| Objective:To assess the effect of anti-thyroid drug methimazole on bone metabolism by Meta-analysis.Method:By searching databases such as Embase,Cochrane Library,Pubmed,CNKI and Wanfang,,we collected all clinical controlled trials of bone metabolizers in patients with hyperthyroidism treated with anti-thyroid drugs methimazole,according to the standard after screening of literature into the quality evaluation,extraction of available data.Data from the date of database establishment to June 2017.Languages were restricted to English and Chinese.According to the inclusion and exclusion criteria established in advance,effective data was extracted and RevMan 5.3 software was used for systematic evaluation.Result:1.Inclusion in the literature: There are a total of 8 documents that meet the standards,3 in Chinese,and 5 in English.A total of 309 cases were included before and after the patient was enrolled.2.Bone metabolism indicators:2.1 Blood Calcium Compared to before treatment,serum calcium after treatment with methimazole decreased slightly compared with before treatment,the weighted mean difference WMD =-0.11(95% CI:-0.24~0.03),P = 0.12,no difference Statistical significance.2.2 Phosphorus Meta analysis results show heterogeneity in the studies included.Compared to before treatment,the combined effect of methamidophos after treatment of phosphorus decreased slightly(WMD =-0.06(95%CI:-0.27~0.14)P=0.54),the results were not statistically significant.2.3 Serum Alkaline PhosphataseWithin 6 months of methimazole treatment,serum alkaline phosphatase levels were slightly lower than before treatment,with a standardized mean difference SMD =-0.56(95% CI:-1.13~0.01)Z = 1.94,P = 0.05;The difference was not statistically significant.Over 6 months of treatment,serum alkaline phosphatase levels were significantly lower than before treatment,and as the treatment time prolonged,the level of decline became more pronounced.The standardized mean difference SMD =-3.42(95% CI:-4.44~-2.40)Z = 6.57,P <0.01,the difference was statistically significant.2.4 OsteocalcinThe treatment period of methimazole was less than 3 months.Compared with before treatment,the level of osteocalcin was slightly decreased.The results showed that SMD =-0.20(95% CI:-0.47~0.07)Z = 1.45,P = 0.15,the difference was not statistically significant significance.At 3 to 6 months of treatment,osteocalcin levels decreased compared with that before treatment,with SMD =-1.72(95% CI:-2.71~-0.74),Z = 3.43,P = 0.0006,and the difference was statistically significant.After treatment for more than 6 months,osteocalcin levels were significantly lower than before treatment,SMD =-1.97(95% CI:-3.37~-0.57),Z = 2.75,P = 0.006,the difference was statistically significant.2.5 Parathyroid hormone(PTH)After treatment with methimazole,the level of parathyroid hormone was higher than before treatment,with WMD=21.94(95%CI:10.88~33.00)P<0.001,indicating that the difference was statistically significant.Conclusion:In this study,meta-analysis was used to systematically evaluate the effect of anti-thyroid drugs methimazole on bone metabolism in the treatment of hyperthyroidism.The bone transition marker PTH,bone formation marker OCN,serum calcium,serum phosphorus,and ALP were selected for analysis.The results showed that methimazole treatment(between 1.5 and 12 months)ranged,and the patients ' bone metabolic markers,serum alkaline phosphatase,osteocalcin,and parathyroid hormone,were all significantly improved before treatment,and with the extension of treatment time.This change tends to be significant. |
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