三种中成药联合优甲乐治疗桥本甲状腺炎的网状Meta分析-现代医学

三种中成药联合优甲乐治疗桥本甲状腺炎的网状Meta分析

单位：1. 北京中医药大学中日友好临床医学院, 北京 100029;
2. 中日友好医院乳甲外科, 北京 100000

分类号：R581.4

出版年·卷·期（页码）：2025·53·第五期（750-760）

摘要：

目的： 基于贝叶斯网状Meta分析评估3种常见中成药联合优甲乐治疗桥本甲状腺炎的临床疗效。方法： 通过中国知网、PubMed等数据库检索自建库以来至今涉及百令胶囊、夏枯草制剂、小金片联合优甲乐治疗桥本甲状腺炎的随机对照试验。筛选后利用Stata 16.0软件进行网状Meta分析。结果： 共纳入27篇RCT研究，涵盖2 828例患者，涉及4种干预方式。网状Meta结果显示：(1) 提高临床有效率方面：夏枯草制剂+优甲乐>小金片+优甲乐＞百令胶囊+优甲乐＞单纯优甲乐治疗；(2) 降低甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb)方面：小金片+优甲乐＞百令胶囊+优甲乐＞夏枯草制剂+优甲乐＞单纯优甲乐治疗；(3) 降低促甲状腺激素(TSH)方面：小金片+优甲乐＞夏枯草制剂+优甲乐＞百令胶囊+优甲乐＞单纯优甲乐治疗；(4) 升高游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)方面：小金片+优甲乐＞百令胶囊+优甲乐＞夏枯草制剂+优甲乐＞单纯优甲乐治疗。结论： 3种中成药联合优甲乐治疗桥本甲状腺炎的效果相较于单纯优甲乐更佳，安全性更好。其中小金片+优甲乐治疗在降低TGAb、TPOAb、TSH水平及升高FT3、FT4水平方面排名第一，夏枯草制剂+优甲乐治疗在提高临床治疗有效率方面排名第一。但不同中成药联合优甲乐治疗间缺乏直接比较，研究结果仍需进一步验证。

Objective: To evaluate the clinical efficacy of three common traditional Chinese patent medicines combined with Euthyrox in the treatment of Hashimoto's thyroiditis based on Bayesian network Meta analysis. Methods: Randomized controlled trials(RCT) involving Bailing Capsules, Prunella vulgaris preparations, and Xiaojin tablets combined with Euthyrox for the treatment of Hashimoto's thyroiditis were searched from databases such as CNKI and PubMed since the establishment of the database. After screening, a network Meta analysis was conducted using Stata 16.0 software. Results: Twenty-seven RCT studies were included, covering 2 828 patients with four intervention methods. The network Meta analysis showed:(1) In terms of improving the clinical response rate: Prunella vulgaris preparation+Euthyrox>Xiaojin tablet+Euthyrox>Bailing Capsules+Euthyrox>Euthyrox monotherapy;(2) In terms of reducing thyroglobulin antibodies(TGAb) and thyroid peroxidase antibody(TPOAb) levels: Xiaojin tablet+Euthyrox>Bailing Capsules+Euthyrox>Prunella vulgaris preparation+Euthyrox>Euthyrox monotherapy;(3) In terms of reducing thyroid-stimulating hormone(TSH) levels: Xiaojin tablet+Euthyrox>Prunella vulgaris preparation+Euthyrox>Bailing Capsules+Euthyrox>Euthyrox monotherapy;(4) In terms of increasing free triiodothyronine(FT3) and free thyroxine(FT4) levels: Xiaojin tablet+Euthyrox>Bailing Capsules+Euthyrox>Prunella vulgaris preparation+Euthyrox>Euthyrox monotherapy. Conclusion: The effects of the three traditional Chinese patent medicines combined with Euthyrox in the treatment of Hashimoto's thyroiditis are better than Euthyrox monotherapy, and the safety is better. Xiaojin tablet combined with Euthyrox treatment ranks first in reducing TGAb, TPOAb and TSH levels, and increasing FT3 and FT4 levels, while Prunella vulgaris preparation combined with Euthyrox treatment ranks first in improving the clinical treatment response rate. However, there is a lack of direct comparison between different traditional Chinese patent medicines combined, and the research results still need further verification.

