当归六黄汤加减联合抗甲状腺药物治疗甲状腺功能亢进症的系统评价与Meta分析

Systematic Evaluation and Meta-Analysis of Modified Danggui Liuhuang Decoction Combined with Antithyroid Drugs in the Treatment of Hyperthyroidism

【目的】系统评价当归六黄汤加减联合抗甲状腺药物(ATD)口服治疗甲状腺功能亢进症(甲亢)的疗效及安全性。【方法】计算机检索中国知网(CNKI)、万方数据(Wanfang)、维普期刊论文检测系统(VIP)、中国生物医学数据库(CBM)、PubMed、Web of Science等数据库中有关当归六黄汤加减联合ATD(试验组)对比单用ATD(对照组)治疗甲亢的随机对照试验(RCT),按照Cochrane系统评价员手册偏倚风险评估方法对纳入文献进行偏倚风险的评估,提取相关数据,运用Review Manager5.3软件进行Meta分析。【结果】最终纳入21项RCTs,涉及病例1 937例。Meta分析结果显示,当归六黄汤加减联合ATD治疗甲亢的临床有效率[RR=1.21,95%CI(1.17,1.26)]优于单用ATD治疗,在改善血清学指标游离三碘甲状腺原氨酸(FT3)[SMD=-1.02,95%CI(-1.62,-0.41)]、游离甲状腺素(FT4)[SMD=-1.69,95%CI(-2.31,-1.07)]、促甲状腺激素(TSH)[SMD=2.28,95%CI(0.99,3.57)]及降低不良反应发生率[RR=0.29,95%CI(0.19,0.43)]方面也优于对照组,差异均有统计学意义(P <0.01)。【结论】当归六黄汤加减联合ATD治疗甲亢具有较好的疗效与安全性,但因纳入文献质量偏低,仍需要高质量、多中心、大样本的研究进行进一步验证。

Objective To systematically evaluate the clinical efficacy and safety of modified Danggui Liuhuang Decoction combined and antithyroid drugs for the treatment of hyperthyroidism. Methods We retrieved the primary databases of CNKI, Wanfang Data, VIP, CBM, PubMed, and Web of Science to collect the randomized controlled trials(RCTs)of modified Danggui Liuhuang Decoction combined with antithyroid drugs(trial group)vs antithyroid drugs(control group)for the treatment of hyperthyroidism. After screening the literature,we extracted the data,and assessed the risk bias of included studies according to Cochrane Handbook for Systematic Reviews of Interventions. And then the meta-analysis was performed by using Review Manager 5.3 software. Results A total of21 RCTs were included in this study,involving 1 937 cases. The results of meta-analysis showed that modified Danggui Liuhuang Decoction combined with antithyroid drugs presented higher clinical effective rate than the antithyroid drugs alone for the treatment of hyperthyroidism[RR = 1.21,95%CI(1.17,1.26)], and was more effective on improving serum indicators of thyroid function parameters of free triiodothyronine(FT3)[SMD =-1.02,95%CI(-1.62,-0.41)],free thyroxine(FT4)[SMD =-1.69,95%CI(-2.31,-1.07)] and thyroid stimulating hormone(TSH)[SMD = 2.28,95%CI(0.99,3.57)],and on decreasing the incidence of adverse reaction [RR=0.29,95%CI(0.19,0.43)],the differences being statistically significant(P < 0.01). Conclusion The modified Danggui Liuhuang Decoction combined with antithyroid drugs has good clinical efficacy and safety for the treatment of hyperthyroidism. However,for the quality of included trials was low in methodology,more clinical trials with high quality,large sample size and multiple centers are needed to verify the conclusion.