Abstract：
BACKGROUND: Menopause is associated with elevated cardiovascular risk due to the loss of the cardioprotective effect of oestrogens. Postmenopausal women are often prescribed hormone replacement therapy (HRT) in order to control menopause symptoms and correct hormone imbalances; however, HRT can impact serum lipids\' concentrations. At present, data on the effect of the administration of medroxyprogesterone acetate plus conjugated equine oestrogens (MPACEE) on the lipid profile in females are uncertain, as the investigations conducted so far have produced conflicting results. Thus, we aimed to clarify the impact of MPACEE prescription on the serum lipids\' values in women by means of a systematic review and meta-analysis of randomized controlled trials (RCTs).
METHODS: We employed a random-effects model based on the DerSimonian and Laird method to determine the combined estimates of the intervention\'s impact on the lipid profile. The computation of the weighted mean difference (WMD) and its corresponding 95% confidence interval (CI) relied on the mean and standard deviation values from both the MPACEE and control group, respectively.
RESULTS: A total of 53 RCTs were included in the meta-analysis with 68 RCT arms on total cholesterol (TC), 70 RCT arms on low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG), and 69 RCT arms on high-density lipoprotein cholesterol (HDL-C). Administration of MPACEE resulted in a significant reduction of TC (WMD = -11.93 mg/dL; 95% CI: -13.42, -10.44; p < .001) and LDL-C (WMD = -16.61 mg/dL; 95% CI: -17.97, -15.26; p < .001) levels, and a notable increase in HDL-C (WMD = 3.40 mg/dL; 95% CI: 2.93, 3.86; p < .001) and TG (WMD = 10.28 mg/dL; 95% CI: 7.92, 12.64; p < .001) concentrations. Subgroup analysis revealed that changes in the lipid profile were influenced by several factors: body mass index (for TC, HDL-C, TG), MPACEE dosages (for TC, LDL-C, HDL-C, TG), age (for TC, LDL-C, HDL-C, TG), durations of the intervention (for TC, LDL-C, HDL-C, TG), continuous/sequential administration of MPACEE (continuous for TC; sequential for LDL-C, TG) administration of MPACEE and serum lipids\' concentrations before enrolment in the RCT (for TC, LDL-C, HDL-C, TG).
CONCLUSIONS: MPACEE administration can influence serum lipids\' concentrations in females by raising HDL-C and TG levels and reducing LDL-C and TC values. Therefore, postmenopausal women who suffer from hypercholesterolaemia might benefit from this type of HRT.
METHODS: We employed a random-effects model based on the DerSimonian and Laird method to determine the combined estimates of the intervention\'s impact on the lipid profile. The computation of the weighted mean difference (WMD) and its corresponding 95% confidence interval (CI) relied on the mean and standard deviation values from both the MPACEE and control group, respectively.
RESULTS: A total of 53 RCTs were included in the meta-analysis with 68 RCT arms on total cholesterol (TC), 70 RCT arms on low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG), and 69 RCT arms on high-density lipoprotein cholesterol (HDL-C). Administration of MPACEE resulted in a significant reduction of TC (WMD = -11.93 mg/dL; 95% CI: -13.42, -10.44; p < .001) and LDL-C (WMD = -16.61 mg/dL; 95% CI: -17.97, -15.26; p < .001) levels, and a notable increase in HDL-C (WMD = 3.40 mg/dL; 95% CI: 2.93, 3.86; p < .001) and TG (WMD = 10.28 mg/dL; 95% CI: 7.92, 12.64; p < .001) concentrations. Subgroup analysis revealed that changes in the lipid profile were influenced by several factors: body mass index (for TC, HDL-C, TG), MPACEE dosages (for TC, LDL-C, HDL-C, TG), age (for TC, LDL-C, HDL-C, TG), durations of the intervention (for TC, LDL-C, HDL-C, TG), continuous/sequential administration of MPACEE (continuous for TC; sequential for LDL-C, TG) administration of MPACEE and serum lipids\' concentrations before enrolment in the RCT (for TC, LDL-C, HDL-C, TG).
