联合应用奥利司他对比单用口服避孕药对多囊卵巢综合征患者疗效的Meta分析

Effect of combined use of orlistat and oral contraceptives versus conventional oral contraceptives on metabolism and endocrine in patients with polycystic ovary syndrome:a Meta-analysis

目的:评价多囊卵巢综合征(PCOS)患者联合应用奥利司他对比常规口服避孕药疗法(OCT)对代谢及内分泌的影响。方法:检索PubMed、Web of Science、Cochrane Database of Systematic Reviews、Embase、CNKI及Wanfang数据库,检索时间从建库截至2020年11月,收集有关奥利司他对比OCT对PCOS患者代谢及内分泌影响的研究,按照纳入排除标准选择文献提取资料、评价质量、交叉核对并进行方法学质量评估,采用Stata 12.0统计软件进行Meta分析。结果:纳入6篇文献,共547例患者。5个主要结局指标中,口服避孕药联合应用奥利司他组与单用口服避孕药组治疗前后睾酮(T)水平变化的差异有统计学意义(SMD=-0.64,95%CI为-1.18~0.10,P=0.021)。10个次要结局指标中,甘油三酯(TG)水平变化的差异有统计学意义(SMD=-0.40,95%CI为-0.068~0.12,P=0.005);高密度脂蛋白胆固醇(HDL-C)水平变化的差异也有统计学意义(SMD=0.62,95%CI为0.32~0.92,P<0.001);但与体质量相关指标变化差异均没有统计学意义(P<0.05)。结论:联合应用奥利司他对比单用OCT治疗多囊卵巢综合征患者在调控T、TG及HDL-C水平方面疗效更佳。

Objective:To evaluate the effect of orlistat combined with conventional oral contraceptive therapy(OCT)on metabolism and endocrine in patients with polycystic ovary syndrome(PCOS).Methods:We searched PubMed,Web of Science,Cochrane Database of Systematic Reviews,Embase,CNKI and Wanfang databases for trials that assessed orlistat in PCOS patients with OCT from establishment of the database to November 2020.The reviewers selected literature,extracted data and evaluated quality independently,cross-checked,and evaluated the quality of methodological according the inclusion and exclusion criteria.Stata 12.0 software was used for the Mete-analysis.Results:A total of 6 studies involving 547 patients were included.The main endpoint of the study:Among the 5 main outcome indicators,the difference in testosterone(T)levels before and after treatment in the oral contraceptive in combination with orlistat group and the oral contraceptive group was statistically significant;among the 10 secondary outcome indicators,the difference in triglyceride(TG)level changes was statistically significant.The difference in high-density lipoprotein cholesterol(HDL-C)levels was statistically significant.While orlistat was known as a weight loss drug,compared with single oral contraceptives,before and after combined oral contraceptive treatment,the changes in weight-related indicators were not statistically significant.Conclusion:Comparing with OCT alone,the combination of orlistat and OCT may be of some auxiliary significance in the regulation of testosterone,triglyceride,and high-density lipoprotein-cholesterol levels in PCOS patients.