病区与非病区水碘(SMD=0.32,95%CI:-0.70～1.34)和小麦中碘水平(MD=-128.21,95%CI:-288.17～-31.74)差异无统计学意义。②大骨节病患儿与健康人群中尿碘(SMD=-0.01,95%CI:-0.25～0.24)、血清TT3(SMD=0.49,95%CI:-0.20～1.19)、TT4(SMD=0.31,95%CI:-0.24～0.85)和TSH水平(SMD=-0.35,95%CI:-1.04～0.35)差异无统计学意义,血清FT3(SMD=1.93,95%CI:0.80～3.07)和FT4水平(SMD=2.13,95%CI:0.67～3.59)高于健康人群。③病区和非病区健康人群血清FT3(SMD=0.54,95%CI:-0.53～1.61)、TT3(SMD=0.50,95%CI:-0.46～1.47)、TT4(SMD=0.80,95%CI:-0.22～1.81)、TSH(SMD=-0.35,95%CI:-2.43～1.72)和尿碘水平(SMD=-21.60,95%CI:-118.37～75.17)差异无统计学意义。结论现有证据显示,外环境中碘与大骨节病无明确关系,大骨节病患儿体内可能存在甲状腺激素的代谢紊乱。

Objective To evaluate the differences of iodine levels in environment between endemic and normal areas, in patients with Kaschin-Beck disease and health people using systematic review method. Methods Chinese Journal Full-text Database, Chinese Biomedical Literature Database, Chinese scientific journals full-text Database, China academic journal network publishing database, Wanfang Database, PubMed, Cochrane Library, EMBASE, and ISI Web of knowledge were searched from establishment of database to April 2013. The comparative studies about the differences of iodine levels in environment （soil, water, and cereal ） between endemic and normal areas and the differences of blood, urine, and hair iodine levels, thyroxine, triiodothyronine, thyrotropin in patients with Kaschin-Beck disease and healthy people were included. Data were analyzed using RevMan 5.10 software that recommended by the Cochrane Collaboration. Results Six studies were included. The results of meta- analysis showed that there were no differences in water iodine levels （SMD = 0.32, 95% CI： -0.70 to 1.34） and cereal iodine levels （MD = -128.21, 95% CI： -288.17 to -31.74） between endemic and normal areas. And there were no differences in urinary iodine （ SMD = -0.01, 95% CI： -0.25 to 0.24）, serum 333 （ SMD = 0.49, 95% CI： - 0.20 to 1.19）, serum TT4 （ SMD = 0.31, 95 % CI - 0.24 to 0.85 ） and serum TSH levels （ SMD = - 0.35, 95 % CI ： - 1.04 to 0.35 ） between Kasehin-Beck disease patients and healthy people. The serum FT3 （ SMD = 1.93, 95% CI： 0.80 to 3.07） and FT4 （SMD = 2.13, 95% CI： 0. 67 to 3.59） levels in patients with Kaschin-Beck disease were higher than those in healthy people. However, there were no differences in urinary iodine （SMD = - 21.60, 95% CI： - 118.37 to 75.17）, serum FT3 （ SMD = 0.54, 95% CI ： - 0.53 to1.61）, 333 （SMD =0.50, 95%CI： -0.46 to 1.47）, TT4 （SMD =0.80, 95%CI：-0.22 to 1.81） orTSH （SMD= -0.35, 95% CI： -2.43 to 1.72） between healthy people in endemic area and those in normal area. Conclusions Current evidence indicated that there was no clearly relationship between iodine and Kaschin-Beck disease. There may be abnormal metabolism of thyroxine in Kascbin-Beck disease patients.