Department of Pharmacy, Yaan People's Hospital, Yaan, China.
Department of Pharmacy, Xichong People's Hospital, Nanchong, China.
Medicine (Baltimore). 2024 Nov 8;103(45):e40495. doi: 10.1097/MD.0000000000040495.
The combination of methimazole and propranolol is considered an effective treatment regimen for hyperthyroidism in clinical practice; however, detrimental effects on the heart rate, bone metabolism and thyroid hormone levels have been reported. Therefore, the present study aimed to systematically review the efficacy and safety differences in patients with hyperthyroidism and the effects of treatment on heart rate, bone metabolism, cortisol, and adrenocorticotropic hormone levels using case-control studies.
Clinical case-control trials of methimazole combined with propranolol for the treatment of hyperthyroidism were selected from Chinese and English databases, and data were collected from the establishment of the database until August 2024. Two independent researchers evaluated the quality of the literature using the Newcastle-Ottawa Scale (NOS). Meta-analysis of each effect index was performed using RevMan software (version 5.3), and the quality of the results was evaluated using the GRADE profiler system letter description method.
Sixteen clinical case-control trials were included in this study. Of these, 2 trials exhibited NOS scores of 7, 6 trials exhibited NOS scores of 6, and 8 trials exhibited NOS scores of 5. These accounted for 12.5% of the high-quality literatures, and included 772 patients treated with methimazole combined with propranolol (observation group) and 771 patients treated with methimazole alone (control group). The results of the meta-analysis demonstrated that methimazole combined with propranolol improved the cure rate, the total effective rate, and heart rate, compared with the control group (P < .05). In addition, calcification, bone glutamate protein, free triiodothyronine, free tetraiodothyronine, thyroid-stimulating hormone, cortisol, and adrenocorticotropic hormone were significantly different between the 2 groups (P < .05). There were no significant differences in leukemia, headache, dizziness, skin pruritus, bone pain, arthralgia, or in improving parathyroid hormone or reducing gastrointestinal reactions between the 2 groups.
The present study demonstrated that methimazole combined with propranolol may significantly improve the heart rate, bone metabolism and associated hormone levels in patients with hyperthyroidism, without significantly increasing the risk of adverse reactions. However, due to the impact of primary literature type, quality or research methods high-quality, multicenter, rigorously designed clinical trials are required for further verification.
甲巯咪唑联合普萘洛尔被认为是临床治疗甲状腺功能亢进的有效治疗方案；然而，据报道，该方案会对心率、骨代谢和甲状腺激素水平产生不良影响。因此，本研究旨在通过病例对照研究系统评价甲状腺功能亢进患者使用甲巯咪唑联合普萘洛尔治疗的疗效和安全性差异，以及治疗对心率、骨代谢、皮质醇和促肾上腺皮质激素水平的影响。
从中文和英文数据库中选择甲巯咪唑联合普萘洛尔治疗甲状腺功能亢进的临床病例对照试验，并从数据库建立到 2024 年 8 月收集数据。两名独立的研究人员使用纽卡斯尔-渥太华量表（NOS）评估文献质量。使用 RevMan 软件（版本 5.3）对每个效应指标进行荟萃分析，并使用 GRADE 分析员系统信函描述法评估结果质量。
本研究纳入了 16 项临床病例对照试验。其中，2 项研究的 NOS 评分为 7 分，6 项研究的 NOS 评分为 6 分，8 项研究的 NOS 评分为 5 分。这占高质量文献的 12.5%，包括 772 例接受甲巯咪唑联合普萘洛尔治疗的患者（观察组）和 771 例接受甲巯咪唑单药治疗的患者（对照组）。荟萃分析结果表明，与对照组相比，甲巯咪唑联合普萘洛尔可提高治愈率、总有效率和心率（P<0.05）。此外，两组间钙化、骨谷氨酸蛋白、游离三碘甲状腺原氨酸、游离甲状腺素、促甲状腺激素、皮质醇和促肾上腺皮质激素水平差异有统计学意义（P<0.05）。两组间白血病、头痛、头晕、皮肤瘙痒、骨痛、关节痛、甲状旁腺激素改善或胃肠道反应减少的差异无统计学意义。
本研究表明，甲巯咪唑联合普萘洛尔可能显著改善甲状腺功能亢进症患者的心率、骨代谢及相关激素水平，且不会显著增加不良反应风险。然而，由于主要文献类型、质量或研究方法的影响，需要进一步验证高质量、多中心、设计严谨的临床试验。
