关键词: 糖皮质激素, 给药方式, 甲状腺相关性眼病, Meta分析

Abstract:

 Objective To systematically review the effectiveness and safety of different glucocorticoid administration methods in the treatment of thyroid-associated ophthalmopathy (TAO). Design Systematic review. Participants Published articles associated with corticosteroids therapy for moderate to severe TAO. Methods Databases including PubMed, EMBase, The Cochrane Library (Issue 6, 2017), CBM, CNKI, VIP and Wan Fang Data were searched to collect randomized controlled trials (RCTs) about the effectiveness and safety of different glucocorticoid administration methods in the treatment of TAO from inception to June 2017. Two reviewers independently screened literatures, extracted data and assessed the quality of included studies. Then meta-analysis was conducted by RevMan 5.3 software. Main Outcome Measures Effective rate and CAS score. Results A total of 12 studies involving 589 patients were included. The results of meta-analysis showed that: compared with the oral administration group, effective rate of intravenous administration group was higher[RR=1.38, 95%CI (1.19, 1.60), P＜0.0001], the CAS score improved better[MD=0.84, 95%CI (0.32, 1.36), P=0.002], the quality of life improved better [MD=1.22, 95%CI (1.04, 1.44), P=0.01], the improvement of the exophthalmos of the retrobular injection group was higher than oral administration group[MD=1.01, 95%CI (0.83, 1.20), P＜0.00001]. Compared with the intravenous administration group, the improvement of the exophthalmos of the retrobular injection group was higher [MD=-3.60, 95%CI (-4.93, -2.27), P＜0.00001], improvement of palpebral fissure width was higher[MD=-3.57, 95%CI (-4.84, -2.30), P<0.00001]. Compared with the intravenous administration group, the incidence rate of adverse reactions such as hypertension [RR=0.26, 95%CI (0.08, 0.87), P=0.03], weight gain [RR=0.27, 95%CI (0.11, 0.70), P=0.007] and Cushing syndrome [RR=0.23, 95%CI (0.12, 0.44), P<0.0001] in the oral administration group was higher, and the difference was statistically significant. Conclusion Current evidence shows that intravenous administration has a more potent effect on TAO treatment efficiency, CAS score improvement, improvement in quality of life, and reduction of adverse events and posterior balloon injection is more effective in improving exophthalmos. Due to the limited quality of included studies, the above conclusion still needs to be verified by more high quality studies. (Ophthalmol CHN, 2018, 27: 269-275)

Key words: glucocorticoids, mode of administration, thyroid-associated ophthalmopathy, Meta-analysis