噻唑烷二酮类药物和二甲双胍联合治疗多囊卵巢综合征的系统评价

目的系统评价二甲双胍和噻唑烷二酮类药物联合治疗多囊卵巢综合征(PCOS)的疗效与安全性。方法计算机检索Cochrane图书馆、Medline、EMbase、EBSCO、ScienceDirect、OVID、SpringerLINK、Wiley、中国生物医学文献数据库(CBM)、中国期刊网(CNKI)、维普数据库(VIP),同时注意未发表文献、会议论文和学位论文的检索,对部分文献使用手工检索。检索年限从建库至2009年11月。查找以噻唑烷二酮类药物和二甲双胍联合治疗为干预措施治疗PCOS的随机对照试验(RCT)/临床对照试验(CCT)进行质量评价,运用Revman5.0统计软件对提取的相关数据进行Meta分析。结果共有5个试验符合纳入标准。Meta分析结果显示:二甲双胍治疗PCOS同时加用噻唑烷二酮类较二甲双胍单药明显改善胰岛素抵抗[P0.00001,WMD=-0.21,95%CI(-0.27,-0.15)]、促进排卵[P=0.003,OR=2.76,95%CI(1.14,5.42)],但其降低腰臀比(waist-hipratio,WHR)[P=0.51,WMD=0.02,95%CI(-0.04,0.08)]和雄激素[P=0.20,WMD=-31.14,95%CI(-79.21,16.92)]的作用较单药无差异,联合治疗反而削弱了二甲双胍单药改善体质量指数(BMI)[P=0.02,WMD=0.54,95%CI(0.08,1.00)]的作用。没有研究报道不良反应。结论噻唑烷二酮类药物和二甲双胍联合治疗PCOS较二甲双胍单药治疗能显著改善胰岛素抵抗、促进排卵且用药相对安全。

Thiazolidinediones combined with metformin in treatment of polycystic ovary syndrome: a systematic review

Objective To assess the efficacy and safety of thiazolidinediones combined with metformin in treatment of polycystic ovary syndrome. Methods Electronic database searching was performed on Medline, Cochrane Library, EMbase, EBSCO, ScienceDirect, OVID, Springer LINK, Wiley, Chinese biology and medicine (CBM), China National Knowledge Infrastructure (CNKD, and Chongqing VIP Database; meanwhile, unpubished literature, conference papers and dissertations were also searched manually. The data included those from the establishment to November 2009. Randomized or clinical controlled trials concerning the thiazolidinediones and metformin combination therapy for PCOS were selected and assessed for the methodological quality, and Meta-analysis was performed using statistical software Revman 5.0. Results Five randomized controlled trials met the inclusion criteria and were included. Compared to metformin group, thiazolidinediones combined with metformin significantly improved insulin resistance(P<0.000 01, WMD= - 0.21,95% CI[- 0.27, - 0.15]) and ovulation rates (P=0.003, OR=2.76,95%CI[1.14,5.42]) . There was no difference in WHR(P=0.51,WMD=0.02,95%CI[-0.04,0.08]) and serum testosterone(P=0.20,WMD=31.14,95%CI[-79.21,16.92]) between the combination and metformin groups. However, single metformin therapy was shown to have more benefit in ameliorating BMI(P = 0.02, WMD= 0.54,95 %CI[0.08, 1.00]) than the combination group. There were no serious adverse events during the treatment. Conclusion Thiazolidinediones combined with metformin can greatly improve of insulin resistance and ovulation rates in PCOS women; besides, it is comparatively safe.