糖皮质激素与非甾体类抗炎药治疗亚急性甲状腺炎有效性和安全性的Meta分析

Efficacy and safety of glucocorticoids versus non-steroidal anti-inflammatory drugs for treating subacute thyroiditis:a Meta-analysis

目的系统评价糖皮质激素对比非甾体类抗炎药(NSAIDs)治疗亚急性甲状腺炎的有效性和安全性。方法检索Medline、PubMed、Embase、中国生物医学文献数据库、中国知网和万方数据库,收集已发表的糖皮质激素对比NSAIDs治疗亚急性甲状腺炎的随机对照试验(RCT),按照纳入标准对所有文献进行筛选及提取资料,运用Rev Man5.2软件对数据进行Meta分析。结果共纳入5项RCT,共计266例患者。Meta分析结果显示:在疗程方面,NSAIDs组短于激素组(SMD=13.43,95%CI:8.25~18.61,P<0.01);临床症状缓解时间方面,激素组明显短于NSAIDs组(SMD=-5.08,95%CI:-5.54^-4.63,P<0.01);NSAIDs组患者的复发率显著低于激素组(OR=3.34,95%CI:1.58~7.06,P<0.01);而在不良反应方面,两者间并无差异性(OR=2.08,95%CI:0.91~4.72,P=0.08)。结论糖皮质激素治疗亚急性甲状腺炎的疗程时间明显长于NSAIDs,在临床症状缓解时间方面优于NSAIDs,使用糖皮质激素治疗容易出现复发现象,但两者在不良反应方面并无差异。由于纳入研究数量较少、质量一般,该结论有待大样本、高质量的RCT进一步验证。

Objective To systematically evaluate the efficacy and safety of glucocorticoids（ GC） and non-steroidal antiinflammatory drugs（ NSAIDs） in the treatment of subacute thyroiditis. Methods Retrieved Medline,Pub Med,Embase,CBM,CNKI and Wanfang databases,the published randomized controlled trials（ RCTs） on GC versus NSAIDs for treatment of subacute thyroiditis were collected. According to inclusive criteria,the literatures met the inclusion criteria were screened,and the relevant data were extracted. A Meta-analysis on obtained data was performed with Rev Man 5. 2 software.Results A total of 5 RCTs involving 266 patients were included. Meta-analysis results showed that the course of treatment in NSAIDs group was significantly shorter than that in GC group（ SMD = 13. 43,95% CI： 8. 25- 18. 61,P 〈 0. 01）; the relieved time of clinical symptoms in GC group was significantly shorter than that in NSAIDs group [SMD =- 5. 08,95% CI：（- 5. 54）-（- 4. 63）,P 〈 0. 01]; the recurrence rate in NSAIDs group was significantly lower than that in GC group（ OR = 3. 34,95% CI： 1. 58- 7. 06,P 〈 0. 01）; there was no significant difference in adverse reactions between two groups（ OR = 2. 08,95% CI： 0. 91- 4. 72,P = 0. 08）. Conclusions For the treatment of subacute thyroiditis,compared with NSAIDs,GC has longer course of treatment,shorter relieved time of clinical symptoms and higher recurrence rate,but there is no significant difference in adverse reaction between two groups. Due to the small number of samples and general quality of included studies,the conclusion needs to be validated futher by large sample size and high-quality RCTs.