罗格列酮对比二甲双胍治疗多囊卵巢综合征的系统评价  

Rosiglitazone versus Metformin for Polycystic Ovary Syndrome:A Systematic Review

作　　者：杜强[1] 杨生[1] 吴波[1] 韩萍[1] 

机构地区：[1]中国医科大学附属盛京医院内分泌科,沈阳110004

出　　处：《中国循证医学杂志》2011年第9期1021-1026,共6页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价罗格列酮对比二甲双胍治疗多囊卵巢综合征(PCOS)的有效性和安全性。方法计算机检索MEDLINE、Cochrane图书馆、EMbase、EBSCO、CBM、CNKI、中华医学会期刊自建数据库、VIP,检索年限从建库至2010年12月。查找罗格列酮与二甲双胍对比治疗PCOS的随机对照试验。由两位研究者按照纳入与排除标准筛选试验、提取资料和评价方法学质量后,采用Stata 11.0软件进行Meta分析。结果共纳入6个RCT,合计286例PCOS患者。Meta分析结果显示:二者在改善胰岛素敏感性[SMD=–0.14,95%CI(–0.46,0.19),P=0.412]和降低雄激素水平[SMD=0.05,95%CI(–0.26,0.36),P=0.747]方面差异无统计学意义;罗格列酮降低体重的作用不如二甲双胍[SMD=0.34,95%CI(0.11,0.58),P=0.004],但不良反应发生率较二甲双胍低。结论罗格列酮和二甲双胍一样,可以改善PCOS患者胰岛素敏感性及降低雄激素水平,在降低体重方面的作用不如二甲双胍,但罗格列酮不良反应发生率较二甲双胍低。故罗格列酮更适用于体重偏轻及不能耐受二甲双胍胃肠道副作用的PCOS患者。鉴于本系统评价纳入研究较少且样本量较小,因此使用上述结论时必须谨慎。未来尚需开展更多大样本、高质量、多中心的随机对照试验。Objective To evaluate the eficacy and safety of rosiglitazone versus metformin in treating polycystic ovary syndrome（PCOS）.Methods Randomized controlled trials（RCTs） about rosiglitazone versus metformin in treating PCOS were retrieved on computer in MEDLINE,The Cochrane Library,EMbase,EBSCO,CBM,CNKI,Chinese Medical Associa-tion Journal Database and VIP from the date of their establishment to December 2010.The trials were screened according to the inclusion and exclusion criteria by two reviewers independently,the data were extracted,the methodological quality was assessed,and nally meta-analysis was conducted with Stata 11.0 so ware.Results A total of six RCTs involving 286 PCOS patients were included.The results of meta-analyses showed that there was no significant difference between rosiglitazone and metformin in improving PCOS patients’ insulin sensitivity（SMD= –0.14,95%CI –0.46 to 0.19,P=0.412） and lowering androgen levels（SMD=0.05,95%CI –0.26 to 0.36,P=0.747）.However,the e ect of rosiglitazone was inferior to metformin in lowing patients’ weight with a signi cant difference（SMD=0.34,95%CI 0.11 to 0.58,P=0.004）.The rosiglitazone showed a lower incidence rate of adverse reaction compared with metformin.Conclusion Compared with metformin,the rosigli-tazone is eqully effective in improving PCOS patients’ insulin sensitivity and lowering androgen levels,and has a lower inci-dence rate of adverse reaction although it is inferior to metformin in lowing patients’ weight.So rosiglitazone is more applica-ble for the patients who are of underweight or cannot tolerate the gastrointestinal side e ects induced by metformin.There is no enough evidence for this conclusion due to the small sample size and limited number of RCTs.More high-quality,large-sample and multicentered RCTs are required to guide clinical treatment and benefit patients.

关 键 词：罗格列酮 二甲双胍 多囊卵巢综合征 系统评价 META分析 随机对照试验 

分 类 号：R711.75[医药卫生—妇产科学]