99锝-亚甲基二膦酸盐联用甲泼尼龙治疗甲状腺相关眼病的Meta分析

Meta-analysis of technetium-99 methylene disphosphonate combined with methylprednisolone for thyroid-associated ophthalmopathy

目的:评价99锝-亚甲基二膦酸盐(^99Tc-MDP)联用甲泼尼龙治疗甲状腺相关眼病(TAO)的临床效果。方法:检索Pubmed、The Cochrane Library、EMbase、ClinicalTrial.gov、Web of Science、中国知网、维普、中国生物医学文献数据库和万方数据库9个数据库,检索时间从建库至2019-03,收集^99Tc-MDP联用甲泼尼龙治疗TAO的随机对照试验(RCT)。2名研究人员根据纳入和排除标准,独立检索文献、提取数据及进行方法学质量评估。采用Review Manager 5.3进行Meta分析。结果:最终纳入8篇RCT文献,共644例患者。Meta分析结果显示,^99Tc-MDP联用甲泼尼龙与单用甲泼尼龙的临床总有效率有差异(RR=1.14,95%CI:1.03~1.26,P=0.01)。两组眼球突出度治疗有效率有差异(RR=1.28,95%CI:1.16~1.41,P<0.00001)。^99Tc-MDP联用甲泼尼龙改善TAO复视症状优于单用甲泼尼龙(RR=1.64,95%CI:1.04~2.58,P=0.03)。两组治疗眼球运动障碍症状无差异(P=0.37)。^99Tc-MDP联用甲泼尼龙组不良反应发生率低于单用甲泼尼龙组。结论:^99Tc-MDP联用甲泼尼龙治疗TAO优于单用甲泼尼龙,是TAO的有效治疗方法,且副作用小。

AIM:To evaluate the clinical effects of using technetium-99 methylene diphosphonate(^99Tc-MDP)with methylprednisolone to treat thyroid-associated ophthalmopathy(TAO).METHODS:We retrieved from 9 databases,from their foundation to March 2019,including Pubmed,the Cochrane Library,EMbase,ClinicalTrial.gov,Web of Science,CNKl,VIP database,China Biology Medicine disc,Wanfang database and collected the randomized controlled trail(RCT)of ^99Tc-MDP combined with methylprednisolone for treatment of TAO.According to inclusion and exclusion criteria,two researchers retrieved the literature independently,extracted data and evaluate methodological quality.Meta analysis was performed by Review Manager 5.3 software.RESULTS:A total of 8 RCTs were identified with 644 patients.There was significant difference in the overall clinical effective rate between ^99Tc-MDP combined with methylprednisolone and methylprednisolone alone(RR=1.14,95%CI:1.03-1.26,P=0.01).Significant difierence was found in the effective rate of proptosis between intravenous injection of ^99Tc-MDP with methyprednisone and methyprednisone only(RR=1.28,95%CI:1.16-1.41,P<0.00001).Meanwhile,great improvement was seen in diplopia(RR=1.64,95%CI:1.04-2.58,P=0.03),but there was no significant difference in disturbance of ocular dyskinesia(P=0.37).CONCLUSION:Applying ^99Tc-MDP combined with methylprednisolone is better than methylprednisolone alone for TAO with less adverse reaction,which appears to be an effective treatment for TAO.