Abstract：
BACKGROUND: Only few studies have assessed sexual dysfunction in men with Klinefelter syndrome (KS).
OBJECTIVE: To define pooled prevalence estimates and correlates of erectile dysfunction (ED) and decreased libido (DL) in KS.
METHODS: A thorough search of Medline, Embase and Web of Science was performed to identify suitable studies. Quality of the articles was scored using the Assessment Tool for Prevalence Studies. Data were combined using random effect models and the between-studies heterogeneity was assessed by the Cochrane\'s Q and I2. The sources of heterogeneity were investigated by meta-regression and sub-group analyses. Funnel plot, Begg\'s rank correlation and trim-and-fill test were used to assess publication bias.
METHODS: The pooled prevalence of ED and DL in KS as well as 95% confidence intervals (CIs) were estimated from the proportion of cases of sexual dysfunction and the sample size. Variables that could affect the estimates were identified by linear meta-regression models.
RESULTS: Sixteen studies included collectively gave information about ED and DL in 482 and 368 KS men, respectively, resulting in a pooled prevalence of 28% (95% CI: 19%-36%) for ED and 51% (95% CI: 36%-66%) for DL, with a large heterogeneity. The trim-and-fill adjustment for publication bias produced a negligible effect on the pooled estimates. At the meta-regression analyses, a higher prevalence of ED was significantly associated with an older age but not with lower testosterone levels. In series with a mean age >35 years, the ED prevalence estimate increased up to 38% (95% CI: 31%-44%) with no heterogeneity (I2=0.0%, P=0.6). On the contrary, the prevalence of DL increased significantly as testosterone levels decreased, without a significant relationship with age.
CONCLUSIONS: While DL would largely reflect an androgen deficiency, in older men with KS, erectile function should be assessed irrespective of testosterone levels.
UNASSIGNED: This is the first meta-analysis defining pooled prevalence estimates and correlates of ED and DL in KS. Nevertheless, caution is required when interpreting results, due to the high risk of bias in many studies, as well as the dearth of data about psychosocial and/or psychosexological variables and age at the diagnosis.
CONCLUSIONS: ED and DL represent common clinical complaints in KS. While the prevalence of ED would increase with age, DL gets more common as serum testosterone decreases. Further studies are warranted to elucidate the pathogenetic mechanism(s) underlying the age-dependent increase in the prevalence of ED, apparently unrelated to the androgenic status.
OBJECTIVE: To define pooled prevalence estimates and correlates of erectile dysfunction (ED) and decreased libido (DL) in KS.
METHODS: A thorough search of Medline, Embase and Web of Science was performed to identify suitable studies. Quality of the articles was scored using the Assessment Tool for Prevalence Studies. Data were combined using random effect models and the between-studies heterogeneity was assessed by the Cochrane\'s Q and I2. The sources of heterogeneity were investigated by meta-regression and sub-group analyses. Funnel plot, Begg\'s rank correlation and trim-and-fill test were used to assess publication bias.
METHODS: The pooled prevalence of ED and DL in KS as well as 95% confidence intervals (CIs) were estimated from the proportion of cases of sexual dysfunction and the sample size. Variables that could affect the estimates were identified by linear meta-regression models.
RESULTS: Sixteen studies included collectively gave information about ED and DL in 482 and 368 KS men, respectively, resulting in a pooled prevalence of 28% (95% CI: 19%-36%) for ED and 51% (95% CI: 36%-66%) for DL, with a large heterogeneity. The trim-and-fill adjustment for publication bias produced a negligible effect on the pooled estimates. At the meta-regression analyses, a higher prevalence of ED was significantly associated with an older age but not with lower testosterone levels. In series with a mean age >35 years, the ED prevalence estimate increased up to 38% (95% CI: 31%-44%) with no heterogeneity (I2=0.0%, P=0.6). On the contrary, the prevalence of DL increased significantly as testosterone levels decreased, without a significant relationship with age.
CONCLUSIONS: While DL would largely reflect an androgen deficiency, in older men with KS, erectile function should be assessed irrespective of testosterone levels.
UNASSIGNED: This is the first meta-analysis defining pooled prevalence estimates and correlates of ED and DL in KS. Nevertheless, caution is required when interpreting results, due to the high risk of bias in many studies, as well as the dearth of data about psychosocial and/or psychosexological variables and age at the diagnosis.
