硒补充治疗Graves病临床疗效的Meta-分析

Efficacy of selenium supplement in treatment of Graves' disease:A Meta-analysis

目的系统评价硒补充剂联合抗甲状腺药物治疗对Graves病患者的疗效。方法全面检索Pubmed、Medline、Cochrane Library、Embase、Web of Science、中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)及万方数据库,检索时间自建库至2018年6月,根据纳入排除标准筛选符合的随机对照试验(RCT),通过RevMan 5.0及Stata12.0软件进行分析。结果共纳入9篇RCT,Meta-分析结果显示:联用硒补充剂治疗组Graves病患者与对照组相比游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平均显著降低[WMD=-1.48,95%CI(-1.93,-1.02)及WMD=-4.89,95%CI(-7.22,-2.56)],血清促甲状腺素(TSH)水平显著升高[WMD=0.57,95%CI(0.29,0.86)];甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)、促甲状腺激素受体抗体(TRAb)及免疫球蛋白IgA、IgG水平均显著降低,而免疫球蛋白IgM水平两组间差异无统计学意义。结论应用抗甲状腺药物联合硒补充治疗可显著改善Graves病患者甲状腺功能水平,显著降低FT3及FT4水平,升高TSH水平,改善自身抗体水平,显著降低TPOAb、TGAb、TRAb、IgA及IgG水平。

Objective To evaluate the efficacy of selenium combined with antithyroid drugs in patients with Graves’disease.Methods Randomized randomized controlled trials(RCTs)from Pubmed,Medline,Cochrane Library,Embase,Web Of Science,CNKI,CBM and Wanfang database were searched from inception up to June 2018,the RCTs were screenedaccording to the inclusion and exclusion criteria.RevMan 5.0 software and Stata 12.0 software was used to process data analysis.Results A total of9 RCTs were included.The result of meta-analysis showed that the levels of serum FT3 and FT4 in selenium supplemental treatment group were significantly decreased than the control group[WMD=-1.48,95%CI(-1.93,-1.02);WMD=-4.89,95%CI(-7.22,-2.56),respectively],while TSH was significantly increased than the control group(WMD=0.57,95%CI(0.29,0.86))The levels of thyroid peroxidase antibodys as TPOAb,TGAb,TRAb and immunoglobulin IgA,IgG in selenium supplemental treatment group were significantly lower than the control group,while no significant difference was showed between the two groups in the level of IgM.Conclusion The results of Meta-analysis shows that selenium combined with antithyroid drugs in supplemental treatment of Graves’disease can significantly improve the thyroid function.The levels of FT3 and FT4 were significantly decrease and the level of TSH was increased.Besides,selenium combined with antithyroid drugs can significantly improve the levels of autoantibodies.The levels of TPOAb,TGAb,TRAb,IgA and IgG were significantly decreased.