左甲状腺素对亚临床甲状腺功能减退患者颈动脉内膜中层厚度进展的影响：一项荟萃分析。
Effect of levothyroxine on the progression of carotid intima-media thickness in subclinical hypothyroidism patients: a meta-analysis.
作者信息
Zhao Tong, Chen Baomin, Zhou Yingying, Wang Xinyi, Zhang Yuanyuan, Wang Haoyu, Shan Zhongyan
机构信息
Department of Endocrinology and Metabolism, Institute of Endocrinology, First Affiliated Hospital, Chinese Medical University, Shenyang, Liaoning, China.
Department of Liver and Gall Surgery, First Affiliated Hospital, Chinese Medical University, Shenyang, Liaoning, China.
出版信息
BMJ Open. 2017 Oct 22;7(10):e016053. doi: 10.1136/bmjopen-2017-016053.
BACKGROUND
Subclinical hypothyroidism (SCH) has been associated with increased carotid intima-media thickness (C-IMT) in recent studies, but the effects of levothyroxine (L-T4) therapy on C-IMT in SCH patients are still controversial.
AIM
To evaluate the effect of L-T4 therapy on endothelial function as determined by C-IMT in patients with SCH.
METHODS
BeforeJuly 2016, we searched the PubMed, Embase, Cochrane Library and Google Scholar databases, selecting published randomised controlled trials (RCTs) and self-controlled trials for the meta-analysis.
RESULTS
Three RCTs with 117 patients were considered appropriate for the meta-analysis. The results of the meta-analysis indicated that L-T4 significantly decreased the development of C-IMT (weighted mean difference (WMD) -0.05 mm, 95% CI -0.08 to -0.01 mm; p=0.025). We also analysed nine studies (self-controlled trials) with 247 patients and extracted the IMT of SCH patients before and after L-T4 treatment. After L-T4 therapy, the pooled estimate of the WMD of decreased C-IMT was -0.04 mm (95% CI -0.07 to -0.02 mm; p=0.05). Subgroup analysis showed that L-T4 therapy was associated with a decrease in C-IMT among patients of mixed genders (WMD -0.03 mm, 95% CI -0.06 to -0.01 mm; p=0.145). L-T4 therapy was associated with a decrease in C-IMT among female patients (WMD -0.07 mm, 95% CI -0.14 to -0.01; p=0.186). Longer treatment (>6 months) also resulted in a significant decrease in C-IMT (WMD -0.05 mm, 95% CI -0.08 to -0.02; p=0.335).
CONCLUSION
This meta-analysis indicates that L-T4 treatment of SCH patients can reduce C-IMT, possibly as a result of the reduction of total cholesterol, triglyceride, low density lipoprotein, systolic blood pressure, diastolic blood pressure, lipoprotein(a), and flow-mediated dilatation. Decreased C-IMT was observed in SCH patients after long-term (>6 months) L-T4 treatment. RCTs with larger samples are needed to verify these observations.
背景
近期研究表明，亚临床甲状腺功能减退（SCH）与颈动脉内膜中层厚度（C-IMT）增加有关，但左甲状腺素（L-T4）治疗对SCH患者C-IMT的影响仍存在争议。
目的
评估L-T4治疗对SCH患者由C-IMT所确定的内皮功能的影响。
方法
2016年7月之前，我们检索了PubMed、Embase、Cochrane图书馆和谷歌学术数据库，选择已发表的随机对照试验（RCT）和自身对照试验进行荟萃分析。
结果
三项包含117例患者的RCT被认为适合进行荟萃分析。荟萃分析结果表明，L-T4显著降低了C-IMT的进展（加权均数差（WMD）-0.05 mm，95%可信区间-0.08至-0.01 mm；p=0.025）。我们还分析了九项包含247例患者的研究（自身对照试验），并提取了SCH患者L-T4治疗前后的IMT。L-T4治疗后，C-IMT降低的WMD合并估计值为-0.04 mm（95%可信区间-0.07至-0.02 mm；p=0.05）。亚组分析显示，L-T4治疗与混合性别患者的C-IMT降低有关（WMD -0.03 mm，95%可信区间-0.06至-0.01 mm；p=0.145）。L-T4治疗与女性患者的C-IMT降低有关（WMD -0.07 mm，95%可信区间-0.14至-0.01；p=0.186）。更长时间的治疗（>6个月）也导致C-IMT显著降低（WMD -0.05 mm，95%可信区间-0.08至-0.02；p=0.335）。
结论
这项荟萃分析表明，L-T4治疗SCH患者可降低C-IMT，这可能是总胆固醇、甘油三酯、低密度脂蛋白、收缩压、舒张压、脂蛋白（a）和血流介导的扩张降低的结果。长期（>6个月）L-T4治疗后，SCH患者的C-IMT降低。需要更大样本量的RCT来验证这些观察结果。
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