甲巯咪唑对甲状腺机能亢进患者骨代谢指标影响的Meta分析

A Meta Analysis on Influence of Methimazole on Index Values of Bone Metabolism in Patients with Hyperthyroidism

目的:通过Meta分析系统评价抗甲状腺药物甲巯咪唑对甲状腺机能亢进(简称“甲亢”)患者骨代谢指标的影响。方法:利用Embase、Cochrane Library、Pubmed、知网、万方等数据库,以甲巯咪唑、甲亢患者、骨代谢指标为检索词,检索甲巯咪唑对甲亢患者骨代谢指标影响测定结果的临床对照试验资料,依照纳入标准筛选文献后进行质量评估,提取有效数据;文献检索时间为建库至2017年6月间;语种主要为英文和中文,应用RevMan5.3版软件评价甲巯咪唑对甲状腺机能亢进患者骨代谢指标的影响。结果:检索纳入8项研究(309例甲亢患者),采用Meta分析结果显示,治疗后甲巯咪唑对甲亢患者骨代谢指标如血钙、血磷水平稍低于治疗前但无统计学意义(P>0.05);血清碱性磷酸酶(ALP)水平按治疗时间段(6月以内组和6月以上组)观察,6月以内组患者治疗后ALP水平稍低于6月以上组但经组间比较其差异无统计学意义(P>0.05);6月以上组患者治疗后相比于治疗前,ALP水平明显低于治疗前(P<0.05);治疗3月以内组患者用药后骨钙素(OCN)水平稍低于3月以上组,但无统计学意义(P>0.05);治疗3~6月的患者OCN水平低于治疗3月以内组(P<0.05);治疗6月以上患者OCN水平明显低于3月以内组(P<0.05);治疗后患者甲状旁腺素(PTH)水平显著高于治疗前(P<0.05)。结论:采用甲巯咪唑治疗甲亢患者1.5~12月,骨代谢指标中血清ALP、OCN及PTH水平较治疗前有所改善,且随着治疗时间的延长,这种变化更为显著。

Objective:To evaluate the influence of anti-thyroid drug methimazole on bone metabolic index values in patients with hyperthyroidism by Meta- analysis.Methods:Using Embase,Cochrane Library,Pubmed,cnz.com, wanfen and other databases,clinical controlled trial data on the effect of methimazole on bone metabolism indexes in patients with hyperthyroidism and thyroid hyperthyroidism were retrieved,and quality assessment was conducted after literature selection according to inclusion criteria to extract effective data.The literature retrieval time was from the establishment of database to June 2017.The languages were English and Chinese,and the effects of methimazole on bone metabolism in patients with hyperthyroidism were evaluated by RevMan 5.3 software.Results:8 studies (309 patients with hyperthyroidism were involved) were included.Meta-analysis results showed that post-treatment methimazole had slightly lower bone metabolism indexes such as blood calcium and blood phosphorus levels in patients with hyperthyroidism, but having no statistical significance (P>0.05).The serum ALP level was observed according to the treatment period (group within 6 months and group above 6 months).The ALP level of patients in the group within 6 months was slightly lower than that in the group above 6 months after treatment,but the difference was not statistically significant (P>0.05).After treatment,ALP level was significantly lower than that before treatment (P<0.05).The level of osteocalcin (OCN) after treatment in the group within 3 months of treatment was slightly lower than that in the group above 3 months of treatment,but there was no statistical significance(P>0.05).OCN level of patients treated between 3 and 6 months was lower than that of the group treated for 3 months (P<0.05).The OCN level in patients over 6 months of treatment was significantly lower than that in the group under 3 months of treatment (P<0.05).The level of parathyroid hormone (PTH) after treatment was significantly higher than that before treatment (P<0.05).Conclusion:In patients with hyperthyroidism treated with methimazole (between 1.5 and 12 months),the serum ALP,OCN and PTH levels in bone metabolism indexes were significantly improved compared with those before treatment,and the changes were more significant with the prolonged treatment time.