早餐前与睡前给予左甲状腺素治疗甲状腺功能减退症的效果：一项荟萃分析。
Effect of l-thyroxine administration before breakfast vs at bedtime on hypothyroidism: A meta-analysis.
机构信息
Department of Nuclear Medicine, Nanchong Central Hospital, The Second Clinical College of North Sichuan Medical College, Nanchong, China.
Department of Blood Transfusion, Affiliated Hospital of North Sichuan Medical College, North Sichuan Medical College, Nanchong, China.
出版信息
Clin Endocrinol (Oxf). 2020 May;92(5):475-481. doi: 10.1111/cen.14172. Epub 2020 Feb 16.
PURPOSE
To compare the effects of l-thyroxine (L-T4) administration before breakfast and administration at bedtime on hypothyroidism.
METHODS
The PubMed, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang databases were searched to identify relevant articles. All prospective or randomized controlled studies (RCTs) comparing L-T4 administration before breakfast to the administration at bedtime in patients with hypothyroidism were included in the analysis.
RESULTS
Initially, 2884 articles were retrieved from the databases, and 10 articles were included in the quantitative analysis. The effect of L-T4 administration before breakfast compared with administration at bedtime had no statistically significant association with hormone thyrotropin (TSH) (Standardized mean differences [SMD] = 0.09, 95% confidence intervals (CI): -0.12, 0.30; P = .39), or free triiodothyronine (FT3) (SMD=-0.19, 95% CI: -0.53, 0.15; P = .28) in patients with hypothyroidism. However, the result of FT4 level was favourable for L-T4 bedtime administration group (SMD=-0.27, 95% CI: -0.52, -0.02; P = .03).
CONCLUSION
Our meta-analysis revealed that L-T4 administration at bedtime is as effective as administration before breakfast for patients with hypothyroidism. Taking L-T4 at bedtime may be an attractive option for patients with hypothyroidism.
目的
比较早餐前和睡前给予左甲状腺素（L-T4）对甲状腺功能减退症的影响。
方法
检索PubMed、EMBASE、Cochrane 图书馆、Web of Science、中国知网（CNKI）和万方数据库，以确定相关文章。所有比较早餐前给予 L-T4 与甲状腺功能减退症患者睡前给予 L-T4 的前瞻性或随机对照研究（RCT）均纳入分析。
结果
最初从数据库中检索到 2884 篇文章，10 篇文章纳入定量分析。早餐前给予 L-T4 与睡前给予 L-T4 的效果与促甲状腺激素（TSH）（标准化均数差 [SMD] = 0.09，95%置信区间 [CI]：-0.12，0.30；P = 0.39）或游离三碘甲状腺原氨酸（FT3）（SMD =-0.19，95% CI：-0.53，0.15；P = 0.28）无统计学显著相关性。然而，FT4 水平的结果有利于 L-T4 睡前给药组（SMD=-0.27，95% CI：-0.52，-0.02；P = 0.03）。
结论
我们的荟萃分析表明，睡前给予 L-T4 与早餐前给予 L-T4 对甲状腺功能减退症患者同样有效。睡前服用 L-T4 可能是甲状腺功能减退症患者的一个有吸引力的选择。
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