参考文献：

[1] WEETMAN A P.An update on the pathogenesis of Hashimoto's thyroiditis[J].J Endocrinol Invest,2021,44(5):883-890.
[2] RAGUSA F,FALLAHI P,ELIA G,et al. Hashimotos' thyroiditis:Epidemiology,pathogenesis,clinic and therapy[J].Best Pract Res Clin Endocrinol Metab,2019,33(6):101367.
[3] CATUREGLI P,DE REMIGIS A,ROSE N R.Hashimoto thyroiditis:clinical and diagnostic criteria[J].Autoimmun Rev,2014,13(4-5):391-397.
[4] CATUREGLI P,DE REMIGIS A,CHUANG K,et al. Hashimoto's thyroiditis:celebrating the centennial through the lens of the Johns Hopkins hospital surgical pathology records[J].Thyroid,2013,23(2):142-150.
[5] CONRAD N,MISRA S,VERBAKEL J Y,et al. Incidence,prevalence,and co-occurrence of autoimmune disorders over time and by age,sex,and socioeconomic status:a population-based cohort study of 22 million individuals in the UK[J].Lancet,2023,401(10391):1878-1890.
[6] HU X,CHEN Y,SHEN Y,et al. Global prevalence and epidemiological trends of Hashimoto's thyroiditis in adults:a systematic review and meta-analysis[J].Front Public Health,2022,10:1020709.
[7] LEESE G P,FLYNN R V,JUNG R T,et al. Increasing prevalence and incidence of thyroid disease in Tayside,Scotland:the Thyroid Epidemiology Audit and Research Study(TEARS)[J].Clin Endocrinol,2008,68(2):311-316.
[8] ANTONELLI A,FERRARI S M,CORRADO A,et al. Autoimmune thyroid disorders[J].Autoimmun Rev,2015,14(2):174-180.
[9] AJJAN R A,WEETMAN A P.The pathogenesis of Hashimoto's thyroiditis:further developments in our understanding[J].Horm Metab Res,2015,47(10):702-710.
[10] CHEN Y K,LIN C L,CHENG F T,et al. Cancer risk in patients with Hashimoto's thyroiditis:a nationwide cohort study[J].Br J Cancer,2013,109(9):2496-2501.
[11] LIN H C,CHANG H M,HUNG Y M,et al. Hashimoto's thyroiditis increases the risk of new-onset systemic lupus erythematosus:a nationwide population-based cohort study[J].Arthritis Res Ther,2023,25(1):20.
[12] CHEN W H,CHEN Y K,LIN C L,et al. Hashimoto's thyroiditis,risk of coronary heart disease,and L-thyroxine treatment:a nationwide cohort study[J].J Clin Endocrinol Metab,2015,100(1):109-114.
[13] GROENEWEGEN K L,MOOIJ C F,VAN TROTSENBURG A S P.Persisting symptoms in patients with Hashimoto's disease despite normal thyroid hormone levels:does thyroid autoimmunity play a role a systematic review[J].J Transl Autoimmun,2021,4:100101.
