屈螺酮炔雌醇对比炔雌醇环丙孕酮治疗多囊卵巢综合征的Meta分析

Drospirenol estradiol versus Ethinyl estradiol in treatment of Polycystic Ovary Syndrome:A Meta-analysis

目的系统评价屈螺酮炔雌醇(优思明)对比炔雌醇环丙孕酮(达英-35)治疗多囊卵巢综合征(Polycystic Ovary Syndrome,PCOS)的效果和安全性。方法检索PubMed、Willy online library、EMBASE、Cochrane Library、中国知网、维普和万方等数据库,收集建库至2020年2月1日研究优思明对比达英-35治疗PCOS的随机对照试验资料,采用Revman 5.3软件进行Meta分析。结果 (1)纳入12个研究,共1680例患者。(2)应用优思明对比达英-35治疗PCOS,对性激素中如促黄体生成素(MD=-1.35,95%CI:-2.07~0.63,P<0.01)、孕酮(MD=0.26,95%CI:0.01~0.51,P<0.01)、睾酮(MD=-0.16,95%CI:-0.24^-0.08,P<0.01)有明显改善作用。(3)对高密度脂蛋白胆固醇(MD=0.09,95%CI:0.03~0.14,P<0.01)、低密度脂蛋白胆固醇(MD=-0.29,95%CI:-0.46^-0.12,P<0.01)有明显改善作用。(4)对改善体重指数(MD=-0.43,95%CI:-1.34~0.48,P=0.36)、毛发评分(MD=0.81,95%CI:-0.02~1.64,P=0.06)、痤疮评分(MD=-0.07,95%CI:-0.24~0.09,P=0.38)方面无明显差异。(5)对改善妊娠率(OR=1.63,95%CI:0.66~4.02,P=0.29)及服药后不良反应发生率(OR=0.61,95%CI:0.35~1.05,P=0.07)方面无明显差异。结论与达英-35治疗PCOS相比,优思明对总体性激素水平和脂质代谢水平有一定改善作用,但在改善患者一般形象、提高妊娠率和降低不良反应发生率方面与达英-35无明显差异。

Objective To systematically review the clinical efficacy and safety of Drospirenol estradiol(Yasminelle)versus Ethinyl estradiol(Diane-35)in treatment of Polycystic Ovary Syndrome(PCOS).Methods To search the Cochrane Library,PubMed,Web of Science,Embase,CNKI,VIP and WanFang Data databases by computers.The search period was from the establishment of the library to February 1st,2020.The studies were collected from the Randomized controlled trials(RCTs)of Yasminelle versus Diane-35 in treatment of PCOS.Results(1)Twelve RCTs were included,including 1680 patients.(2)Meta-analysis results showed that compared with Diane-35,Yasminelle in the treatment of PCOS on Luteinizing hormone(MD=-1.35,95%CI:-2.07~0.63,P<0.01),Progesterone(MD=0.26,95%CI:0.01~0.51,P<0.01),Testosterone(MD=-0.16,95%CI:-0.24^-0.08,P<0.01),High density lipoprotein cholesterol(MD=0.09,95%CI:0.03~0.14,P<0.01)and Low density lipoprotein cholesterol(MD=-0.29,95%CI:-0.46^-0.12,P<0.01)have better treatment effects.(3)In terms of pregnancy rate(OR=1.63,95%CI:0.66~4.02,P=0.29)and safety(OR=0.61,95%CI:0.35~1.05,P=0.07),there was no difference in the incidence of adverse reactions between the two groups.Conclusion Compared with Diane-35,Yasminelle in the treatment of PCOS have better treatment effects on Sex hormone levels and lipid Metabolism for patients.However,it is not significantly different from Diane-35 in improving patients’general image,increasing pregnancy rate and reducing the incidence of adverse reactions.