睾酮替代疗法改善性腺功能减退症患者代谢指标的meta分析

Testosterone replacement therapy improves metabolic indexes of the patients with hypogonadism:A meta-analysis

目的:系统评价睾酮替代疗法(TRT)对性腺功能减退症患者代谢指标的影响。方法:通过计算机检索CNKI、CBM、Wanfang Data、VIP、PubMed、Medline、Embase及Cochrane Library数据库从建立至2021年5月有关TRT改善性腺功能减退症患者代谢指标的临床随机对照试验(RCT),按照纳入与排出标准进行文献筛选、资料提取和质量评价运用,并采用STATA15.1软件进行统计分析。结果:共纳入19篇RCT,共计纳入1553例患者。meta分析结果显示:(1)代谢标志物:与安慰剂相比,TRT可以有效降低FPG、FINS水平,改善HOMA-IR;(2)血脂谱:TRT可以有效降低TC、HDL-C和LDL-C水平;(3)人体测量标志物:TRT可以增加BMI、降低WC;(4)血压:TRT会导致SBP和DBP升高。与安慰剂组相比,TRT在改善HbA1c、TG方面,差异无统计学意义。Egger’s检验和Begg’s检验结果显示,各研究间无明显发表偏倚。结论:TRT可以显著改善性腺功能减退症患者的代谢紊乱,需要进一步的研究证实TRT对伴有代谢紊乱人群的长期有效性和安全性。

Objective:To systematically evaluate the effect of testosterone replacement therapy(TRT)on metabolic indexes in patients with hypogonadism.Methods:We searched the databases of CNKI,CBM,Wanfang Data,VIP,PubMed,Medline,Embase and Cochrane Library from the establishment to May 2021 for clinical randomized controlled trials(RCT)on the improvement of metabolic indexes of the patients with hypogonadism treated by TRT.According to the inclusion and excretion criteria,we screened the literature,extracted the data and evaluated the quality of the included RCTs,followed by statistical analysis with the STATA15.1 software.Results:Totally 19 RCTs with 1553 cases were included.Compared with placebo,TRT effectively reduced the levels of fasting plasma glucose(FPG)and fasting insulin(FINS),improved Homeostatic Model Assessment-insulin resistance(HOMA-IR),decreased total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C),increased the body mass index(BMI),lowered the waist circumference(WC),but elevated the systolic blood pressure(SBP)and diastolic blood pressure(DBP)of the patients.No statistically significant differences were observed in the improvement of glycosylated hemoglobin(HbA1c)and triglyceride(TG)between the TRT-treated patients and placebo controls.The results of Egger’s and Begg’s tests showed no significant publication bias among the studies.Conclusion:TRT can significantly improve metabolic indexes in patients with hypogonadism,though further studies are needed to confirm its long-term efficacy and safety in patients with metabolic disorders.