[14] DJUROVIC M,PEREIRA A M,SMIT J W A,et al. Cognitive functioning and quality of life in patients with Hashimoto thyroiditis on long-term levothyroxine replacement[J].Endocrine,2018,62(1):136-143.
[15] LIONTIRIS M I,MAZOKOPAKIS E E.A concise review of Hashimoto thyroiditis(HT) and the importance of iodine,selenium,vitamin D and gluten on the autoimmunity and dietary management of HT patients.Points that need more investigation[J].Hell J Nucl Med,2017,20(1):51-56.
[16] ESKES S A,ENDERT E,FLIERS E,et al. Selenite supplementation in euthyroid subjects with thyroid peroxidase antibodies[J].Clin Endocrinol(Oxf),2014,80(3):444-451.
[17] TOPLISS D J.Clinical update in aspects of the management of autoimmune thyroid diseases[J].Endocrinol Metab(Seoul),2016,31(4):493-499.
[18] World Health Organization.WHO traditional medicine strategy:2014—2023[M].Geneva:World Health Organization,2013:44-49.
[19] TAO Y X,LI Q,LI C C,et al. Efficacy of Chinese medicine in the adjuvant treatment of Hashimoto's thyroiditis with hypothyroidism:a systematic review and meta-analysis[J].Biotechnol Genet Eng Rev,2024,40(1):492-518.
[20] MENG X,LIU S,DENG X,et al. Clinical efficacy of Bupleurum inula flower soup for immune damage intervention in Hashimoto's thyroiditis:a placebo-controlled randomized trial[J].Front Pharmacol,2022,13:1049618.
[21] 田依依,王娜,胡剑卓.百令胶囊治疗桥本氏甲状腺炎临床观察[J].实用中医内科杂志,2020,34(8):75-78.
[22] 王鄂明,齐若谷,韩丽丽,等.夏枯草胶囊辅助治疗桥本甲状腺炎临床研究[J].新中医,2020,52(19):91-94.
[23] 任意,赵铁铮,王玉文,等.小金胶囊联合左甲状腺素钠片治疗桥本氏甲状腺炎的临床研究[J].中国中西医结合外科杂志,2020,26(3):465-470.
[24] HUTTON B,SALANTI G,CALDWELL D M,et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions:checklist and explanations[J].Ann Intern Med,2015,162(11):777-784.
[25] HIGGINS J P T,THOMAS J,CHANDLER J,et al. Cochrane Handbook for Systematic Reviews of Interventions[M].2nd Edition.New York:John Wiley & Sons,2019:138-560.
[26] 魏静,田建卿,陈江辉,等.左甲状腺素钠与夏枯草胶囊对桥本甲状腺炎的临床疗效[J].检验医学与临床,2014,11(24):3430-3432.
[27] 马艳,马新艳.左甲状腺素钠片联合夏枯草颗粒对桥本甲状腺炎患者甲状腺功能的影响[J].临床医学研究与实践,2022,7(4):140-142.
[28] 颜翠兰,赵西敏,刘刚.超声观察夏枯草胶囊治疗桥本甲状腺炎前后的声像图变化[J].中国卫生标准管理,2018,9(15):109-110.
[29] 迪丽卡麦尔·艾沙.优甲乐联合硒维尔与百令胶囊对桥本氏甲状腺炎并甲减患者的(Anti-TPO,Anti-TG)抗体水平比较[D].南昌:南昌大学,2016.
[30] 詹添福,陈丹杰.百令胶囊辅助治疗桥本甲状腺炎的疗效及对血清TNF-α、IL-2、IL-6水平的影响[J].实用中医内科杂志,2021,35(8):129-131.
