睾酮补充治疗对中老年男性胰岛素抵抗疗效与安全性的系统评价  

Testosterone Supplementary Treatment for the Middle-aged and the Senile with Insulin Resistance: A Systematic Review

作　　者：姚慧 赵翠平 康冬梅 

机构地区：[1]安徽医科大学附属省立医院干部病房四病区,合肥230001

出　　处：《中国循证医学杂志》2011年第3期314-319,共6页Chinese Journal of Evidence-based Medicine

基　　金：安徽省科技计划项目(编号:08020303073)

摘　　要：目的系统评价睾酮补充治疗对中老年男性胰岛素抵抗的疗效及安全性。方法计算机检索PubMed(1966.1～2010.7)、EMbase(1984.1～2010.7)、Cochrane图书馆临床对照试验资料库(2010年第3期)和CBM(1978～2010.7)、CNKI(1994.1～2010.7)、万方数据库(1994～2010.7)、维普信息资源系统(1989～2010.7),收集国内外所有关于睾酮治疗中老年男性胰岛素抵抗的随机对照试验。按Cochrane系统评价方法选择试验和评价质量后,对同质研究采用RevMan 5.0软件进行Meta分析。对不能进行Meta分析的数据,则只进行描述性的定性分析。结果共纳入9个随机对照试验,合计573例患者,其中睾酮治疗308例,使用安慰剂治疗265例,各研究基线具有可比性。Meta分析结果显示:治疗后,睾酮治疗组在胰岛素抵抗指数(HOMA-IR)[WMD=–0.56,95%CI(–0.75,–0.37)]和空腹胰岛素(FINS)[WMD=–2.40,95%CI(–3.25,–1.56)]方面优于安慰剂组,而两组前列腺特异抗原(PSA)水平差异无统计学意义[WMD=–0.02,95%CI(–0.22,0.18)]。结论睾酮补充治疗在改善中老年男性糖尿病患者胰岛素抵抗方面优于安慰剂,而对PSA的影响与安慰剂相比差异无统计学意义。由于纳入研究质量有限,样本量又较少,上述结论尚需进一步开展大样本、多中心的随机双盲安慰剂对照试验加以验证。Objective To evaluate the efficacy and safety of testosterone supplementary treatment for the middle-aged and the senile with insulin resistance（IR）.Methods Such databases as PubMed（Jan.1966 to July 2010）,EMbase（Jan.1984 to July 2010）,The Cochrane Library（Issue 3,2010）,CBM（1978 to July 2010）,CNKI（Jan.1994 to July 2010）,WanFang Data（1994 to July 2010） and VIP Data（1989 to July 2010） were searched.Randomized controlled trials（RCTs） about testosterone treatment for IR were included.Two reviewers independently extracted the data and evaluated the quality of the included studies.Meta-analyses were performed for the results of homogeneous studies by using RevMan 5.0 software,and other results not suitable for meta-analysis were described with qualitative analyses.Results Nine RCTs involving 573 patients were included.Of them,308 cases were in the testosterone group and 265 in the placebo group.The baseline data of studies was comparable.The results of meta-analyses showed that,a） Efficacy： testosterone was superior to placebo in decreasing insulin resistance index（HOMA-IR）（WMD= – 0.56,95%CI – 0.75 to – 0.37） and fasting insulin（FINS）（WMD= –2.4,95%CI –3.25 to –1.56）;and b） Safety： no significant difference was found in prostate specific antigen（PSA）（WMD= – 0.02,95%CI – 0.22 to 0.18）.Conclusion The testosterone supplementary treatment for insulin resistance is superior to the placebo,and there is no significant difference in PSA compared to the placebo.More multicenter double-blind RCTs in large-scale are required to verify this conclusion because of lack of high quality literature with large sample size.

关 键 词：睾酮 胰岛素抵抗 系统评价 META分析 随机对照试验 

分 类 号：R587[医药卫生—内分泌]