甲状腺激素对心力衰竭伴低T3综合征患者心功能影响的Meta分析

摘要

Objective To systematically assess the curative effect of thyroxine in patients with heart failure complicating low T 3 syn-drome.Methods Retrieving databases including Pubmed ,Web of Science ,Cochrane Library ,CBM ,WanFang database and VIP database.The retrieval time limited from the foundation of database to June 2013.Meantime ,references of articles were searched.According to the inclusion criterion ,relevant articles were screened.After extracting data ,quality of data was assessed ,and meta_analysis was performed by RevMan 5.2.Results A total of 11 RCTs involving 662 patients were included.The result of meta_analyses showed that ,compared with the control group ,after short_term treatment with thyroxine ,left ventricular ejection fraction (LVEF) and cardiac output (CO ) of the treatment group obviously increased (MD=5.16 ,95% CI=3.11~7.21 , P<0.01;MD=0.55 ,95%CI=0.33~0.7 P<0.01 ).Besides ,the evaluation index of ventricular diastolic function E/A was improved and left ventricular end diastolic diameter (LVDD ) was decreased (MD=0.22 ,95% CI=0.09~0.34 ,P<0.01;MD= -4.14 ,95% CI= -6.66~ -1.61 ,P<0.01 ).Conclusions Thyroxine based on routine treatment can improve the heart ejection function and the ventricular dias-tolic function for patients with heart failure complicating low T 3 syndrome.%目的：系统评价甲状腺激素替代治疗心力衰竭伴低T3综合征患者的疗效。方法计算机检索数据库包括Pubmed、Web of Science、COCHRANE LIBRARY、中国生物医学数据库、万方数据库和维普数据库，检索时限从建库至2013年6月，同时追索纳入文章的参考文献。严格按照纳入标准筛选文献、提取资料和评价质量后，应用Review Man-ager 5.2软件对所纳入的研究结果进行Meta分析。结果共纳入11篇RCT文献资料，包括662例心力衰竭伴低T3综合征患者。Meta分析结果显示：与常规治疗组相比，甲状腺素组（甲状腺激素加常规治疗）的左心室射血分数（LVEF）和心输出量（CO ）明显增加（MD＝5.16，95％ CI＝3.11～7.21，P＜0.01；MD＝0.55，95％ CI＝0.33～0.77，P＜0.01），评价心室舒缩功能的E/A值升高和左心室舒张末内径（LVDD ）降低（MD＝0.22，95％ CI＝0.09～0.34，P＜0.01；MD＝-4.14，95％ CI＝-6.66～-1.61，P＜0.01）。结论心力衰竭伴低T3综合征患者在常规治疗基础上加用甲状腺激素可明显提高患者的心脏射血功能及改善心室的舒缩功能。