慢性肾脏病儿童的甲状腺功能障碍：系统综述与荟萃分析。
完整摘要 · 中文译文
背景/目的：已有报道显示慢性肾脏病（CKD）患儿存在甲状腺异常，但“甲状腺功能障碍”这一宽泛术语涵盖了临床表型不同的情况。本研究旨在估计亚临床甲状腺功能减退症（SCH）的患病率，并分别描述其他甲状腺异常的特征。 方法：按照PRISMA 2020指南系统检索了PubMed/MEDLINE、Scopus和Google Scholar。纳入的研究包括年龄0-18岁、CKD分期1-5期（包括接受肾脏替代治疗）的患者。主要荟萃分析纳入经同行评审、具有明确或由作者分类的SCH定义且可获取分子和分母数据的研究。随机效应模型采用限制性最大似然估计并结合改良Hartung-Knapp推断。 结果：共纳入11项研究，涉及694名儿童。7项经同行评审的研究（共403名参与者、50例SCH病例）纳入主要荟萃分析。合并SCH患病率为12.8%（95% CI，9.2-17.6%），95%预测区间为9.1-17.9%，未检测到异质性（I2 = 0%）。二项-正态广义线性混合模型得出相似估计值12.4%（95% CI，9.3-15.9%）。纳入一篇预印本后患病率升至14.8%，并引入显著异质性（I2 = 65.9%）。显性甲状腺功能减退症仅有零星报道，而低T3/非甲状腺疾病模式更为常见，但不适合进行定量合成。 结论：在纳入的CKD队列中，约八分之一的儿童被归类为h 根据各研究特定定义，脑微出血（SCH）的患病率存在差异；其持续存在及临床意义仍不确定。当前证据不足以支持常规进行CKD特异性的左甲状腺素治疗。需要标准化的纵向研究来明确其持续性、临床意义及潜在的治疗获益。
完整摘要 · 英文原文
BACKGROUND/OBJECTIVES: Thyroid abnormalities have been reported in children with chronic kidney disease (CKD), but the broad term "thyroid dysfunction" encompasses clinically distinct phenotypes. This study aimed to estimate the prevalence of subclinical hypothyroidism (SCH) and characterize other thyroid abnormalities separately. METHODS: PubMed/MEDLINE, Scopus, and Google Scholar were systematically searched according to PRISMA 2020. Eligible studies included patients aged 0-18 years with CKD stages 1-5, including kidney replacement therapy. The primary meta-analysis included peer-reviewed studies with an explicit or author-classified SCH definition and recoverable numerator and denominator data. Random-effects models used restricted maximum likelihood estimation with modified Hartung-Knapp inference. RESULTS: Eleven studies involving 694 children were included. Seven peer-reviewed studies comprising 403 participants and 50 SCH cases contributed to the primary meta-analysis. The pooled SCH prevalence was 12.8% (95% CI, 9.2-17.6%), with a 95% prediction interval of 9.1-17.9% and no detected heterogeneity (I2 = 0%). A binomial-normal generalized linear mixed model yielded a similar estimate of 12.4% (95% CI, 9.3-15.9%). Including one preprint increased prevalence to 14.8% and introduced substantial heterogeneity (I2 = 65.9%). Overt hypothyroidism was reported sporadically, whereas low-T3/non-thyroidal-illness patterns were more frequent but unsuitable for quantitative synthesis. CONCLUSIONS: Approximately one in eight children in the included CKD cohorts was classified as having SCH according to study-specific definitions; persistence and clinical significance remain uncertain. Current evidence is insufficient to support routine CKD-specific levothyroxine therapy. Standardized longitudinal studies are needed to clarify persistence, clinical significance, and potential treatment benefits.