左旋甲状腺素治疗亚临床甲状腺功能减退的疗效及对血脂影响的Meta分析

THE EFFECT OF LEVOTHYROXINE ON BLOOD LIPID IN THE PATIENTS WITH SUBCLINICAL HYPOTHYROIDISM:A META-ANALYSIS

目的:运用循证医学方法评价左旋甲状腺素(L-T4)治疗亚临床甲状腺功能减退的疗效及对血脂的影响。方法:通过计算机检索谷歌数据库、维普(VIP)、万方、中国科学引文数据库、中国生物医学文献数据库、中国期刊全文数据库以及Cochrane协作网数据库(Cochrane Central)国内有关左旋甲状腺素治疗亚临床甲状腺功能减退的疗效及对血脂影响的文献,经过对文献质量评价后采用Review Manager v.5.1.0软件进行Meta分析。结果:共纳入9篇,共400例患者。Meta分析结果显示:疗效方面:治疗后促甲状腺素(TSH)较治疗前显著降低,差异有统计学意义(P<0.000 01);治疗后游离甲状腺素(FT4)和游离三碘甲状腺原氨酸(FT3)较治疗前轻度升高,差异有统计学意义(均P<0.000 01)。血脂方面:治疗后低密度脂蛋白(LDL)、甘油三酯(TG)及总胆固醇(TC)较治疗前显著降低,差异有统计学意义(均P<0.05);治疗后在升高高密度脂蛋白(HDL)方面与治疗前比较差异无统计学意义(P=0.10)。结论:左旋甲状腺素治疗亚临床甲状腺功能减退的疗效显著及对改善血脂具有重要临床意义,但鉴于纳入分析的研究质量差异较大,仍需大样本、多中心及高质量的随机对照实验来证实。

Objective：To systematically evaluate the efficacy of levothyroxine （L-T4） on subclinical hypot- hyroidism and its influence on blood lipid level by using evidence-based medicine method. Methods： Google Database, VIP Journal Integration Platform （VJIP）, Wanfang Med Database, Chinese Science Citation Da- tabase, Chinese Biological Medical Disc, China National Knowledge Infrastructure （CNKI） and Cochrane Library were retrieved for the randomized controlled trials （RCTs） of L T4 for subclinical hypothyroidism. The extracted data were analyzed with the Review Manager v 5.1.0 software. Results： 9 RCTs involving 400 patients met the inclusion criteria. The meta-analysis showed that in patients treated with L-T4, the TSH, LDL, TG and TC levels were significantly decreased, while the FT4 and FT3 were markedly in- creased （ P 〈0.05）. There was no statistical difference in HDL level at pre- and post-treatment （ P = 0.10）. Conclusion： The current evidence shows that L-T4 is effective in the treatment of subclinical hypot- hyroidism and can significantly improve blood lipid, but still need multi-centers, more cases and higher quality of RCTs to further verified.