生长抑素类似物治疗Graves眼病有效性的Meta分析

Effectiveness of Somatostatin Analogs versus Placebo for Graves' Ophthalmopathy: A Meta-Analysis

目的系统评价生长抑素类似物治疗Graves眼病(GO)的有效性。方法计算机检索PubMed、EMbase、e Cochrane Library、WanFang Data、CNKI、VIP和CBM中关于生长抑素类似物治疗Graves眼病的随机对照试验(RCT),检索时间截至2012年3月,并追溯纳入文献的参考文献。由2位研究者按照纳入标准筛选文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.0软件进行Meta分析。结果最终纳入5个RCT,共210例患者。Meta分析结果显示:生长抑素类似物治疗GO可降低临床活动性评分[MD=0.58,95%CI(0.02,1.13),P=0.04],但尚不能证实可降低突眼度(mm)[MD=0.21,95%CI(–0.14,0.56),P=0.24];对复视程度、球后体积、眼压、视力及眼球活动受限未显示出明显疗效;目前证据尚不能说明生长抑素类似物治疗GO有效[OR=1.32,95%CI(0.45,3.9),P=0.61]。结论生长抑素类似物治疗GO可降低患者的临床活动性评分,但未能明显降低突眼度,目前证据尚不能证实生长抑素类似物治疗GO有效。受纳入研究的质量和数量限制,上述结论尚需开展更多高质量RCT加以验证。

Objective To systematically evaluate the effectiveness of somatostatin analogs versus placebo for Graves＇ ophthalmopathy （GO）. Methods Such databases as PubMed, EMbase, The Cochrane Library, WanFang Data, CNKI, VIP and CBM were searched to collect the randomized controlled trails （RCTs） about somatostatin analogs for Graves＇ Ophthalmopathy （GO） pulished by March 2012, while the bibliographies of the included literatue were also retrieved. According to the inclusion criteria, two reviewers screened literature, extracted data and assessed the quality of the included studies. Then meta-analysis was conducted using RevMan 5.0 software. Results A total of 5 RCTs involving 210 patients were included. The results of meta-analysis showed that somatostatin analogs could reduce the clinical activ- ity score （CAS） of GO patients （MD=0.58, 95%CI 0.02 to 1. 13, P=0.04）, but the effects in reducing the degree of proptosis （ram） was still unverifiable （MD=0.21, 95%CI -0.14 to 0.56, P=0.24）. It did not show obvious effects for diplopia, orbital volume, intraocular pressure, visual acuity or the restriction of eye movements. The existing evidence could not confirm that somatostatin analogs were effective for GO （OR=1.32, 95%CI 0.45 to 3.9, P=0.61）. Conclusion Somatostatin analogs can reduce the CAS of GO patients, but without significantly clinical significance. Moreover, the effect of reducing proptosis is sitll unverifiable. So the existing evidence cannot confirm that somatostatin analogs are effective for GO. For the quality and quantity limitation of the included studies, this conclusion needs to be proved by performing more high quality RCTs.