地塞米松联合利多卡因甲状腺内注射治疗亚急性甲状腺炎的网状Meta分析。
完整摘要 · 中文译文
背景：单独甲状腺内注射地塞米松（Dex）或地塞米松合用利多卡因（联合治疗）已用于治疗亚急性甲状腺炎（SAT）。我们开展本研究以同时确定甲状腺内注射Dex是否优于口服泼尼松，以及联合治疗是否优于单一治疗。 方法：我们检索了PubMed、Embase、Cochrane图书馆、中国知网（CNKI）和万方数据库，截至2021年12月31日。评估了临床疗效、复发率、不良反应以及临床症状（包括发热、甲状腺疼痛和甲状腺肿大）的消退时间。计算累积排序曲线下面积（SUCRA）以确定排序概率，并采用雷达图确定最佳方案。使用STATA 14进行数据分析。 结果：共纳入23项研究。结果显示，与口服泼尼松相比，甲状腺内注射显著提高了临床疗效并缩短了临床症状的消退时间。然而，未检测到甲状腺内注射泼尼松的两种方案之间的差异。雷达图提示，单一治疗可能是复发率（79.9%）、发热消退时间（83.6%）、甲状腺疼痛消退时间（92.5%）和不良反应（87.1%）的最佳方案；然而，联合治疗可能是临床疗效（80.0%）和甲状腺肿大消退时间（93.7%）的最佳方案。 结论：甲状腺内注射地塞米松治疗亚急性甲状腺炎（SAT）优于口服泼尼松，且应推荐单药治疗而非联合治疗，因为联合治疗不产生额外的治疗获益。
完整摘要 · 英文原文
BACKGROUND: Intrathyroidal injection of dexamethasone (Dex) alone (monotherapy) or combined Dex with lidocaine (combination therapy) has been used for treating subacute thyroiditis (SAT). We performed this study to simultaneously determine whether intrathyroidal injection of Dex was better than oral prednisone and whether combination therapy was superior to monotherapy. METHODS: We identified studies from PubMed, Embase, Cochrane library, China National Knowledge Infrastructure (CNKI), and Wanfang databases through December 31, 2021. Clinical efficacy, recurrence rate, adverse reactions, and remission time of clinical symptoms including fever, pain of thyroid and thyroid enlargement were assessed. The surface under the cumulative ranking curve (SUCRA) was estimated to determine the rank probabilities, and radar plot was to determine the optimal protocol. STATA 14 was utilized for data analysis. RESULTS: Twenty-three studies were included. Results revealed that, compared with oral prednisone, intrathyroidal injection significantly increased clinical efficacy and shortened remission time of clinical symptoms. However, no difference between the 2 protocols of intrathyroidal injection of prednisone was detected. Radar plot suggested that monotherapy might be the optimal protocol for recurrence rate (79.9%), remission time of fever (83.6%) and pain of thyroid (92.5%), and adverse reactions (87.1%); however, combination therapy for clinical efficacy (80.0%) and remission time of thyroid enlargement (93.7%). CONCLUSION: Intrathyroidal injection of Dex is better than oral prednisone for treating SAT, and monotherapy should be recommended over combination therapy because combination therapy do not produce additional therapeutic benefits.