炔雌醇环丙孕酮片协同二甲双胍对多囊卵巢综合征患者激素水平影响的Meta分析

Meta-analysis of the effect of ethinylestradiol cyproterone tablets combined with metformin in treatment of polycystic ovarian syndrome on hormone levels

目的分析炔雌醇环丙孕酮片联用二甲双胍对多囊卵巢综合征(PCOS)患者激素水平的影响,为其提供循证医学证据。方法从Pub Med、Cochrane、CBM、CNKI获得炔雌醇环丙孕酮片联用二甲双胍及单用炔雌醇环丙孕酮片治疗PCOS的随机对照试验(RCTs)文献,使用"Rev Man 5.3"软件进行分析,以评估炔雌醇环丙孕酮片联用二甲双胍及单用炔雌醇环丙孕酮片对PCOS患者激素水平的影响。结果文献检索共纳入24项随机对照试验,包括1 548例PCOS患者,其中对照组775例,试验组773例。Meta分析结果显示,与单用炔雌醇环丙孕酮片相比,炔雌醇环丙孕酮片协同二甲双胍对于改善患者卵泡刺激素(MD=-0.49,95%CI[-1.11,0.13],Z=1.54,P=0.12)和脱氢表雄酮(MD=0.07,95%CI[-0.24,0.38],Z=0.43,P=0.67)的疗效并不显著;改善患者黄体生成素(MD=-1.24,95%CI[-2.09,-0.39],Z=2.87,P=0.004)效果明显;改善患者性激素结合球蛋白(MD=28.22,95%CI[7.78,48.66],Z=2.71,P=0.007)效果差。结论炔雌醇环丙孕酮片协同二甲双胍可明显改善患者黄体生成素水平,对于单纯改善PCOS患者体内卵泡刺激素和脱氢表雄酮水平上并不显著。

AIM To analyze the effect of progesterone on the hormone levels in patients with polycystic ova- ry syndrome （PCOS）, and to provide evidence-based medicine. METHODS A randomized controlled trial （RCT） of PCOS was obtained from PubMed, Cochrane, CBM and CNKI in the treatment of PCOS with ethi- nylestradiol cyproterone tablets combined with metformin and ethinylestradiol alone. The ＂ RevMan 5.3＂ software was used to estimate the effect of ethinylestradiol cyproterone tablets combined with metformin and ethinylestradiol cyproterone tablets alone on the level of hormone in PCOS patients. RESULTS A total of 24 randomized con- trolled trials were incorporated into the literature search, including 1 548 patients with PCOS, of which 775 were in the control group and 773 in the trial group. Meta-analysis showed that ethinylestradiol cyproterone tablets combined with metformin were not effective in improving follicle-stimulating hormone level （MD = -0.49,95 % CI[ -1.11,0.13] , Z = 1.54,P =0.12） and dehydroepiandrosterone （MD =0.07,95% CI[ -0.24,0.38] , Z=0. 43, P = 0. 67） level in patients compared with ethinylestradiol cyproterone alone in patients. The ethi- nylestradiol cyproterone tablets combined with metformin were effective in improving luteinizing hormone level （MD = - 1.24,95% CI [ - 2.09, - 0.39 ] , Z = 2.87, P = 0. 004） in patients compared with ethinylestradiol cyprot- erone alone in patients. The ethinylestradiol cyproterone tablets combined with metformin were less effective in im- proving sex hormone binding globulin level （ MD = 28.22,95% CI [ 7.78,48.66 ], Z = 2. 71, P = 0. 007 ） in pa- tients compared with ethinylestradiol cyproterone alone in patients. CONCLUSION Ethinylestradiol cyproterone tablets combined with metformin can significantly improve the level of luteinizing hormone in patients, and it is not significant for the simple improvement of follicle stimulating hormone and dehydroepiandrosterone in PCOS patients.