CONCLUSIONS: ED and DL represent common clinical complaints in KS. While the prevalence of ED would increase with age, DL gets more common as serum testosterone decreases. Further studies are warranted to elucidate the pathogenetic mechanism(s) underlying the age-dependent increase in the prevalence of ED, apparently unrelated to the androgenic status.
摘要：
背景：只有少数研究评估了Klinefelter综合征（KS）男性的性功能障碍。
目的：定义KS中勃起功能障碍（ED）和性欲下降（DL）的合并患病率估计值和相关性。
方法：对Medline进行彻底搜索，进行Embase和WebofScience以确定合适的研究。使用患病率研究评估工具对文章的质量进行评分。使用随机效应模型合并数据，并通过Cochrane的Q和I2评估研究之间的异质性。通过荟萃回归和亚组分析调查异质性的来源。漏斗图，使用Begg的等级相关性和修剪填充检验来评估发表偏倚。
方法：根据性功能障碍病例的比例和样本量估算KS中ED和DL的合并患病率以及95％置信区间（CIs）。通过线性元回归模型确定了可能影响估计的变量。
结果：共有16项研究提供了482和368名KS男性的ED和DL信息，分别,导致ED的合并患病率为28%(95%CI:19%-36%)，DL的合并患病率为51%(95%CI:36%-66%)，具有很大的异质性。对出版偏差的修剪和填充调整对合并估计的影响可以忽略不计。在荟萃回归分析中，ED患病率较高与年龄较大显著相关,但与睾酮水平较低无关.在平均年龄>35岁的系列中，ED患病率估计值增加到38%(95%CI:31%-44%)，没有异质性(I2=0.0%，P=0.6)。相反,随着睾酮水平的降低，DL的患病率显着增加，与年龄无关。
结论：虽然DL在很大程度上反映了雄激素缺乏，在患有KS的老年男性中，无论睾酮水平如何，都应评估勃起功能。
■这是第一个荟萃分析，定义KS中ED和DL的合并患病率估计和相关性。然而，解释结果时需要谨慎，由于许多研究中偏倚的风险很高，以及诊断时缺乏有关心理社会和/或心理性别变量和年龄的数据。
结论：ED和DL代表KS的常见临床表现。虽然ED的患病率会随着年龄的增长而增加，随着血清睾酮降低,DL变得更常见。需要进一步的研究来阐明ED患病率的年龄依赖性增加的潜在发病机制。显然与雄激素状态无关。
目的：定义KS中勃起功能障碍（ED）和性欲下降（DL）的合并患病率估计值和相关性。
方法：对Medline进行彻底搜索，进行Embase和WebofScience以确定合适的研究。使用患病率研究评估工具对文章的质量进行评分。使用随机效应模型合并数据，并通过Cochrane的Q和I2评估研究之间的异质性。通过荟萃回归和亚组分析调查异质性的来源。漏斗图，使用Begg的等级相关性和修剪填充检验来评估发表偏倚。
方法：根据性功能障碍病例的比例和样本量估算KS中ED和DL的合并患病率以及95％置信区间（CIs）。通过线性元回归模型确定了可能影响估计的变量。
结果：共有16项研究提供了482和368名KS男性的ED和DL信息，分别,导致ED的合并患病率为28%(95%CI:19%-36%)，DL的合并患病率为51%(95%CI:36%-66%)，具有很大的异质性。对出版偏差的修剪和填充调整对合并估计的影响可以忽略不计。在荟萃回归分析中，ED患病率较高与年龄较大显著相关,但与睾酮水平较低无关.在平均年龄>35岁的系列中，ED患病率估计值增加到38%(95%CI:31%-44%)，没有异质性(I2=0.0%，P=0.6)。相反,随着睾酮水平的降低，DL的患病率显着增加，与年龄无关。
结论：虽然DL在很大程度上反映了雄激素缺乏，在患有KS的老年男性中，无论睾酮水平如何，都应评估勃起功能。
■这是第一个荟萃分析，定义KS中ED和DL的合并患病率估计和相关性。然而，解释结果时需要谨慎，由于许多研究中偏倚的风险很高，以及诊断时缺乏有关心理社会和/或心理性别变量和年龄的数据。
结论：ED和DL代表KS的常见临床表现。虽然ED的患病率会随着年龄的增长而增加，随着血清睾酮降低,DL变得更常见。需要进一步的研究来阐明ED患病率的年龄依赖性增加的潜在发病机制。显然与雄激素状态无关。
