左甲状腺素片治疗肾病综合征合并甲状腺功能减低的疗效的系统评价

Evaluation of efficacy of levothyroxine tablets in the treatment of nephrotic syndrome with hypothyroidism: A systematic review and meta-analysis

目的系统评价左甲状腺素片治疗肾病综合征(nephrotic syndrome,NS)合并甲状腺功能减低的疗效。方法中国生物医学文献服务系统(CBM)、中国知网(CNKI)、维普(VIP)、PubMed、Cochrane Library、Web of Science、Embase、万方数据库,搜索自建库以来至2019年1月18日数据库中关于使用左甲状腺激素治疗NS合并甲状腺功能低下的相关文章。2名研究员单独进行文献筛选和数据提取,使用Stata进行数据分析。结果共纳入16篇文献,总样本量为826人。Meta分析结果为:使用左甲状腺素片治疗前2个月,2组缓解效果无明显差异;使用3个月以上,治疗组缓解率高于对照组(1月:RR=2.03,95%CI 0.41~9.97,P=0.107;2月:RR=1.43,95%CI 0.85~2.43,P=0.181;3月:RR=1.59,95%CI 1.36~1.86,P<0.01;6月:RR=1.53,95%CI 1.32~1.77,P<0.01;12月:RR=1.34,95%CI 1.11~1.63,P<0.01)。治疗组与对照组FT3浓度升高程度(SMD=2.29,95%CI 1.58~3.00,P<0.01)、尿蛋白降低程度(WMD=-1.21 g/L,95%CI-2.19^-0.22,P<0.01)、水肿消退速度(WMD=-10.55 d,95%CI-12.53^-8.56,P<0.01)比较,差异有统计性意义。尿蛋白转阴时间(SMD=-2.05,95%CI-4.20~0.10,P=0.062)比较,2组差异无统计学意义。结论左甲状腺素治疗NS合并甲状腺功能减退患者,可减轻肾脏负担,加速甲状腺功能的恢复,进而促进患者良好预后。

Objective To systematically assess the efficacy of levothyroxine tablets in the treatment of nephrotic syndrome with hypothyroidism.Methods A data search was done on CBM,CNKI,VIP,PubMed/Medline,Cochrane Library,Web of Science,Embase and Wan Fang databases,so as to find studies from database development up to 18 th-Jan-2019 that use the levothyroxine to treat patients who were diagnosed as nephrotic syndrome(NS)with hypothyroidism.Two researchers retrieved the data and extracted studies separately.Data analysis was done by Stata software.Results A total 16 studies were included,which contained 826 patients.The results about meta-analysis were:in the first two months of treatment with levothyroxine tablets,there was no significant difference in the improvement effect between the two groups.After more than 3 months,the left thyroxine tablets group had higher remission rate than the untreated group(1 month:RR=2.03,95%CI 0.41~9.97,P=0.107;2 months:RR=1.43,95%CI 0.85~2.43,P=0.181;3 months:RR=1.59,95%CI 1.36~1.86,P<0.01;6 months:RR=1.53,95%CI 1.32~1.77,P<0.01;12 months:RR=1.34,95%CI 1.11~1.63,P<0.001).Comparisons between the treatment group and the control group,in increase magnitude in the level of FT3(SMD=2.29,95%CI 1.58~3.00,P<0.01),the level of urinary protein(WMD=-1.21 g/L,95%CI-2.19^-0.22,P<0.01)and the edema elimination rate(WMD=-10.55 d,95%CI-12.53^-8.56,P<0.01),showed statistically significant differences.The difference in the time for negative transformation of urinary protein between the two groups were not statistically significant(SMD=-2.05,95%CI-4.20~0.10,P=0.062).Conclusions Treatment with levothyroxine in patients with NS and hypothyroidism can reduce the burden on the kidneys,accelerate the recovery of thyroid function,and promote a good prognosis.