ABSTRACT
Background Glucocorticoid is a common drug for treatment of thyroid-associated ophthalmopathy (TAO) with good effectiveness.But some adverse reactions of glucocorticoid are inevitable.At recent years,99technetium-methylene bisphosphonate(99Tc-MDP) is being paid more and more attentions in the treatment of TAO,but its effectiveness and safety is worthy of comparison to traditional treatment methods.Objective This study was to evaluate the efficacy of treatment with intravenous injection of 99Tc-MDP for TAO.Methods The Cochrane Library,CNKI,PubMed,Wanfang database,Weipu net were searched in computer and Google Scholar was searched manually.The randomized controlled trail (RCT) of intravenous injection of 99Tc-MDP for TAO were collected from establishment of database through April,2012.The quality of included literature was assessed based on the methodology of the study.The evaluating indexes included the primary treating outcomes,such as total efficacy,exophthalmic extent and recurrence rate as well as secondary outcomes such as adverse effect.RevMan 5.1 software was used for Mate analysis.Results A total of 11 RCTs were identified with 706 patients.Subgroup analysis was carried out based on the outcome measures and intervention.No significant difference was found in the overall effective rate between intravenous injection of 99Tc-MDP and immunosuppressive treatment (RR =0.96,95 ％ CI:0.76 to 1.22,P=0.740).However,the effective rate was significant different between intravenous injection of 99Tc-MDP and oral prednisone (RR =1.25,95 ％ CI:1.06-1.46,P =0.007) or between intravenous injection of 99 Tc-M DP and the blank control group (RR =2.53,95 ％ CI:1.68-3.81,P =0.000).Significant difference also was found in the total effective rate between intravenous injection of 99Tc-MDP with methyprednisone and methyprednisone alone (RR =1.27,95％ CI:1.05-1.53,P =0.010).There were significant differences in the effective rate of proptosis between intravenous injection of 99Tc-MDP and oral prednisone (RR=2.02,95％ CI:1.44-3.56,P=0.020).The recurrence rate of TAO was significant different between intravenous injection of 99Tc-MDP and oral prednisone (RR =0.51,95％ CI:0.33-0.78,P=0.002).Less adverse responses were seen in the intravenous injection of 99Tc-MDP group than the oral prednisone group and immunosuppressive treatment group.Conclusions Intravenous injection of 99Tc-MDP for TAO appears to be of a similar effectiveness to immunosuppressive method.The combination of intravenous injection of 99Tc-MDP with methyprednisone seems to be more effective than methyprednisone alone,with little systemic adverse effect after application.