左旋甲状腺素治疗伴轻度认知功能障碍甲状腺功能减退症患者临床疗效的Meta分析

Meta-analysis of L-T_4 replacement therapy in patients with MCI hypothyroidism

目的系统评估左旋甲状腺素(L-T4)对伴轻度认知功能障碍(MCI)甲状腺功能减退症患者的临床疗效。方法以"甲状腺功能减退""甲状腺功能减退症""认知功能障碍""阿尔茨海默病"等为关键词在中国知网、维普数据库、万方数据库、Pubmed、Emerald Insight数据库进行检索,检索日期自数据库建库日期起至2017年9月30日,对检索出的文献进行人工筛选。检索L-T_4治疗伴MCI甲状腺功能减退症的随机对照研究文献,进行数据提取和方法学质量评价,将数据录入Rev Man 5.3软件并进行Meta分析,分析L-T_4替代治疗对促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)、简易精神状态量表(MMSE)评分等指标的影响。结果共有6项研究被纳入Meta分析,治疗后试验组TSH、FT3、FT4、MMSE评分均优于对照组:TSH(OR=6.52,95%CI 6.36~6.68,P<0.01)。FT_3(OR=-1.98,95%CI-2.06^-1.90,P<0.01),FT_4(OR=-6.43,95%CI-6.72^-6.15,P<0.01),MMSE评分(OR=-6.12,95%CI-6.46^-5.79,P<0.01)。结论 L-T_4替代治疗具有改善伴MCI甲状腺功能减退症患者甲状腺功能和情志状态的作用。

Objective To evaluate the clinical efficacy of L-T 4 in the treatment of cognitive dysfunction with hypothyroidism.Methods Using the keywords"hypothyroidism","hypothyroidism","cognitive dysfunction"and“Alzheimer”in CNKI,VIP and Wanfang database to retrieve the database,retrieval date to Sep.30,2017.A randomized controlled study of L-T 4 treatment with cognitive dysfunction hypothyroidism was conducted to extract data and evaluate methodological quality.The data were entered into Revman 5.3 software and analyzed TSH,FT 3,FT 4 and MMSE score by Meta.Results 6 studies were included in the Meta-analysis.The experimental group was better than the control group after the treatment:TSH(I 2=99%,OR=6.52,95%CI 6.36,6.68,P<0.01),FT 3(I 2=100%,OR=-1.98,95%CI-2.06,-1.90,P<0.01),FT 4(I 2=99%,OR=-6.43,95%CI-6.72,-6.15,P<0.01),MMSE score(I 2=99%,OR=-6.12,95%CI-6.46,-5.79,P<0.01).Conclusion L-T 4 replacement therapy can improve the thyroid function of hypothyroidism patients.