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与抗甲状腺药物,放射性和甲状腺功能障碍手术相关的死亡风险:系统审查和网络元分析

Carol Chiung-Hui Peng1, Brianna R Spiegel2, David Flynn3

  • 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.

Thyroid : official journal of the American Thyroid Association
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概括

与抗甲状腺药物 (ATD) 或放射性 (RAI) 相比,甲状腺功能高的手术显著降低了全因和心血管死亡率. 在不同治疗方法中,主要心血管不良事件和癌症死亡风险相似.

关键词:
抗甲状腺药物甲状腺功能过高死亡率网络元分析放射性甲状腺切除术

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科学领域:

  • 内分泌学和新陈代谢
  • 心血管医学
  • 外科瘤学

背景情况:

  • 甲状腺功能过高的治疗方案包括抗甲状腺药物 (ATD),放射性 (RAI) 和手术.
  • 这些甲状腺功能障碍治疗的长期比较结果对于临床决策至关重要.

研究的目的:

  • 进行系统性审查和网络元分析 (NMA),评估ATD,RAI和甲状腺功能障碍手术的长期结果.
  • 在不同治疗方式中比较全因死亡率,心血管死亡率,主要心血管不良事件 (MACE) 和癌症死亡率的风险.

主要方法:

  • 在主要数据库 (PubMed,EMBASE,Web of Science,Cochrane Library) 进行系统的文献搜索,截至2025年3月7日.
  • 使用随机效应模型计算危险比率 (HR) 和置信区间 (CI) 的 12 项观察研究的网络元分析.
  • 这项研究与PROSPERO注册 (CRD420250543380) 并遵循PRISMA- NMA指南.

主要成果:

  • 手术与所有原因死亡率 (HR 0. 58 [0. 45- 0. 75] 与ATD;HR 0. 68 [0. 56- 0. 84] 与RAI) 和心血管死亡率 (HR 0. 43 [0. 19- 0. 98] 与ATD;HR 0. 55 [0. 33- 0. 93] 与RAI) 的显著降低有关.
  • 在治疗组中没有观察到MACE或癌症死亡率的显著差异.
  • 分析包括大量患者,主要使用ATD治疗.

结论:

  • 与ATD和RAI相比,甲状腺功能过高的手术显示出显著的生存益处,降低了全因和心血管死亡率.
  • 治疗方式没有影响MACE或癌症死亡率的风险.
  • 由于潜在的异质性和选择偏差,观察性研究的结果需要谨慎解释.