硒治疗自身免疫性甲状腺疾病的荟萃分析  

A meta-analysis of selenium in the treatment of autoimmune thyroid diseases

作　　者：房方[1] 卫红艳[1] 王坤玲[1] 朱梅[1] 

机构地区：[1]天津医科大学总医院内分泌科,300052

出　　处：《国际内分泌代谢杂志》2016年第4期247-252,F0003,共7页International Journal of Endocrinology and Metabolism

摘　　要：目的 评价元素硒治疗自身免疫性甲状腺疾病（AITD）的有效性和安全性.方法 通过5个数据库（MEDLINE,Cochrane Central Register of Controlled Trials,中国期刊全文数据库,中国生物医学文献数据库和维普数据库）检索所有研究元素硒治疗AITD的随机对照试验（RCT）.由两名研究者独立筛选文献、提取数据和进行结果的统计分析.将结果数据形式一致的同类临床试验的结果进行荟萃分析,对不能荟萃分析的数据进行描述性分析.共纳入30项RCT,涉及2 963例AITD患者.结果 （1）与对照组相比,硒治疗组桥本甲状腺炎患者甲状腺过氧化物酶抗体（TPOAb）和甲状腺球蛋白抗体（TgAb）水平明显下降[标准化均数差（SMD）=-1.35,95％ CI：-1.93～-0.67,P ＜0.000 01和SMD=-0.92,95％ CI：-1.53～-0.31,P＜0.01].（2）硒治疗组与对照组相比,Graves病患者促甲状腺激素受体抗体（TRAb）水平降低（均数差=-2.5,95％ CI：-2.99～-2.01,P＜0.000 01）.（3）元素硒可以降低Graves病患者血清游离T3（FT3）和游离T4（FT4）水平（均数差=-1.57,95％ CI：-2.56～-0.58,P＜0.001和均数差=-3.74,95％ CI：-5.65～-1.82,P=0.000 01）,但对桥本甲状腺炎患者FT3、FT4和促甲状腺激素的作用不明显（P均＞0.05）.结论 对AITD患者使用200 μg∥d的元素硒治疗3～12个月,能够有效降低抗甲状腺自身抗体（TPOAb,TgAb和TRAb）的水平,并具有较好的安全性.Objective To assess the effectiveness and safety of selenium in the treatment of autoimmune thyroid diseases （AITD）.Methods Five databases （MEDLINE,Cochrane Central Register of Controlled Trials,CBM,CNKI and VIP） were searched for all randomized controlled trial （RCT） which investigating the effectiveness of selenium in the treatment of AITD.Two authors independently selected studies,extracted data and analyzed the results.Meta-analyses were performed when more than one study with sufficient similarity provided data on an outcome.Thirty RCTs were included involving 2 963 patients with AITD.Results （1） Compared with control group,serum thyroid peroxidase antibody （TPOAb） and thyroglobulin antibody （TgAb） were reduced in patients with Hashimoto＇s thyroiditis treated with selenium[standardized mean difference （SMD） =-1.35（95% CI：-1.93 to-0.67,P〈0.000 01）,-0.92（95%CI：-1.53 to-0.31,P 〈0.01）,respectively].（2） Compared with control group,the concentration of thyrotropin receptor antibody （TRAb） was significantly decreased in patients of Graves＇ disease treated with selenium [mean difference （MD） =-2.5,95% CI-2.99 to-2.01,P〈0.000 01].（3） Serum concentrations of free T3 （FT3） and free T4 （FT4） were significantly reduced in patients of Graves＇ disease treated with selenium （MD =-1.57,95% CI：-2.56 to-0.58,P〈0.001 and MD =-3.74,95%CI：-5.65 to-1.86,P =0.000 01）,but serum FT3,FI4 and thyroid stimulating hormone in patients of Hashimoto＇s thyroiditis treated with selenium were not significantly decreased（all P 〉 0.05）.Conclusion Selenium supplementation of 200 μg/d for 3 to 12 months in patients with AITD can effectively decrease the concentration of anti-thyroid autoimmune antibodies （including TPOAb,TgAb and TRAb）,and have safety profile.

关 键 词：硒 自身免疫性甲状腺疾病 桥本甲状腺炎 GRAVES病 

分 类 号：R581[医药卫生—内分泌]