炔雌醇环丙孕酮和二甲双胍联合对改善多囊卵巢综合征患者代谢指标的Meta分析

The meta-analysis about combination of Diane-35 and metformin for improving the metabolic indexex indexes in patients with PCOS: A meta-analysis

目的综合评价炔雌醇环丙孕酮(达英-35)及其与二甲双胍联合应用对多囊卵巢综合征(PCOS)患者代谢指标的影响。方法在PubMed、EMBASE、Cochrane Library、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)等相关数据库,对2001年至2013年的中英文文献进行检索。纳入的研究包括达英-35单用组及达英-35与二甲双胍联用组,对纳入研究的质量进行评价,用Revman4.2.10软件进行Meta分析。结果共纳入19项临床试验,包括1 385例PCOS患者。其方法学质量的Jadad评分均≥3分。荟萃分析结果显示:(1)激素指标:与单用达英-35组比较,联用组卵泡刺激素(FSH)差异无统计学意义;黄体生成素(LH)、睾酮(T)均明显降低,差异有统计学意义。(2)脂代谢指标:与单用达英-35组比较,联用组低密度脂蛋白(LDL)差异和高密度脂蛋白(HDL)均差异无统计学意义;总胆固醇(TC)、总三酰甘油(TG)均有所降低,差异有统计学意义。(3)胰岛素指标:单用达英-35组与联用组空腹血糖(FBG)差异无统计学意义;但联用组空腹胰岛素(FIns)明显降低,差异有统计学意义。结论联合用药较达英-35单药治疗能更有效地纠正PCOS患者的代谢紊乱,改善胰岛素抵抗。

Objective To comprehensively assess the effect of Diane-35 and metformin for metabolic inde-xes in patients with PCOS.Methods The related datum during 2001 -2013 in PubMed、EMBASE、Cochrane Librar-y、CNKI、CBMdisc was collected during the year of 2001 -2013.The studies were involved in researches included Di-ane-35 group and combined group ed group of Diane-35 with mefformin.Quality assessment was conducted.Rev-man 4.2.10 was applied to perform the analysis.Results 19 RCTs with a Jadad scale above 3,were identified were brought into this research,including 1385 PCOS patients.Its Jadad was ≥3.The results of meta-analysis showed that：（1 ）Hormonal level：Compared with Diane-35 group,the serum LH and T in the combined group were signifi-cantly lower than those in Diane-35 group.However,The level of FSH in the combined group was decreased.but with no significantly differences between these two groups.（2）Lipid metebolism：Compared with Diane-35 group,the lev-els of serum TG and TC in the combined group were significantly lower than those in Diane-35 group.AlthoughHow-ever,the level of LDL was decreased and the level of HDL was increased in the combined group with no significantly differences,these difference failed to achieve statistical significance.（3 ）Insulin level：Compared with Diane -35 group,the level of serum FIns in the combined group was significantly lower than that in Diane-35 group,while the level of FBG in the combined group was decreased with no significantly differences.,but no the significance differ-ence.Conclusions The combination of Diane-35 with metformin may be associated with the improvements of meta-bolic indexes in patients with PCOS compared with Diane-35 only.