去氧孕烯炔雌醇治疗多囊卵巢综合征的系统评价

目的系统评价（systematic review，SR）去氧孕烯炔雌醇（desogestrel ethinylestradiol，DE；妈富隆，marvelon）治疗多囊卵巢综合征（polycystic ovary syndrome，PCOS）的效果并与其他治疗措施相比较。方法采用Cochrane系统评价法，检索Evidence Base Medicine Reviews，Medline，EMbase和CNKI等数据库，纳入去氧孕烯炔雌醇治疗多囊卵巢综合征患者的随机／半随机对照研究。评价纳入研究的方法学质量，采用RevMan4．2软件对有关数据进行meta分析。结果本研究共纳入相关文献15篇，1073例患者，纳入研究的方法学质量整体偏低。①去氧孕烯炔雌醇与二甲双胍（metformin，MET）比较，在高胰岛素血症的多囊卵巢综合征患者中，降低雄激素的作用单用前者，可能不及后者（WMD=0．72，95％CI 0．54～0．90）；而在非高胰岛素血症的多囊卵巢综合征患者中，前者的作用，可能优于后者（WMD=-0．53，95％CI-0．83～-0．22）。相比去氧孕烯炔雌醇，二甲双胍对空腹血糖（WMD=0．19，95％CI 0．02～0．36）、空腹血胰岛素（WMD=4．27，95％CI 2．19～6．34）和胰岛素抵抗指数（WMD=0．21，95％CI 0．12～0．30）有明显改善作用；②去氧孕烯炔雌醇＋二甲双胍与二甲双胍比较，前者降低雄激素水平作用，可能优于后者（WMD=-0．71，95％CI-0．95～-0．48）；③去氧孕烯炔雌醇和炔雌醇环丙孕酮（ethinyl estradiol cyproterone，EEC；达因35，diane35）比较，两者对内分泌和代谢的作用无差异；④去氧孕烯炔雌醇＋促排卵治疗与促排卵治疗比较，前者提高排卵率（OR=2．21，95％CI 1．18～4．12；P=0．01）和妊娠率（OR=2．44，95％CI 1．67～3．56；P=0．001）的作用，可能优于后者。结论本研究显示，去氧孕烯炔雌醇对改善高雄激素血症相关症状和卵巢功能有效，而对糖脂代谢可能存在损害作用，可能更适用于无高胰岛素血症的多囊卵巢综合征患者的降雄激素治疗。二甲双胍可能比去氧孕烯炔雌醇更适用于有高胰岛素血症的多囊卵巢综合征患者的降雄激素治疗。去氧孕烯炔雌醇与二甲双胍联用降雄激素作用更明显，但对有明显糖脂代射异常的多囊卵巢综合征患者是否联合用药，需慎重。治疗多囊卵巢综合征，去氧孕烯炔雌醇与炔雌醇环丙孕酮降低雄激素的效果相当。去氧孕烯炔雌醇与促排卵治疗联用，比单用促排卵治疗，更适于多囊卵巢综合征不孕患者的治疗。

Systematic Review of Desogestrel Ethinylestradiol for Treating Polycystic Ovary Syndrome

Objective To systematically evaluate the effect of desogestrel ethinylestradiol （DE, marvelon） for treating polycystic ovary syndrome（PCOS） and compare it with other interventions. Methods A systematic review and recta-analysis of randomized/semi-randomized controlled trial studied desogestrel ethinylestradiol used for treating polycystic ovary syndrome. Articles were really searched from the Evidence Base Medicine Reviews, Medline, EMbase, CNKI databases. Results Fifteen studies with 1 073 patients were included in this study. The quality of included studies was low. （1） Desogestrel ethinylestradiol vs. metformin, in polycystic ovary syndrome patients with hyperinsulinemia, desogestel ethinylestradiol may be less effective thanmetformin for reducing testosterone （T） （WMD=0.72,95%CI 0. 5-0. 90）, but may be better than metformin for reducing testosterone（WMD= 0.53, 95%CI -0.83～-0.22） in polycystic ovary syndrome patients without hyperinsulinemia; compared to desogestrel ethinylestradiol, metformin can effectively improve fasting blood glucose （FBG） （WMD = 0. 19, 95% CI 0. 02 ～ 0. 36）, fasting blood insulin （ FI ） （WMD=4.27, 95% CI 2.19～6.34） and HOMA- IR （WMD=0.21, 95%CI 0. 12～0.30） ; （2） Desogestrel ethinylestradiol ＋ metformin vs. metformin, desogestrel ethinylestradiol ＋ metformin better than metformin for reducing testosterone （WMD=-0. 71, 95%CI -0.95～-0.48） ;（3） Desogestrel ethinylestradiol vs. ethinyl estradiol cyproterone （EEC, diane 35）, desogestrel ehtinylestradiol may be as effective as diane 35 for treating polycystic ovary syndrome; （4） Desogestrel ehtinylestradiol ＋ induce ovulation vs. induce ovulation alone, desogestrel ethinylestradiol q-induce ovulation may be better than induce ovulation alone for increasing the rate of ovulation（OR=2.21, 95%CI 1. 18～4. 12;P=0.01） and the pregnancy rate （OR=2.44, 95%CI 1.67～3.56;P=0.001）. Conclusion Desogestrel ethinylestradiol is an optional choice for reducing testosterone and improving the function of ovaries in polycystic ovary syndrome patients, but it may be bad for the metabolic function. Desogestrel ethinglestradiol may be less suitable than metformin for polycystic ovary syndrome with hyperinsulinemia, but more suitable for polycystic ovary syndrome patients without hyperinsulinemia. The using of desogestrel ethinylestradiol ＋ metformin for treating polycystic ovary syndrome with metabolic disorder should be chosen carefully. Both desogestrel ethinylestradiol and etbinyl estradiol cyproterone may treat polycystic ovary syndrome effectively on reducing testosterone. But desogestrel ethinylestradiol may be more suitable for polycystic ovary syndrome with metabolic disorders than ethiny estradiol cyproteone. Desogestrel ethinylestradiol--induce ovulation treatment is more suitable for treating polycystic ovary syndrome with infertility.