[31] 袁娟.优甲乐联合夏枯草颗粒对桥本甲状腺炎患者甲状腺功能影响研究[J].辽宁中医药大学学报,2015,17(12):149-152.
[32] 薛磊,苏冬月,庞妩燕.优甲乐联合夏枯草胶囊对桥本甲状腺炎患者自身抗体及Th17细胞的影响[J].中国老年学杂志,2014,34(14):4053-4054.
[33] 范智媛,张淋淋,米蕊.夏枯草胶囊治疗桥本甲状腺炎的效果及治疗前后甲状腺形态的超声诊断变化[J].河北医科大学学报,2017,38(4):446-449.
[34] 胡锟,张显林.小金胶囊联用左甲状腺素钠治疗结节性桥本氏甲状腺炎的临床观察[J].世界中医药,2018,13(8):1850-1854.
[35] 罗润佳.小金丸治疗桥本氏甲状腺炎亚临床甲减期的代谢组学研究[D].济南:山东中医药大学,2021.
[36] 石元同,张思德.夏枯草胶囊联合优甲乐治疗桥本甲状腺炎临床疗效[J].陕西中医,2017,38(11):1562-1563.
[37] 王娜娜,李雪锋,邓卫平,等.百令胶囊与夏枯草口服液联合优甲乐治疗桥本甲状腺炎甲减的临床疗效对比研究[J].湖北医药学院学报,2021,40(2):134-138.
[38] 汪天翔,黄小娥,周小栋.左甲状腺素钠片联合夏枯草胶囊治疗桥本氏甲状腺炎伴结节效果分析[J].新中医,2017,49(10):60-62.
[39] 殷东华.左甲状腺素片与小金胶囊联合治疗桥本甲状腺炎的效果及对过氧化物酶抗体和炎症因子的影响研究[J].贵州医药,2021,45(3):369-370.
[40] 李晏.夏枯草口服液对桥本甲状腺炎甲状腺功能和自身抗体的影响研究[J].南通大学学报(医学版),2017,37(5):488-489.
[41] 曾奕斐.基于氨基酸代谢组学探究小金丸治疗甲减期桥本氏甲状腺炎的临床疗效及作用机制[D].济南:山东中医药大学,2022.
[42] 张立春.小金胶囊联合左甲状腺素钠片治疗桥本甲状腺炎的临床效果[J].临床合理用药杂志,2021,14(20):93-95.
[43] 刘家斌,杨云梅,侯宁.夏枯草对桥本氏甲状腺炎并结节甲状腺功能和结节大小影响[J].中国卫生标准管理,2018,9(17):100-101.
[44] 刘家斌,杨云梅,侯宁.夏枯草在桥本甲状腺炎合并结节中的应用效果与安全性[J].中国卫生标准管理,2018,9(19):115-117.
[45] 刘宝忠,张花,杨坤,等.百令胶囊对桥本甲状腺炎患者自身免疫性抗体的影响[J].医药导报,2009,28(6):727-728.
[46] 刘婧茹,王清.夏枯草胶囊对桥本甲状腺炎患者自身抗体及Th17细胞的影响[J].中国老年学杂志,2012,32(24):5413-5415.
[47] 党乐,徐晶,尹璐.优甲乐联合夏枯草对桥本甲状腺炎伴甲减患者的疗效及机制分析[J].贵州医药,2021,45(11):1704-1705.
[48] 任意,赵铁铮,王玉文,等.小金胶囊联合左甲状腺素钠片对桥本氏甲状腺炎伴结节患者甲状腺抗体的临床干预[J].河北医药,2018,40(14):2179-2181,2185.
[49] 乔雪,罗润佳,刘炳蔚,等.小金丸治疗桥本甲状腺炎疗效评价与基于代谢组学机制研究[J].辽宁中医药大学学报,2023,25(10):184-191.
[50] 张艺梁,胡瑞学,赵晖,等.夏枯草制剂治疗桥本甲状腺炎系统评价与试验序贯分析[J].中国中药杂志,2020,45(23):5777-5788.
[51] 柳杨青,汪艳芳,郭丽君.百令胶囊对桥本甲状腺炎自身免疫性抗体影响的Meta分析[J].中国循证医学杂志,2020,20(4):453-457.
[52] 王钰涵,杨雪梅,崔姗姗,等.夏枯草中药制剂治疗桥本甲状腺炎Meta分析[J].河南中医,2024,44(11):1726-1733.
[53] 李艳杰,赵康超,吴善瑛,等.桥本甲状腺炎中医治疗策略[J].中国临床保健杂志,2023,26(5):709-712.
[54] 吴海,魏华.魏华教授分期辨治桥本甲状腺炎经验总结[J].西部中医药,2024,37(8):51-54.
[55] 李骏,梁金玲,麦高阳.百令胶囊联合利拉鲁肽治疗早期糖尿病肾病的疗效观察[J].现代药物与临床,2016,31(2):174-177.
[56] 杨立娜,丁萌,张翠兰,等.不同剂量百令胶囊联合左甲状腺素治疗桥本甲状腺炎的临床研究[J].现代药物与临床,2018,33(5):1193-1197.
[57] 赵海月,宋旸,沈迪寒,等.甲状腺癌的分型及其分子发病机制研究进展[J].中国体视学与图像分析,2017,22(4):465-471.
[58] 熊燚.线粒体通路在夏枯草诱导人甲状腺乳头状癌细胞凋亡中的作用初探[D].广州:暨南大学,2017.
[59] 黄海斌,张朵,宋佳,等.夏枯草水提物活性成分促进人甲状腺乳头状癌细胞自噬性死亡[J].中国中西医结合杂志,2022,42(7):856-862.
[60] 郑雅娟,仲妙春,孟可馨,等.小金丸配合优甲乐治疗结节性甲状腺肿的临床观察[J].中国中西医结合外科杂志,2013,19(3):297-298.
[61] 刘现栋.小金丸治疗甲状腺结节临床研究[J].河南中医,2014,34(6):1189-1190.

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