系统评价睾酮治疗对男性性功能障碍患者代谢综合征相关因素的作用

目的:系统评价睾酮治疗对男性性功能障碍患者代谢综合征相关因素的作用。方法:检索PubMed(1980～2009.8)、EMBASE(1980～2009.8)、Cochrane图书馆临床对照试验资料库、中文期刊全文数据库(CNKI,1995～2009.8),按纳入与排除标准选择试验、评价质量、提取资料,用RevMan5.0对数据进行Meta分析。结果:共纳入6项随机对照试验(RCT),方法学质量评价中5项为B级,1项为C级。分析显示:睾酮治疗可显著改善男性性功能障碍患者的空腹血糖、总胆固醇(TC)水平及胰岛素抵抗(HOMA-IR)程度;可降低低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、甘油三酯(TG)和收缩压(SBP)水平,但并不优于对照治疗组;对腹围(WC)、腰臀比(WHR)和舒张压(DBP)的影响目前证据不足。结论:现有临床证据显示,睾酮治疗可以控制血糖(改善胰岛素抵抗,降低空腹血糖),调节血脂(降低TC、TG、LDL、HDL)。但由于纳入研究存在异质性和发生偏倚的高度可能性,势必影响结果的论证强度,期待针对睾酮治疗后代谢状况的全面的大规模的随机双盲对照试验进一步提供证据。

Effects of testosterone substitution on metabolic syndrome-related factors in hypogonadal males: A meta-analysis

Objective:To conduct a meta-analysis on the effects of testosterone on the related factors of metabolic syndrome in hypogonadal males.Methods:Based on the principles and methods of Cochrane systematic reviews,we searched the PubMed (1980 to August 2009),Embase (1980 to August 2009),the Cochrane Central Register of Controlled Trials and CNKI (1995 to August 2009),and handsearched some relevant journals and conference proceedings as well.We also identified randomized controlled trials addressing the use of testosterone for the treatment of hypogonadism,screened the retrieved studies according to the predefined inclusion and exclusion criteria,evaluated the quality of the included studies,and performed a meta-analysis on the results of homogeneous studies using the Cochrane Collaboration's RevMan 5.0 software.Results:Six randomized controlled trials were included.The results of analysis indicated that testosterone substitution could significantly ameliorate fasting blood glucose,total cholesterol and insulin resistance in hypogonadism patients,and it could also reduce LDL,HDL,triglyceride and systolic blood pressure,though with no significant difference from the controls.However,there was insufficient evidence to show the effects of testosterone on waist circumference,waist-hip ratio and diastolic blood pressure.Conclusion:Existing clinical evidence has demonstrated the positive effects of testosterone substitution on the improvement of insulin resistance,blood glucose and lipids,but due to the heterogeneity and high risk of bias in the included studies,the evidence might be insufficient to give full support to the demonstration.Further large-scale trials are required to define the metabolic effects of testosterone in the treatment of hypogonadism.