背景:多囊卵巢综合征(PCOS)是一种影响育龄妇女的复杂内分泌疾病。它以胰岛素抵抗为特征,并且是2型糖尿病(T2DM)的风险。这项研究的目的是回顾有关吡格列酮和罗格列酮在PCOS女性患者中的作用的文献。
方法:我们搜索了PubMed,MEDLINE,Scopus,Embase,Cochrane图书馆和WebofScience于2020年4月发布,并于2023年3月更新。如果研究是报告吡格列酮和罗格列酮在PCOS中的作用的随机对照试验(RCT),则认为它们是合格的。该研究遵循了2020年系统评价和荟萃分析(PRISMA)的首选报告项目。两名评审员独立提取数据,并使用Cochrane偏差风险工具评估偏差风险。
结果:在最初检索到的814个引文中,纳入976名参与者的24项随机临床试验(RCT)被认为是合格的。在患有PCOS的女性中,与二甲双胍相比,罗格列酮治疗导致平均体重显著增加(平均差异(MD)1.95kg;95%CI0.03-3.87,p=0.05).与吡格列酮相比,二甲双胍治疗与平均体重指数(BMI)降低相关(MD0.85kg/m2;95%CI0.13-1.57,p=0.02)。吡格列酮与安慰剂相比(MD2.56kg/m2;95%CI1.77-3.34,p<0.00001)和罗格列酮与二甲双胍相比(MD0.74kg/m2;95%CI0.07-1.41,p=0.03)均与BMI显着增加相关。与安慰剂相比,吡格列酮治疗显示甘油三酸酯(MD-0.20mmol/L;95%CI-0.38至-0.03,p=0.02)和空腹胰岛素水平(MD-11.47mmol/L;95%CI-20.20,-2.27,p=0.01)显着降低。与二甲双胍相比,罗格列酮与促黄体生成素(LH)的降低有轻微的相关性(MD-0.62;95%CI-1.25-0.00,p=0.05)。
结论:与二甲双胍或安慰剂相比,吡格列酮和罗格列酮均与体重和BMI显著增加相关。与安慰剂相比,吡格列酮显着降低了甘油三酸酯和空腹胰岛素,而与二甲双胍相比,罗格列酮显示了LH的适度降低。
■CRD42020178783。
BACKGROUND: Polycystic ovary syndrome (PCOS) is a complex endocrine condition affecting women of reproductive age. It is characterised by insulin resistance and is a risk for type 2 diabetes mellitus (T2DM). The aim of this study was to review the literature on the effect of pioglitazone and rosiglitazone in women with PCOS.
METHODS: We searched PubMed, MEDLINE, Scopus, Embase, Cochrane Library and the Web of Science in April 2020 and updated in March 2023. Studies were deemed eligible if they were randomised controlled trials (RCTs) reporting the effect of pioglitazone and rosiglitazone in PCOS. The study follows the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two reviewers independently extracted data and assessed the risk of bias using the Cochrane risk of bias tool.
RESULTS: Out of 814 initially retrieved citations, 24 randomised clinical trials (RCTs) involving 976 participants were deemed eligible. Among women with PCOS, treatment with rosiglitazone compared to metformin resulted in a significant increase in the mean body weight (mean difference (MD) 1.95 kg; 95% CI 0.03-3.87, p = 0.05). Metformin treatment was associated with a reduction in mean body mass index (BMI) compared to pioglitazone (MD 0.85 kg/m2; 95% CI 0.13-1.57, p = 0.02). Both pioglitazone compared to placebo (MD 2.56 kg/m2; 95% CI 1.77-3.34, p < 0.00001) and rosiglitazone compared to metformin (MD 0.74 kg/m2; 95% CI 0.07-1.41, p = 0.03) were associated with a significant increase in BMI. Treatment with pioglitazone compared to placebo showed a significant reduction in triglycerides (MD - 0.20 mmol/L; 95% CI - 0.38 to - 0.03, p = 0.02) and fasting insulin levels (MD - 11.47 mmol/L; 95% CI - 20.20, - 2.27, p = 0.01). Rosiglitazone compared to metformin was marginally significantly associated with a reduction in the luteinising hormone (LH) (MD - 0.62; 95% CI - 1.25-0.00, p = 0.05).
CONCLUSIONS: Both pioglitazone and rosiglitazone were associated with significant increases in body weight and BMI when compared with metformin or placebo. Pioglitazone significantly reduced triglycerides and fasting insulin when compared with placebo while rosiglitazone showed a modest reduction of LH when compared with metformin.
UNASSIGNED: CRD42020178783.