球后注射糖皮质激素治疗甲状腺相关眼病的Meta分析  

Treatment for Thyroid-associated Ophthalmopathy with Retrobular Injection of Glucocorticoid:A Meta-analysis

作　　者：齐冬梅[1] 何为民[1] 

机构地区：[1]四川大学华西医院眼科,成都610041

出　　处：《中国循证医学杂志》2010年第6期678-682,共5页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价球后注射糖皮质激素治疗甲状腺相关眼病的临床效果。方法计算机检索CochraneLibrary(2010年第1期)、EBMReviews、PubMed和中国生物医学文献数据库。检索时间为建库至2010年4月。全面收集球后注射糖皮质激素治疗甲状腺相关眼病的随机对照试验(RCT),评价纳入研究质量,提取有效数据,采用RevMan4.2.8软件进行Meta分析。结果共纳入7个RCT,共398例患者。按测量指标和干预措施进行亚组分析。Meta分析结果显示,总有效率比较,球后注射优于空白对照组,差异有统计学意义[RR=1.35,95%CI(1.10,1.65),P=0.004],球后注射与口服激素间差异无统计学意义[RR=1.15,95%CI(0.93,1.42),P=0.20],球后注射组与球后注射联合放疗组差异有统计学意义[RR=0.85,95%CI(0.72,1.00),P=0.04]。球后注射组3例患者出现眶内出血和2例患者出现软组织加重的局部并发症,未出现体重加重及柯兴综合征等全身并发症。结论现有临床研究证据显示,球后注射糖皮质激素是治疗甲状腺相关眼病的有效治疗方案,可避免全身用药的副作用。联合球后放疗可提高疗效。Objective To evaluate the efficacy of treatment of thyroid-associated ophthalmopathy with retrobular injection of glucocorticoid.Methods We searched The Cochrane Library（Issue 1,2010）,EBM Reviews,PubMed and CBMdisc to collect randomized controlled trials（RCTs） of retrobular injection of glucocorticoid for thyroid-associated ophthalmopathy.The quality of the included trials was assessed and meta-analyses were conducted by RevMan 4.2.8 software.We conducted subgroup analyses based on the outcome measures and intervention.Results A total of 7 RCTs were identified.There were significant differences between retrobular injection of glucocorticoid and blank in the effective rate（RR=1.35,95%CI 1.10 to 1.65,P=0.004）.There were no signif icant differences between retrobular injection of glucocorticoid and oral glucocorticoid in the effective rate（RR=1.15,95%CI 0.93 to 1.42,P=0.20）.And there were significant differences between retrobular injection of glucocorticoid alone and retrobular injection of glucocorticoid combined with radiotheraphy in the effective rate（RR=0.85,95%CI 0.72 to 1.00,P=0.04）.Three patients of the ROGC experienced intraorbital hemorrhage and two of the ROGC experienced aggravation of soft tissues.There were no systemic adverse reactions such as weight gaining and Cushing＇s syndrome.Conclusion Retrobular injection of glucocorticoid appears to be an effective treatment for thyroid-associated ophthalmopathy.And combination retrobular injection of glucocorticoid with radiotheraphy seems to be more effective.

关 键 词：甲状腺相关眼病 球后注射治疗 糖皮质激素 META分析 

分 类 号：R581[医药卫生—内分泌]