关键词: 甲状腺肿瘤, 唾液腺, 131I治疗, 保护作用, 网状Meta分析

Abstract: Background　Although 131I adjunctive therapy can significantly improve the survival rate of patients with thyroid cancer，its induced salivary gland damage seriously affects the quality of life. Currently，there are a variety of drugs for the prevention and treatment of 131I-induced salivary gland damage，but it needs to conduct a network Meta-analysis to fill the gap of comparison of these medications. Objective　To perform a network Meta-analysis of different medications for preventing 131I-induced salivary gland damage in thyroid cancer patients. Methods　Randomized controlled trials（RCTs） or non-RCTs about different medications for preventing 131I-induced salivary gland damage in thyroid cancer patients were searched in databases of Cochrane Central Register of Controlled Trials，Web of Science，PubMed，and EMBase，VIP，CNKI，Wanfang Data and SinoMed from inception to January 2021. Literature screening and data extraction were performed by two researchers，separately. The literature quality was evaluated using the risk of bias assessment tool in the Cochrane Handbook for Systematic Reviews of Interventions（Version 5.1.0） and MINORS. Consistency test，publication bias analysis and graph drawing were carried out using Stata 16.0. OpenBUGS 3.2.3 was used for network Meta-analysis. Results　A total of 11 articles were included，involving 7 intervention schemes：amifostine，vitamin C，amifostine with vitamin C，citric acid，vitamin E，selenium and propylthiouracil. Network Meta-analysis revealed that in terms of preventing 131I-induced loss of salivary excretion fraction in the parotid gland，amifostine with vitamin C was superior to citric acid and propylthiouracil，so was amifostine（P<0.05）. Amifostine was also superior to the regular treatment（P<0.05）. The SUCRA score for the schemes in preventing 131I-induced loss of salivary excretion fraction in the parotid gland ranked from highest to lowest was：amifostine with vitamin C> amifostine > vitamin C>regular treatment > vitamin E> selenium >citric acid > propylthiouracil. In terms of preventing 131I-induced loss of salivary excretion fraction in the submandibular gland，propylthiouracil was inferior to vitamin E，amphostine with vitamin C，amphostine and regular treatment（P<0.05）. The SUCRA score for the schemes in preventing 131I-induced loss of salivary excretion fraction in the submandibular gland ranked from highest to lowest was：vitamin E>amphostine with vitamin C> amphostine>selenium> vitamin C> citric acid> regular treatment > propylthiouracil. The funnel plot of comparing different medications for preventing 131I-induced loss of salivary excretion fraction in the parotid gland or submandibular gland was obviously symmetrical. Conclusion　Amphostine with vitamin C may be the best intervention for preventing 131I-induced loss of salivary excretion fraction in the parotid gland. And vitamin E may be the best scheme for preventing 131I-induced loss of salivary excretion fraction in the submandibular gland，followed by amphostine with vitamin C. Due to limitations of this study，these results should be taken with caution，which still need to be verified by more large-sample，high-quality clinical studies.

Key words: Thyroid neoplasms, Salivary glands, 131I irradiation, Protective effect, Network Meta-analysis