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JCEM:抗甲状腺药物治疗GD复发率高

2013-07-09 desperado-c dxy

有多种治疗方案可用于Graves病(GD),包括抗甲状腺药物(ATDs)、放射性碘(RAI)和甲状腺切除术。为了确定各种治疗方案的复发率,以及现有的关于ATDs不良反应的数据,来自美国马约诊所Rebecca S Bahn教授及其团队进行了一项研究,该研究发现ATDs治疗GD复发率高。该研究结果在线发表在2013年7月3日的《临床内分泌代谢杂志》(The journal of clinical en

有多种治疗方案可用于Graves病(GD),包括抗甲状腺药物(ATDs)、放射性碘(RAI)和甲状腺切除术。为了确定各种治疗方案的复发率,以及现有的关于ATDs不良反应的数据,来自美国马约诊所Rebecca S Bahn教授及其团队进行了一项研究,该研究发现ATDs治疗GD复发率高。该研究结果在线发表在2013年7月3日的《临床内分泌代谢杂志》(The journal of clinical endocrinology & metabolism)上。

该研究在2012年3月前搜索了多个数据库。合格的研究为在成人进行的、包括2种或2种以上GD治疗方案的随机临床试验(RCTs)和比较队列研究。由两名评审员独立选择研究,评价研究质量,提取结果数据,并确定不良反应范围。

该研究找到8个研究的包括来自5个洲的1402患者。平均随访时间(月)为:ATDs:57,RAI:64,手术:59。研究倾向与中到高风险。网络荟萃分析提示ATDs(52.7%,352/667)比RAI(15%,46/304)有更高的复发率[比值比(OR)=6.25;95%可信区间(CI),2.40-16.67],并且,ATDs比手术有更高的复发率(10%,39/387)[OR=9.09;95%CI,4.65-19.23]。RAI和手术之间的复发率没有统计学差异。检查31项队列研究,确定在692/5136(13%)例患者中出现ATDs不良反应。不良反应在使用甲巯咪唑的患者中更常见,主要是因为皮肤并发症,而肝脏反应在使用丙基硫氧嘧啶患者中更常见。

该研究确认了ATDs治疗与RAI或手术相比,有相对较高的复发率,同时这些药物伴有重要的副作用。这些数据可以告知医师和患者之间关于GD治疗选择的讨论。这篇文章证据质量的局限性强调需要在这个领域的进一步RCTs。


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    2014-02-13 smallant2015
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    2014-02-10 achengzhao
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