生長抑素類似物治療Graves眼病有效性的Meta分析_《中國循證醫學雜志》

作者：

石少敏 ,  賀冶冰

華中科技大學同濟醫學院附屬同濟醫院內分泌科（武漢 430030）;

關鍵詞：

Graves眼病生長抑素類似物臨床活動性評分突眼度 Meta分析

DOI：

10.7507/1672-2531.20130019

視頻：

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目的　系統評價生長抑素類似物治療Graves眼病（GO）的有效性。
方法　計算機檢索PubMed、EMbase、The Cochrane Library、WanFang Data、CNKI、VIP和CBM中關于生長抑素類似物治療Graves眼病的隨機對照試驗（RCT），檢索時間截至2012年3月，并追溯納入文獻的參考文獻。由2位研究者按照納入標準篩選文獻、提取資料和評價納入研究的方法學質量后，采用RevMan 5.0軟件進行Meta分析。
結果　最終納入5個RCT，共210例患者。Meta分析結果顯示：生長抑素類似物治療GO可降低臨床活動性評分［MD=0.58，95%CI（0.02，1.13），P=0.04］，但尚不能證實可降低突眼度（mm）［MD=0.21，95%CI（–0.14，0.56），P=0.24］；對復視程度、球后體積、眼壓、視力及眼球活動受限未顯示出明顯療效；目前證據尚不能說明生長抑素類似物治療GO有效［OR=1.32，95%CI（0.45，3.9），P=0.61］。
結論　生長抑素類似物治療GO可降低患者的臨床活動性評分，但未能明顯降低突眼度，目前證據尚不能證實生長抑素類似物治療GO有效。受納入研究的質量和數量限制，上述結論尚需開展更多高質量RCT加以驗證。

引用本文： 石少敏,賀冶冰. 生長抑素類似物治療Graves眼病有效性的Meta分析. 中國循證醫學雜志, 2013, 13(1): 106-111. doi: 10.7507/1672-2531.20130019 復制

1.	Bartalena L, Baldeschi L, Dickinson A, et al. Consensus statement of the European Group on Graves’ orbitopathy (EUGOGO) on management of GO. European Journal of Endocrinology, 2008, 158: 273-285.
2.	Bartalena L, Marcocci C, Tanda ML, et al. An update on medical management of Graves’ ophthalmopathy. J Endocrinol Invest, 2005, 28: 469-478.
3.	Bartalena L, Marcocci C, Pinchera A. Editorial: Somatostatin analogs for Graves’ ophthalmopathy - Do they bounce off like a rubber bullet? J Clin Endocrinol Metab, 2004, 89(12): 5908-5909.
4.	Kung AW, Michon J, Tai KS, et al. The effect of somatostatin versus corticosteroid in the treatment of Graves’ ophthalmopathy. Thyroid, 1996, 6(5): 381-384.
5.	Krassas GE, Dumas A, Pontikides N, et al. Somatostatin receptor scintigraphy and octreotide treatment in patients with thyroid eye disease. Clin Endocrinol, 1995, 42: 571-580.
6.	Wemeau JL, Caron P, Beckers A, et al. Octreotide (long-acting release formulation) treatment in patients with Graves’ orbitopathy: clinical results of a four-month, randomized, placebo-controlled, double-blind study. J Clin Endocrinol Metab, 2005, 90(2): 841-848.
7.	Chang TC, Liao SL. Slow-release lanreotide in Graves’ ophthalmopathy: A double-blind randomized, placebo-controlled clinical trial. J Endocrinol Invest, 2006, 29: 413-422.
8.	Stan MN, Garrity JA, Bradley EA, et al. Randomized, double-blind, placebo-controlled trial of long-acting release octreotide for treatment of Graves’ ophthalmopathy. J Clin Endocrinol Metab, 2006, 91(12): 4817-4824.
9.	Dickinson AJ, Vaidya B, Miller M, et al. Double-blind, placebo-controlled trial of octreotide long-acting repeatable (LAR) in thyroid-associated ophthalmopathy. J Clin Endocrinol Metab, 2004, 89(12): 5910-5915.
10.	Julian PT, Sally G (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. Available from: http://www.cochrane-handbook.org.
11.	Krassas GE, Kaltsas T, Dumad A, et al. Lanreotide in the treatment of patients with thyroid eye disease. European journal of endocrinology, 1997, 136: 416-422.
12.	Cozma I, Zhang L, Uddin J, et al. Modulation of expression of somatostatin receptor subtypes in Graves’ ophthalmopathy orbits: relevance to novel analogs. Am J Physiol Endocrinol Metab, 2007, 293: E1630-E1635.
13.	孫斌, 張朝霞. 生長抑素類藥物治療甲狀腺相關性眼病的研究進展. 國際眼科縱覽, 2011, 35(5): 303-306.
14.	劉志民李顧沈. 生長抑素類似物對Graves眼病治療作用的Meta分析. 第二軍醫大學學報, 2004, 25(4): 426-430.
15.	Krassas GE, Doumas A, Kaltsas T, et al. Somatostatin receptor scintigraphy before and after treatment with somatostatin analogues in patients with thyroid eye disease. Thyroid, 1999, 9(1): 47-52.
16.	Pichler R, Maschek W, Holzinger C. Therapy with somatostatin analogs in patient with orbitopathy and positive Octreoscan. Acta Med Austriaca, 2001, 28: 99-101.

