空腹与餐后状态对甲状腺功能检测参数及诊断解读的影响：系统综述与荟萃分析。
完整摘要 · 中文译文
背景：甲状腺功能检查是最常被申请的检查之一；若干分析前因素可能对其产生影响。参考范围未针对空腹与餐后采样进行标准化。我们旨在综合比较空腹与餐后甲状腺功能检查的证据，并评估这些因素对诊断分类的影响。 方法：本系统综述与荟萃分析遵循PRISMA 2020报告规范，并进行前瞻性注册（PROSPERO CRD420261344874）。使用PECO框架检索MEDLINE（通过PubMed）、Embase、Scopus和Web of Science，纳入报告同一受试者同日配对空腹与餐后TSH、FT4或FT3的观察性研究和随机对照试验（RCT）研究（发表截止日期为2026年3月24日）。数据提取和偏倚风险评估由两人独立重复进行。比较采用单组前后数据进行分析，使用随机效应模型，平均差值按餐后减去空腹水平计算。分析在研究层面、对照亚组层面以及三水平模型作为替代方案进行。异质性采用I²量化，证据确定性采用GRADE评级。 结果：共纳入14项研究。对于TSH（14项研究，24个亚组比较；n = 1257），合并平均差值（MD）为- 0.802 mIU/L（95% CI - 1.073至- 0.531；I² = 99.7%），表明餐后TSH显著降低（证据确定性低）；且在各亚组和敏感性分析中结果稳健，在显性（- 2.518 mIU/L）和亚临床甲状腺功能减退症（- 2. 173 mIU/L）。FT4或FT3未发现显著的空腹-餐后差异。 结论：热量摄入可能显著降低餐后TSH，但证据确定性较低。这在临界甲状腺功能障碍中具有临床意义，可能促使错误分类为甲状腺功能正常状态。标准化并记录空腹状态可能改善临界甲状腺结果的解读，尽管当前证据尚未确立任一采样条件的优越性。
完整摘要 · 英文原文
BACKGROUND: Thyroid function tests are among the most frequently requested investigations; several pre-analytical factors may influence them. Reference ranges are not standardized for fasting versus postprandial sampling. We aimed to synthesize evidence comparing fasting and postprandial thyroid function test and to assess the effect of these on diagnostic classification. METHODS: This systematic review and meta-analysis followed PRISMA 2020 for reporting and was prospectively registered (PROSPERO CRD420261344874). MEDLINE (through PubMed), Embase, Scopus and Web of Science were searched using a PECO framework for observational & RCT studies (publication cut off as March 24th, 2026) reporting paired, same-day fasting and postprandial TSH, FT4 or FT3 in the same individuals. Data extraction and risk-of-bias assessment were performed in duplicate. Comparisons were analysed as single-group pre-post data using random-effects models with the mean difference calculated as postprandial minus fasting levels. The analysis was conducted at study level, comparator sub-group level and a three-level model as alternatives. Heterogeneity was quantified with I² and certainty was rated using GRADE. RESULTS: Fourteen studies were included. For TSH (14 studies with 24 subgroup comparisons; n = 1257), the pooled mean difference (MD) was - 0.802 mIU/L (95% CI - 1.073 to - 0.531; I² = 99.7%), indicating significantly lower postprandial TSH (low certainty of evidence); and robust across subgroups and sensitivity analyses, with greatest in overt (- 2.518 mIU/L) and subclinical hypothyroidism (- 2.173 mIU/L). No significant fasting-postprandial difference was found for FT4 or FT3. CONCLUSION: Caloric intake might significantly lower postprandial TSH, but with low certainty. This has clinical relevance in borderline thyroid dysfunction, where it may drive misclassification towards euthyroid state. Standardizing and recording fasting status may improve interpretation of borderline thyroid results, although current evidence does not establish superiority of either sampling condition.