Effectiveness and potential mechanism of Jiawei-Xiaoyao-San for hyperthyroidism: a systematic review.
Effectiveness and potential mechanism of Jiawei-Xiaoyao-San for hyperthyroidism: a systematic review.
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DOI：
10.3389/fendo.2023.1241962
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发表时间：
2023
影响因子：
5.2
通讯作者：
中科院分区：
文献类型：
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探讨加味逍遥散作为抗甲状腺药物（ATDs）的辅助或单药治疗甲亢的疗效及可能机制。从开始到2023年5月，检索了8个数据库和3个试验登记研究。纳入随机对照试验（RCT），并使用RevMan 5.4和Stata 14.0进行荟萃分析。使用科克伦偏倚风险（ROB）工具1.0和GRADE工具进行质量评价。使用单JWXYS和药理学研究的病例报告的结果总结在表格中。纳入了13项RCT，979例受试者。大多数纳入的研究在一个ROB领域被评估为偏倚风险高。与ATDs相比，JWXYS + ATDs导致游离三碘甲状腺原氨酸（FT 3）降低。（MD = -1.31 pmol/L，95% CI [-1.85，-0.76];低确定性），游离甲状腺素较低（MD = -3.24 pmol/L，95% CI [-5.06，-1.42];低确定性），促甲状腺激素升高（MD = 0.42 mIU/L，95% CI [0.26，0.59];低确定性），中医证候有效率较高（RR = 1.28，95% CI [1.08，1.52];低确定性），甲状腺肿评分较低（MD =-0.66，95% CI [-1.04，-0.29];极低确定性），促甲状腺素受体抗体降低（SMD =-0.44，95% CI [-0.73，-0.16];低确定性）和更少的不良事件（AE）（RR = 0.34，95% CI [0.18，0.67];中等确定性）。与常规剂量ATD相比，加味逍遥散加半剂量ATD导致的AE较少（RR = 0.24，95%CI [0.10，0.59];低确定性）。与ATDs相比，在1项试验中，JWXYS导致FT 3较高，甲状腺肿评分较低，AE较少。3份病例报告显示，患者寻求仅中药治疗的原因包括重度AE和多次复发。三项药理学研究表明，JWXYS在小鼠或大鼠模型中恢复Th 17/Treg平衡，降低脱碘酶活性，调节甲状腺细胞增殖和凋亡，并减轻肝脏氧化应激。加味逍遥散可增强ATDs治疗甲亢的疗效，尤其在缓解症状和减少AE方面。不推荐单JWXYS，除非患者不耐受ATD。由于总体偏倚风险较高，应谨慎解释这些结果。需要更可靠的模型进行进一步的药理学研究。 ，标识符CRD 42023394923。
To evaluate the effectiveness and potential mechanism of traditional Chinese medicine Jiawei-Xiaoyao-San (JWXYS) as an adjunct or mono- therapy for antithyroid drugs (ATDs) in the treatment of hyperthyroidism. Eight databases and three trial registries were searched from inception until May 2023. Randomized controlled trials (RCTs) were included and meta-analysis was conducted using RevMan 5.4 and Stata 14.0. The Cochrane risk of bias (ROB) tool 1.0 and GRADE tool was used for quality appraisal. The findings from case reports using mono-JWXYS and pharmacological studies were summarized in tables. Thirteen RCTs with 979 participants were included. The majority of the included studies were assessed as high risk of bias in one ROB domain. Compared with ATDs, JWXYS plus ATDs resulted in lower free triiodothyronine (FT3) (MD = -1.31 pmol/L, 95% CI [-1.85, -0.76]; low-certainty), lower free thyroxine (MD = -3.24 pmol/L, 95% CI [-5.06, -1.42]; low-certainty), higher thyroid stimulating hormone (MD = 0.42 mIU/L, 95% CI [0.26, 0.59]; low-certainty), higher effectiveness rate of traditional Chinese medicine syndrome (RR = 1.28, 95% CI [1.08, 1.52]; low-certainty), lower goiter score (MD = -0.66, 95% CI [-1.04, -0.29]; very low-certainty), lower thyrotrophin receptor antibody (SMD = -0.44, 95% CI [-0.73, -0.16]; low-certainty) and fewer adverse events (AEs) (RR = 0.34, 95% CI [0.18, 0.67]; moderate-certainty). Compared with regular dosage of ATDs, JWXYS plus half-dose ATDs resulted in fewer AEs (RR = 0.24, 95% CI [0.10, 0.59]; low-certainty). Compared with ATDs in 1 trial, JWXYS resulted in higher FT3, lower goiter score and fewer AEs. Three case reports showed that the reasons patients sought TCM-only treatment include severe AEs and multiple relapses. Three pharmacological studies demonstrated that JWXYS restored Th17/Treg balance, lowered deiodinases activity, regulated thyroid cell proliferation and apoptosis, and alleviated liver oxidative stress in mouse or rat models. JWXYS may enhance the effectiveness of ATDs for hyperthyroidism, particularly in relieving symptoms and reducing AEs. Mono-JWXYS is not recommended except in patients intolerant to ATDs. The findings should be interpreted with caution due to overall high risk of bias. Further pharmacological studies with more reliable models are needed. , identifier CRD42023394923.
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影响因子：
5.6
作者：
He, Qiongyao;Dong, Hui;Gong, Minmin;Guo, Yujin;Xia, Qingsong;Gong, Jing;Lu, Fuer
通讯作者：
Lu, Fuer
影响因子：
5.4
作者：
Dong, Shi;Liu, Qunying;Shi, Yuanyuan
通讯作者：
Shi, Yuanyuan
DOI：
10.1155/2022/5500604
发表时间：
2022
期刊：
Evidence-based complementary and alternative medicine : eCAM
影响因子：
--
作者：
通讯作者：
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影响因子：
6.6
作者：
Brito, Juan P.;Payne, Stephanie;Stan, Marius N.
通讯作者：
Stan, Marius N.
影响因子：
3.6
作者：
Kim, Jiman;Kim, Tae-Hun
通讯作者：
Kim, Tae-Hun