1. Bartalena L, Baldeschi L, Dickinson A, et al. Consensus statement of the European Group on Graves’ orbitopathy (EUGOGO) on management of GO. European Journal of Endocrinology, 2008, 158: 273-285.
2. Bartalena L, Marcocci C, Tanda ML, et al. An update on medical management of Graves’ ophthalmopathy. J Endocrinol Invest, 2005, 28: 469-478.
3. Bartalena L, Marcocci C, Pinchera A. Editorial: Somatostatin analogs for Graves’ ophthalmopathy - Do they bounce off like a rubber bullet? J Clin Endocrinol Metab, 2004, 89(12): 5908-5909.
4. Kung AW, Michon J, Tai KS, et al. The effect of somatostatin versus corticosteroid in the treatment of Graves’ ophthalmopathy. Thyroid, 1996, 6(5): 381-384.
5. Krassas GE, Dumas A, Pontikides N, et al. Somatostatin receptor scintigraphy and octreotide treatment in patients with thyroid eye disease. Clin Endocrinol, 1995, 42: 571-580.
6. Wemeau JL, Caron P, Beckers A, et al. Octreotide (long-acting release formulation) treatment in patients with Graves’ orbitopathy: clinical results of a four-month, randomized, placebo-controlled, double-blind study. J Clin Endocrinol Metab, 2005, 90(2): 841-848.
7. Chang TC, Liao SL. Slow-release lanreotide in Graves’ ophthalmopathy: A double-blind randomized, placebo-controlled clinical trial. J Endocrinol Invest, 2006, 29: 413-422.
8. Stan MN, Garrity JA, Bradley EA, et al. Randomized, double-blind, placebo-controlled trial of long-acting release octreotide for treatment of Graves’ ophthalmopathy. J Clin Endocrinol Metab, 2006, 91(12): 4817-4824.
9. Dickinson AJ, Vaidya B, Miller M, et al. Double-blind, placebo-controlled trial of octreotide long-acting repeatable (LAR) in thyroid-associated ophthalmopathy. J Clin Endocrinol Metab, 2004, 89(12): 5910-5915.
10. Julian PT, Sally G (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. Available from: http://www.cochrane-handbook.org.
11. Krassas GE, Kaltsas T, Dumad A, et al. Lanreotide in the treatment of patients with thyroid eye disease. European journal of endocrinology, 1997, 136: 416-422.
12. Cozma I, Zhang L, Uddin J, et al. Modulation of expression of somatostatin receptor subtypes in Graves’ ophthalmopathy orbits: relevance to novel analogs. Am J Physiol Endocrinol Metab, 2007, 293: E1630-E1635.
13. 孫斌, 張朝霞. 生長抑素類藥物治療甲狀腺相關性眼病的研究進展. 國際眼科縱覽, 2011, 35(5): 303-306.
14. 劉志民李顧沈. 生長抑素類似物對Graves眼病治療作用的Meta分析. 第二軍醫大學學報, 2004, 25(4): 426-430.
15. Krassas GE, Doumas A, Kaltsas T, et al. Somatostatin receptor scintigraphy before and after treatment with somatostatin analogues in patients with thyroid eye disease. Thyroid, 1999, 9(1): 47-52.
16. Pichler R, Maschek W, Holzinger C. Therapy with somatostatin analogs in patient with orbitopathy and positive Octreoscan. Acta Med Austriaca, 2001, 28: 99-101.

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生長抑素類似物治療Graves眼病有效性的Meta分析

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《中國循證醫學雜志》

生長抑素類似物治療Graves眼病有效性的Meta分析

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