眼眶放疗联合糖皮质激素与单用糖皮质激素治疗Graves眼病疗效的Meta分析

Comparation of combined therapy of orbital irradiation and systemic steroids and systemic steroid therapy alone in Graves ophthalmopathy:a meta-analysis

目的:研究眼眶放疗联合糖皮质激素治疗能否有效治疗Graves眼病,并比较其与单用糖皮质激素的疗效。方法:检索Pubmed、Ovid、TheCochraneLibrary、EMBASE及中国生物医学文献数据库发表的有关眼眶放疗联合糖皮质激素治疗与单用糖皮质激素治疗Graves眼病的对照研究,并辅以手工检索、因特网搜索。共纳入4项试验,针对3项临床指标对其疗效进行分析。结果:对于眼眶组织炎症联合治疗组效果比单用糖皮质激素组好,差异有显著性(P<0.0001);对于突眼及眼肌肥大的症状改善与单用激素无明显差异,它们的合并效应值(合并OR值、合并OR值、合并均数差)分别为0.01[0.00,0.09]、0.52[0.16,1.69]、-0.01[-0.10,0.08]。结论:眼眶放疗联合糖皮质激素治疗Graves眼病引起的眼眶组织炎症比单纯用激素治疗有效,对于突眼及眼肌肥大的症状改善,与单用糖皮质激素的作用相当。

Objective To compare the combined therapy of orbital irradiation and systemic steroids and systemic steroid therapy alone in Graves ophthalmopathy by a recta-analysis. Methods Both a computer-aided search of Pubmed and Ovid and the Cochrane Library and EMBASE, an intensive search by hand was conducted to identify all control studies so as to assess the .effects of both therapeutic methods on Graves ophthalmopathy. Results Four studies were finally included, three clinical index were analysed and the therapeutic alliance was found to be significantly more effective than systemic steroids alone in the management of the orbital soft tissue involvement, however, there was no significant different for proptosis and maximum thickness of extraocular muscle between the two groups. The pooled OR, pooled OR and pooled mean difference were 0.01 [0.00, 0.09],0.2 [0.16, 1.69] and -0.01 [-0.10, 0.08] respectively. Conclusions This Meta analysis demonstrates that combined therapy of orbital irradiation and systemic steroids is effective in the treatment of Graves ophthalmopathy. Systemic steroids alone is equally effective in reduction of proptosis and maximum thickness of extra-ocular muscle to therapeutic alliance, but less effective in soft tissue involvement than the combined therapy.