CONCLUSIONS: MPACEE administration can influence serum lipids\' concentrations in females by raising HDL-C and TG levels and reducing LDL-C and TC values. Therefore, postmenopausal women who suffer from hypercholesterolaemia might benefit from this type of HRT.
摘要：
背景：由于雌激素的心脏保护作用丧失，绝经与心血管风险升高有关。绝经后妇女经常被处方激素替代疗法（HRT），以控制更年期症状和纠正激素失衡；然而，HRT可影响血清脂质浓度。目前,关于醋酸甲羟孕酮加共轭马雌激素（MPACEE）对女性血脂谱的影响的数据是不确定的，因为到目前为止进行的调查产生了相互矛盾的结果。因此，我们旨在通过对随机对照试验(RCTs)的系统评价和荟萃分析,阐明MPACEE处方对女性血脂值的影响.
方法：我们采用了基于DerSimonian和Laird方法的随机效应模型，以确定干预对血脂谱影响的综合估计。加权平均差（WMD）及其相应的95％置信区间（CI）的计算依赖于MPACEE和对照组的平均值和标准偏差值，分别。
结果：共有53个RCT被纳入荟萃分析，其中68个RCT组涉及总胆固醇（TC），低密度脂蛋白胆固醇（LDL-C）和甘油三酯（TG）的70RCT臂，和高密度脂蛋白胆固醇（HDL-C）的69个RCT臂。MPACEE的管理导致TC（WMD=-11.93mg/dL;95％CI：-13.42，-10.44;p<.001）和LDL-C（WMD=-16.61mg/dL;95％CI：-17.97，-15.26;p<.001）水平显着降低，HDL-C（WMD=3.40mg/dL；95％CI：2.93，3.86；p<.001）和TG（WMD=10.28mg/dL；95％CI：7.92，12.64；p<.001）浓度显着增加。亚组分析显示，脂质分布的变化受以下几个因素的影响：体重指数（对于TC，HDL-C,TG),MPACEE剂量(对于TC，LDL-C,HDL-C,TG),年龄(对于TC，LDL-C,HDL-C,TG),干预的持续时间(对于TC，LDL-C,HDL-C,TG),MPACEE连续/序贯给药(TC连续给药；LDL-C顺序给药，TG)在RCT登记前给予MPACEE和血脂浓度(对于TC，LDL-C,HDL-C,TG）。
结论：MPACEE给药可通过提高HDL-C和TG水平，降低LDL-C和TC值影响女性血脂浓度。因此,患有高胆固醇血症的绝经后妇女可能会从这种类型的HRT中受益.
方法：我们采用了基于DerSimonian和Laird方法的随机效应模型，以确定干预对血脂谱影响的综合估计。加权平均差（WMD）及其相应的95％置信区间（CI）的计算依赖于MPACEE和对照组的平均值和标准偏差值，分别。
结果：共有53个RCT被纳入荟萃分析，其中68个RCT组涉及总胆固醇（TC），低密度脂蛋白胆固醇（LDL-C）和甘油三酯（TG）的70RCT臂，和高密度脂蛋白胆固醇（HDL-C）的69个RCT臂。MPACEE的管理导致TC（WMD=-11.93mg/dL;95％CI：-13.42，-10.44;p<.001）和LDL-C（WMD=-16.61mg/dL;95％CI：-17.97，-15.26;p<.001）水平显着降低，HDL-C（WMD=3.40mg/dL；95％CI：2.93，3.86；p<.001）和TG（WMD=10.28mg/dL；95％CI：7.92，12.64；p<.001）浓度显着增加。亚组分析显示，脂质分布的变化受以下几个因素的影响：体重指数（对于TC，HDL-C,TG),MPACEE剂量(对于TC，LDL-C,HDL-C,TG),年龄(对于TC，LDL-C,HDL-C,TG),干预的持续时间(对于TC，LDL-C,HDL-C,TG),MPACEE连续/序贯给药(TC连续给药；LDL-C顺序给药，TG)在RCT登记前给予MPACEE和血脂浓度(对于TC，LDL-C,HDL-C,TG）。
结论：MPACEE给药可通过提高HDL-C和TG水平，降低LDL-C和TC值影响女性血脂浓度。因此,患有高胆固醇血症的绝经后妇女可能会从这种类型的HRT中受益.
