甲状腺激素治疗亚临床甲状腺功能减退症对血脂水平影响的荟萃分析

Effect of L-thyroxine versus placebo treatment on serum lipid levels in subclinical hypothyroidism

    摘要
  • 摘要:
    目的 使用荟萃分析方法汇总随机对照试验，评估甲状腺激素对亚临床甲状腺功能减退症（SCH）患者血脂水平的影响。
    方法 以“thyroxine”、“ levothyroxin”及“levothyroxine”为关键词检索了2015年7月前包括Cochrane Library、PubMed、Medline、Google Scholar及Embase等在内的数据库中有关甲状腺激素替代治疗SCH的随机对照试验文献，所有数据均为连续型变量，采用Cochrane提供的RevMan 5.2软件进行统计学分析，依据Cochrane质量评价标准进行文献质量评估。当研究间存在异质性时（I2 > 50%），采用随机效应模型进行荟萃分析；否则采用固定效应模型进行荟萃分析。
    结果 最终纳入7篇随机对照试验文献，共319例患者。纳入的7篇文献方法学整体质量较好。共进行4组荟萃分析评价甲状腺激素对血脂的影响，4组研究之间无统计学异质性总胆固醇（TC）：I2=42%，P=0.11；甘油三酯（TG）：I2=0，P=0.92；低密度脂蛋白胆固醇（LDL-C）：I2=34%，P=0.18；高密度脂蛋白胆固醇（HDL-C）：I2=0，P=0.96，均采用固定效应模型进行荟萃分析。荟萃分析结果显示，甲状腺激素及安慰剂对血浆中血脂水平的影响程度如下：TC（平均差：-0.18；95% CI：-0.40，0.03；P=0.09）、TG（平均差：-0.02；95% CI：-0.17，0.13；P=0.78）、LDL-C（平均差：-0.23；95% CI：-0.44，-0.33；P=0.02）、HDL-C（平均差：-0.06; 95% CI：-0.14，0.02；P=0.14）。
    结论 对于SCH患者，在进行外源性甲状腺激素治疗后，血浆LDL-C水平得到改善，而血浆TC、TG、HDL-C水平未见明显变化。

     

    Abstract:
    Objective Subclinical hypothyroidism is a common disease. However, whether L-thyroxine replacement treatment can affect serum lipids in cases of subclinical hypothyroidism remains controversial. The objective of this meta-analysis was to assess the effect of L-thyroxine therapy on serum lipid levels of patients with subclinical hypothyroidism.
    Methods Literature dated until July 2015 was retrieved from the Cochrane Library, PubMed, Medline, Google Scholar, and Embase searching for the keywords "hyroxine", "levothyroxin" and "levothyroxine". All randomized controlled trials(RCTs) to determine the effects of L-thyroxine replacement on serum lipid levels were included in this study. After screening, the eligible RCTs were included in this meta-analysis. Statistical analyses were performed by the Review Manager 5.2 software. All the assessed outcomes were continuous data.
    Results A total of 7 RCTs involving 319 patients were included. The overall methodological quality of the RCTs was good. Results showed that the serum low density lipoprotein-cholesterol(LDL-C) level significantly decreased after L-thyroxine treatment mean difference(MD):-0.23; 95% CI: -0.44, -0.03; P=0.02. Meanwhile, changes in the total cholesterol(MD: -0.18; 95% CI: -0.40, 0.03; P=0.09), triglyceride(MD: -0.02; 95% CI: -0.17, 0.13; P=0.78), and high density lipoprotein-cholesterol(MD: -0.06; 95% CI: -0.14, 0.02; P=0.14) levels were not significant.
    Conclusions All available RCT evidence on the effect of L-thyroxine on serum lipid levels in subclinical hypothyroidism revealed a significant improvement in the serum LDL-C levels. However, the serum TC, TG, and HDL-C levels did not significantly change.

     

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