甲巯咪唑与丙硫氧嘧啶对甲状腺功能亢进患者肝功能影响的系统评价

Effect of Methimazole and Propylthiouracil on Liver Function in Patients with Hyperthyroidism:A Systematic Review

目的系统评价甲巯咪唑与丙硫氧嘧啶对甲状腺功能亢进(甲亢)患者肝功能的影响。方法计算机检索CNKI、VIP、WANFANG、CBM、PUBMED、COCHRANELIBRARY、EMBASE、MEDLINE等中英文数据库,筛选比较甲巯咪唑与丙硫氧嘧啶对甲亢患者肝功能影响的随机对照试验(RCTs),检索时间为建库起至2017年10月。对纳入的文献进行资料提取和质量评价,并采用Revman5.3.5版软件进行Meta分析。结果共纳入28项RCT,甲亢患者3181例。Meta分析结果显示,丙硫氧嘧啶组肝损伤发生率高于甲巯咪唑组[RR=2.73,95%CI(2.23,3.34),P<0.00001]。且治疗前后丙硫氧嘧啶所致丙氨酸氨基转移酶(ALT)变化值、天冬氨酸氨基转移酶(AST)变化值、碱性磷酸酶(ALP)变化值、总胆红素(T-BiL)变化值均高于甲巯咪唑组[SMD=0.68,95%CI(0.46,0.90),P<0.00001;SMD=0.38,95%CI(0.17,0.59),P=0.0005;SMD=0.47,95%CI(0.23,0.72),P=0.0002;SMD=0.70,95%CI(0.45,0.95),P<0.00001],均差异有统计学意义。结论甲亢患者应用丙硫氧嘧啶导致肝损伤的风险高于应用甲巯咪唑,甲亢伴肝功能异常的患者选用甲状腺治疗药物时尤需谨慎。

Objective To evaluate the effect of methimazole and propylthiouracil on liver function in patients with hyperthyroidism. Methods RCTs comparing the effect of methimazole and propylthiouracil on liver function in patients with hyperthyroidism were searched through databases such as CNKI,VIP,WANFANG,CBM,PUBMED,COCHRANE LIBRARY,EMBASE and MEDLINE from inception to October 2017.The quality of the included RCTs was evaluated by Jaded scale.Then,meta-analysis was performed by Revman 5.3.5 software. Results A total of 28 RCTs were enrolled,including 3181 patients.meta-analysis showed that the incidence of liver injury in propylthiouracil group was higher than that in methimazole group[RR =2.73,95%CI( 2.23,3.34),P<0.00001],the variation of ALT,AST,ALP and total bilirubin in propylthiouracil group were also significantly larger in propylthiouracil group [SMD = 0.68,95% CI( 0.46,0.90),P< 0.00001;SMD = 0.38,95% CI( 0.17,0.59),P = 0.0005;SMD = 0.47,95% CI( 0.23,0.72),P = 0.0002;SMD = 0.70,95% CI( 0.45,0.95),P< 0.00001]. Conclusion The risk of liver injury in propylthiouracil group is higher than that in methimazole group,suggesting that patients with liver dysfunction be careful in the selection of antithyroid drugs.