PDF(Pubmed)
Abstract：
OBJECTIVE: Polycystic ovary syndrome (PCOS) is a prevalent and complex endocrine disorder that affects women of reproductive age. It has significant implications for female endocrine function, reproductive health, and metabolic disturbances, including insulin resistance, impaired glucose tolerance, and dyslipidemia. Studies have shown that decreased heart rate variability (HRV), a marker of autonomic dysfunction, is associated with adverse cardiovascular events. Recent research has focused on investigating autonomic function in PCOS, and some studies have suggested altered autonomic drive in these patients. The aim of this systematic review and meta-analysis was to evaluate cardiac autonomic function by analyzing HRV in women with PCOS.
METHODS: This systematic review was prepared using PRISMA reporting guidelines. The databases searched were PubMed, Scopus, Web of Science, and Cochrane. Risk of Bias was assessed using ROBINS-I for non-RCTs. The GRADE approach was employed to evaluate the level of certainty in the evidence for each outcome. In order to identify the underlying cause of high heterogeneity, a subgroup analysis was conducted. Sensitivity analysis was checked. A random effect model was used and calculated a pooled standardized mean difference (SMD) with a 95% confidence interval (CI).
RESULTS: Seventeen articles were included in the final analysis, varied in quality, ranging from a \"low\" to a \"high risk of bias\". Combined analyses indicated a notable decrease in HRV among individuals with PCOS compared to the control group. Significant changes were observed in SDNN (SMD: -0.763, 95%CI [-1.289 to -0.237], p=0.004), PNN50 (SMD: -1.245, 95%CI [-2.07, -0.419], p=0.003), LF/HF ratio (SMD: 0.670, 95%CI [0.248, 1.091], p=0.002), HFnu (SMD: -0.873, 95%CI [-1.257, -0.489], p=0.000), LFnu (SMD: 0.840, 95%CI [0.428, 1.251], p=0.000) and TP (SMD: -1.997, 95%CI [-3.306, -0.687], p=0.003). The heterogeneity was partially explained by types of study design. Subgroup analysis revealed significant alterations of HRV in normal-weighted and overweight PCOS cases. Conversely, no significant changes in HRV were observed in obese PCOS cases.
CONCLUSIONS: The findings of this meta-analysis provide evidence suggesting diminished HRV in individuals with PCOS compared to non-PCOS control group.
METHODS: This systematic review was prepared using PRISMA reporting guidelines. The databases searched were PubMed, Scopus, Web of Science, and Cochrane. Risk of Bias was assessed using ROBINS-I for non-RCTs. The GRADE approach was employed to evaluate the level of certainty in the evidence for each outcome. In order to identify the underlying cause of high heterogeneity, a subgroup analysis was conducted. Sensitivity analysis was checked. A random effect model was used and calculated a pooled standardized mean difference (SMD) with a 95% confidence interval (CI).
RESULTS: Seventeen articles were included in the final analysis, varied in quality, ranging from a \"low\" to a \"high risk of bias\". Combined analyses indicated a notable decrease in HRV among individuals with PCOS compared to the control group. Significant changes were observed in SDNN (SMD: -0.763, 95%CI [-1.289 to -0.237], p=0.004), PNN50 (SMD: -1.245, 95%CI [-2.07, -0.419], p=0.003), LF/HF ratio (SMD: 0.670, 95%CI [0.248, 1.091], p=0.002), HFnu (SMD: -0.873, 95%CI [-1.257, -0.489], p=0.000), LFnu (SMD: 0.840, 95%CI [0.428, 1.251], p=0.000) and TP (SMD: -1.997, 95%CI [-3.306, -0.687], p=0.003). The heterogeneity was partially explained by types of study design. Subgroup analysis revealed significant alterations of HRV in normal-weighted and overweight PCOS cases. Conversely, no significant changes in HRV were observed in obese PCOS cases.
CONCLUSIONS: The findings of this meta-analysis provide evidence suggesting diminished HRV in individuals with PCOS compared to non-PCOS control group.
摘要：
目的：多囊卵巢综合征（PCOS）是一种影响育龄期妇女的常见且复杂的内分泌疾病。它对女性内分泌功能有重大影响，生殖健康,和代谢紊乱，包括胰岛素抵抗，糖耐量受损,和血脂异常。研究表明，心率变异性（HRV）降低，自主神经功能障碍的标志,与不良心血管事件有关。最近的研究集中在研究PCOS的自主神经功能，一些研究表明，这些患者的自主神经驱动发生了改变。本系统评价和荟萃分析的目的是通过分析PCOS女性患者的HRV来评估心脏自主神经功能。
方法：本系统综述使用PRISMA报告指南编制。搜索的数据库是PubMed,Scopus,WebofScience,还有Cochrane.使用ROBINS-I评估非随机对照试验的偏倚风险。采用等级方法来评估每个结果的证据的确定性水平。为了找出高度异质性的根本原因，进行了亚组分析.检查敏感性分析。使用随机效应模型并计算具有95%置信区间(CI)的合并标准化平均差(SMD)。
结果：最终分析包括17篇文章，质量各不相同，从“低”到“高偏见风险”。综合分析表明，与对照组相比，PCOS患者的HRV显着降低。在SDNN中观察到显着变化（SMD：-0.763，95CI[-1.289至-0.237]，p=0.004),PNN50（SMD：-1.245，95CI[-2.07，-0.419]，p=0.003),LF/HF比（SMD：0.670，95CI[0.248，1.091]，p=0.002),HFnu（SMD：-0.873，95CI[-1.257，-0.489]，p=0.000)，LFnu（SMD：0.840，95CI[0.428，1.251]，p=0.000）和TP（SMD：-1.997，95CI[-3.306，-0.687]，p=0.003)。异质性部分由研究设计类型解释。亚组分析显示，在正常加权和超重的PCOS病例中，HRV发生了显着变化。相反，在肥胖PCOS病例中,HRV无显著变化.
结论：这项荟萃分析的结果提供的证据表明，与非PCOS对照组相比，PCOS患者的HRV降低。
方法：本系统综述使用PRISMA报告指南编制。搜索的数据库是PubMed,Scopus,WebofScience,还有Cochrane.使用ROBINS-I评估非随机对照试验的偏倚风险。采用等级方法来评估每个结果的证据的确定性水平。为了找出高度异质性的根本原因，进行了亚组分析.检查敏感性分析。使用随机效应模型并计算具有95%置信区间(CI)的合并标准化平均差(SMD)。
结果：最终分析包括17篇文章，质量各不相同，从“低”到“高偏见风险”。综合分析表明，与对照组相比，PCOS患者的HRV显着降低。在SDNN中观察到显着变化（SMD：-0.763，95CI[-1.289至-0.237]，p=0.004),PNN50（SMD：-1.245，95CI[-2.07，-0.419]，p=0.003),LF/HF比（SMD：0.670，95CI[0.248，1.091]，p=0.002),HFnu（SMD：-0.873，95CI[-1.257，-0.489]，p=0.000)，LFnu（SMD：0.840，95CI[0.428，1.251]，p=0.000）和TP（SMD：-1.997，95CI[-3.306，-0.687]，p=0.003)。异质性部分由研究设计类型解释。亚组分析显示，在正常加权和超重的PCOS病例中，HRV发生了显着变化。相反，在肥胖PCOS病例中,HRV无显著变化.
结论：这项荟萃分析的结果提供的证据表明，与非PCOS对照组相比，PCOS患者的HRV降低。
