碳酸锂联合131I治疗毒性弥漫性甲状腺肿伴白细胞减少症疗效和安全性的系统评价

Systematic Review of Efficacy and Safety of Lithium Carbonate Combined with I in the Treatment of Toxic Diffuse Goiter with Leucopenia

目的:系统评价碳酸锂联合131I对毒性弥漫性甲状腺肿伴白细胞减少症的疗效和安全性。方法:计算机检索the Cochrane Library、PubMed、万方数据库、中国知网及维普数据库,辅以网络检索和手工检索,收集有关碳酸锂联合131I治疗毒性弥漫性甲状腺肿伴白细胞减少症的临床研究(观察组患者采用碳酸锂与131I联合治疗;对照组患者单纯采用131I治疗),对纳入的研究采用Rev Man 5.3软件进行荟萃分析(Meta分析)。结果:共纳入5篇文献,涉及777例患者。Meta分析结果显示,观察组患者的血清游离三碘甲状腺原氨酸(FT3)水平在联合用药后15 d(MD=-17.85,95%CI=-21.79^-13.91,P<0.00001)、30 d(MD=-16.21,95%CI=-29.62^-2.80,P=0.02)和90 d(MD=-3.14,95%CI=-5.34^-0.93,P=0.005)均明显低于对照组,差异均有统计学意义;观察组患者的血清游离甲状腺素(FT4)水平在联合用药后15 d(MD=-18.09,95%CI=-22.78^-13.41,P<0.00001)、30 d(MD=-20.67,95%CI=-32.56^-8.78,P=0.0007)和90 d(MD=-7.64,95%CI=-12.18^-3.09,P=0.001)均明显低于对照组,差异均有统计学意义;观察组患者的白细胞计数(WBC)在联合用药后15 d(MD=0.56,95%CI=0.25~0.88,P=0.0004)、30 d(MD=0.72,95%CI=0.38~1.07,P<0.0001)均明显高于对照组,差异均有统计学意义,而在联合用药后90 d时与对照组的差异无统计学意义(MD=1.12,95%CI=-0.05~2.28,P=0.06)。结论:碳酸锂联合131I可有效降低毒性弥漫性甲状腺肿伴白细胞减少症患者的FT3和FT4水平,并可升高患者的WBC水平。

OBJECTIVE:To systematically evaluate the efficacy and safety of lithium carbonate combined with 131I in the treatment of toxic diffuse goiter with leucopenia.METHODS:PubMed,the Cochrane Library,CNKI,Wanfang database and VIP database were retrieved by computer,and supplemented by online and manual search,clinical studies of lithium carbonate combined with 131I in the treatment of toxic diffuse goiter with leucopenia(the observation group was treated with lithium carbonate combined with 131I,while the control group received 131I alone)were collected.Meta-analysis was performed on the included studies by using RevMan 5.3 software.RESULTS:Totally 5 literature were collected,including 777 patients.Meta-analysis results showed that the serum levels of free triiodothylamine(FT3)in the observation group were significantly lower than those in the control group at 15 d(MD=-17.85,95%CI=-21.79--13.91,P<0.00001),30 d(MD=-16.21,95%CI=-29.62--2.80,P=0.02)and 90 d(MD=-3.14,95%CI=-5.34--0.93,P=0.005)after drug combination,and the differences were statistically significant.The serum levels of free thyroxine(FT4)in the observation group were significantly lower than those in the control group at 15 d(MD=-18.09,95%CI=-22.78--13.41,P<0.00001),30 d(MD=-20.67,95%CI=-32.56--8.78,P=0.0007)and 90 d(MD=-7.64,95%CI=-12.18--3.09,P=0.001)after drug combination,and the differences were statistically significant.The white blood cell count(WBC)of the observation group was significantly higher than that of the control group at 15 d(MD=0.56,95%CI=0.25-0.88,P=0.0004)and 30 d(MD=0.72,95%CI=0.38-1.07,P<0.0001),while there was no statistically significant difference between two groups at 90 d(MD=1.12,95%CI=-0.05-2.28,P=0.06).CONCLUSIONS:Lithium carbonate combined with 131I can effectively reduce the levels of FT3 and FT4 and increase the levels of WBC in patients with toxic diffuse goiter associated with leucopenia.