抗精神病药对甲状腺激素影响的meta分析及系统综述  

Meta-analysis and systematic review of the impact of antipsychotics on thyroid hormones

作　　者：薛千姿 苑妍妍 张鹏飞 王思懿 泮俊宇 李琳 李文强[2] 苏玺 XUE Qianzi;YUAN Yanyan;ZHANG Pengfei;WANG Siyi;PAN Junyu;LI Lin;LI Wenqiang;SU Xi(The Second Clinical College,Xinxiang Medical University,Henan Province,Xinxiang 453003,China;Psychoneurological Institute,the Second Affiliated Hospital of Xinxiang Medical University,Henan Province,Xinxiang 453002,China)

机构地区：[1]新乡医学院第二临床学院,河南新乡453003 [2]新乡医学院第二附属医院精神神经研究所,河南新乡453002

出　　处：《中国当代医药》2024年第30期4-12,共9页China Modern Medicine

基　　金：国家级大学生创新创业训练计划项目(202310472005)。

摘　　要：目的 系统评价抗精神病药对甲状腺功能的影响,探讨其潜在机制并提出临床管理建议。方法 检索中国知网、万方、PubMed和Web of Science数据库2013-2023年关于抗精神病药对甲状腺功能影响的相关文献,由两位研究者独立筛选文献并提取资料,采用RevMan5.3和Stata16.0进行meta分析,并使用Cochrane风险评估工具进行质量评估。结果 共有22篇文献符合纳入标准,其中阿立哌唑、利培酮、喹硫平和奥氮平治疗后,游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、三碘甲状原氨酸(T3)、甲状腺素(T4)水平不同程度降低,促甲状腺激素(TSH)水平有所升高。结论 抗精神病药普遍对甲状腺激素水平产生影响,其潜在机制包括抑制下丘脑-垂体-甲状腺轴、抑制甲状腺激素合成及免疫调控。临床上应根据患者具体情况监测甲状腺功能和抗精神病药的血药浓度,以减少药物引起的甲状腺功能异常,确保用药安全。未来研究需进一步探讨抗精神病药影响甲状腺的具体机制和个体化治疗方案。Objective To systematically evaluate the effects of antipsychotics on thyroid function,explore their underlying mechanisms,and propose clinical management recommendations.Methods Literature from CNKI,Wanfang Database,PubMed,and Web of Science between 2013 and 2023 was reviewed to examine the impact of antipsychotics on thyroid function.Two researchers independently screened and extracted data from the studies.Meta-analysis was conducted using RevMan 5.3 and Stata 16.0,with quality assessment performed using the Cochrane risk of bias tool.Results A total of 22 studies were included based on the criteria.Treatment with Aripiprazole,Risperidone,Quetiapine,and Olanzapine resulted in different levels of reduction in free triodothyronine(FT3),free thyroxine(FT),triodothyronine(T3),and thyroxine(T),a-long with an elevation in thyroid stimulating hormone(TSH)levels.Conclusion Antipsychotics have been shown to impact thyroid hormone levels through various potential mechanisms,such as inhibiting the hypothalamic-pituitary-thyroid axis,suppressing thyroid hormone production,and modulating immune responses.It is important to monitor both thyroid function and blood concentrations of antipsychotics based on individual patient conditions to minimize drug-induced thyroid dys-function and ensure safety.Future research should focus on investigating the precise mechanisms through which antipsy-chotics influence the thyroid gland and developing personalized treatment approaches.

关 键 词：抗精神病药 甲状腺激素 META分析 下丘脑-垂体-甲状腺轴 系统综述 

分 类 号：R749[医药卫生—神经病学与精神病学]