肺癌与血清甲状腺激素水平关系的Meta分析

Correlation between serum thyroid hormone level and lung cancer:a meta-analysis

目的 系统评价血清甲状腺激素水平与肺癌相关性的病例对照研究.方法 检索PubMed、EMBASE、Web of Science、中国生物医学文献数据库、中文科技期刊全文数据库、中国期刊全文数据库及万方数据库等中英文数据库,并辅以文献追溯的方法,收集国内外发表的评价血清甲状腺激素水平与肺癌相关性的病例对照研究,检索时间均从建库至2014年4月.两位研究者按纳入排除标准筛选文献并评价纳入研究方法学质量,应用RevMan5.2软件进行Meta分析.结果 共纳入17个病例对照研究,包含肺癌组814例、对照组724例.Meta分析结果显示：肺癌患者血清总三碘甲状腺原氨酸（TT3）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）水平较对照组低（P＜0.01）,血清逆-三碘甲腺原氨酸（rT3）水平较对照组高（P＜0.01）,但血清总甲状腺素（TT4）、促甲状腺激素（TSH）水平与对照组的差异无统计学意义（P＞0.05）;肺癌Ⅲ-Ⅳ期患者血清TT3水平较Ⅰ～Ⅱ期患者低（P＜0.01）,血清rT3水平较Ⅰ～Ⅱ期患者增高（P＜0.01）,但血清TT4、FT4和TSH水平与Ⅰ～Ⅱ期患者比较差异无统计学意义（P＞0.05）.结论 现有证据表明肺癌患者可伴有甲状腺功能的改变,血清甲状腺激素水平检测可能对判断肺癌病情及预后产生一定的意义.

Objective To investigate the correlation between serum thyroid hormone level and lung cancer using meta-analysis. Methods Case-control studies on the correlation between serum thyroid hormone level and lung cancer reported on PubMed, EMBASE,Web of Science, CBM, VIP, CNKI and WanFang Database till April 2014 were searched and analyzed. The studies were selected by two reviewers according to the inclusion and exclusion criteria. The methodological quality of the included studies was assessed and the data were analyzed using RevMan 5.2. Results 17 case-control studies were identified, including 814 cases of lung cancer and 724 cases of controls. Serum levels of total triiodothyronine（TT3） ,free triiodothyronine（FT3） and free thyroxine（FT4） in the lung cancer group were significantly lower than those in the control group,respectively （ P 〈0.01）, while serum level of reverse triiodothyronine（rT3） was higher in the lung cancer group than in the control group （ P 〈0.01）. There were no significant differences in the serum levels of total thyroxine（TT4） and thyrotropin（TSH） between the two groups （ P 〉0.05）. In terms of clinical stage,patients in clinical stages III/IV had lower serum levels of TT3 （ P 〈0.01） but higher level of rT3 （ P 〈0.01） than patients in clinical stages I /II. However, there were no significant differences in the serum levels of TT4, FT4 and TSH between the different clinical stages （ P 〉 0.05）. Conclusion Serum thyroid hormone level decreases in patients with lung cancer. Thus, the serum level of thyroid hormone may be a prognostic factor for lung cancer patients.