胰岛素增敏剂治疗多囊卵巢综合征疗效的系统评价  

The efficacy and safety of insulin-sensitizing drugs for treatment of polycystic ovary syndrome:a Meta-analysis

作　　者：余亚信[1] 李学军[1] 闫冰[1] 王丽英[1] 张惠杰[1] 杨叔禹[1] 

机构地区：[1]厦门大学附属第一医院糖尿病科厦门市糖尿病研究所,福建省361003

出　　处：《中华临床医师杂志（电子版）》2011年第22期6671-6679,共9页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的系统评价胰岛素增敏剂噻唑烷二酮类药物(TZDs,包括吡格列酮和罗格列酮)与二甲双胍,对多囊卵巢综合征(PCOS)患者在改善临床症状、激素水平和生化指标等的有效性和安全性。方法检索并选取国内、外公开发表的采用头对头设计的关于胰岛素增敏剂治疗PCOS的随机对照试验文献,筛选合格文献进行研究,应用Jadad评分法进行质量评价,运用异质性检验、Mata分析等方法统计相关数据。共有25项研究符合纳入标准。结果在3个月疗程组,二甲双胍降低体质量指数(BMI)的疗效优于TZDs(P<0.00001);TZDs组的排卵率高于二甲双胍组(OR=0.65,95%CI:0.43～0.99);TZDs降低雄烯二酮(A2)、硫酸脱氢表雄酮(DHEAS)和促黄体生成素(LH)的幅度大于二甲双胍(P值分别为0.01、0.0002、0.002);TZDs降低空腹胰岛素(FINS)和胰岛素抵抗指数(HOMA-IR)优于二甲双胍组(P值分别为0.0008和0.03)。在6个月疗程组,二甲双胍降低BMI和甘油三酯(TG)的幅度大于TZDs,差异具有统计学意义(P<0.00001和P<0.0001),而TZDs降低多毛评分(F-G)分数的幅度大于二甲双胍(P=0.0001);TZDs提高促卵泡素(FSH)和HDL-C的幅度大于二甲双胍(P=0.04和P=0.008)。在副作用方面,二甲双胍组副作用的发生率在各疗程组均高于TZDs组(OR=31.24,95%CI:11.54～84.54,P<0.00001)。结论 Meta分析结果显示,二甲双胍在降低体重及调脂方面优于TZDs,而TZDs在改善胰岛素抵抗和性激素异常方面优于二甲双胍。临床上可有针对性地选用。ObjectiveInsulin-sensitizing drugs(ISDs)have been advocated for the long-term treatment of polycystic ovary syndrome(PCOS).We performed a systemic review and Meta-analysis of the available literature to compare the efficacy and safety of ISDs such as metformin and thiazolidinediones(TZDs)with respect to clinical,hormonal,and metabolic outcomes.MethodsA Meta analysis to assess the effectiveness and safety of metformin versus thiazolidinediones(TZDs,including pioglitazone and rosiglitazone)in the treatment of PCOS was conducted,using MEDLINE(1966 to 2010)and EMBASE(1988 to 2010)and CNKI(1994 to 2009)and VIP(1989 to 2009)to select head to head and randomized controlled trials comparing clinical,hormonal,and metabolic results.ResultsTwenty five trials were included.TZDs were superior to metformin in reducing serum levels of androstenedione(P=0.01)and dehydroepiandrosterone sulfate(P=0.0002)and luteinizing hormone(P=0.002)and FINS(P=0.008)and HOMA-IR(P=0.03)after three months treatment.Decreases in triglyceride levels were more pronounced with metformin after six months(P<0.0001).TZDs were superior to metformin in elevating FSH(P=0.04)and HDL-C(P=0.008)and in reducing F-G(P=0.001).Decreases in BMI were greater with metformin treatment as assessed at three and six months(P<0.00001).Metformin caused a significantly higher incidence of side-effects such as nausea,diarrhoea,and abdominal cramping(OR=31.24,95% CI:11.54-84.54,P<0.00001).ConclusionsThe findings from this Meta-analysis do not indicate that metformin is superior to TZDs for the treatment of PCOS or vice versa.Metformin is superior to TZDs in controlling weight and improving lipid disorders,but TZDs are superior to metformin in ameliorating insulin resistance and abnormal serum sex hormone.

关 键 词：多囊卵巢综合征 META分析 胰岛素增敏剂 

分 类 号：R711.75[医药卫生—妇产科学]