Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring Road, 56403 Nea Efkapria, Thessaloniki, Greece.
Hum Reprod Update. 2011 Nov-Dec;17(6):741-60. doi: 10.1093/humupd/dmr025. Epub 2011 May 30.
The relation between polycystic ovary syndrome (PCOS) and cardiovascular disease (CVD) remains unclear. In an attempt to provide high-quality evidence on the relation between PCOS and CVD, relevant literature for CVD risk markers [C-reactive protein (CRP), homocysteine (Hcy), tumor necrosis factor-alpha (TNF-α), plasminogen activator inhibitor-1 (PAI-1), lipoprotein (a) [Lp(a)], advanced glycation end-products (AGEs), vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), asymmetric dimethylarginine (ADMA), endothelin-1 (ET-1) and fibrinogen] in women with PCOS was reviewed and analyzed.
A systematic search was conducted electronically using specific eligibility criteria. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated and combined appropriately. To ensure synthesis of the best available evidence, sensitivity analyses were performed. RESULTS A total of 130 data sets were included in 11 different outcomes, involving 7174 and 5076 CVD markers in women with PCOS and controls, respectively. Women with PCOS demonstrated significantly elevated CRP [WMD (95% CI) 0.99 (0.77-1.21)], Hcy [2.25 (1.46-3.03)], PAI-1 antigen [16.96 (7.25-26.28)], PAI-1 activity [0.71 (0.18-1.23)], VEGF [1.72 (0.96-2.48)], ADMA [0.19 (0.08-0.3)], AGEs [3.91 (2.36-5.45)] and Lp(a) [0.81 (0.58-1.04)] concentrations compared with controls, yet with significant between-study heterogeneity. Borderline significance (not robust in the sensitivity analyses) was detected for TNF-α [0.75 (0.07-1.44)], ET-1 [1.06 (0.52-1.59)] and fibrinogen [0.20 (0.01-0.39)], whereas no difference was detected for IL-6 [0.71 (-0.16 to 1.59)]. CONCLUSIONS Women with PCOS have increased serum concentrations of CVD risk markers compared with controls. Whether this apparent risk is translated into increased incidence of CVD in later life remains to be elucidated.
多囊卵巢综合征（PCOS）与心血管疾病（CVD）之间的关系仍不清楚。为了提供有关 PCOS 与 CVD 之间关系的高质量证据，对 PCOS 患者的 CVD 风险标志物[C 反应蛋白（CRP）、同型半胱氨酸（Hcy）、肿瘤坏死因子-α（TNF-α）、纤溶酶原激活物抑制剂-1（PAI-1）、脂蛋白（a）[Lp（a）]、晚期糖基化终产物（AGEs）、血管内皮生长因子（VEGF）、白细胞介素-6（IL-6）、不对称二甲基精氨酸（ADMA）、内皮素-1（ET-1）和纤维蛋白原]相关的文献进行了综述和分析。
使用特定的纳入标准，通过电子方式进行系统搜索。计算并适当合并加权均数差值（WMDs）和 95%置信区间（CIs）。为了确保综合最佳现有证据，进行了敏感性分析。
共纳入 11 项不同结局的 130 组数据，涉及 PCOS 患者和对照组的 7174 个和 5076 个 CVD 标志物。与对照组相比，PCOS 患者的 CRP [WMD（95%CI）0.99（0.77-1.21）]、Hcy [2.25（1.46-3.03）]、PAI-1 抗原[16.96（7.25-26.28）]、PAI-1 活性[0.71（0.18-1.23）]、VEGF [1.72（0.96-2.48）]、ADMA [0.19（0.08-0.3）]、AGEs [3.91（2.36-5.45）]和 Lp（a）[0.81（0.58-1.04）]浓度明显升高，但存在显著的研究间异质性。TNF-α [0.75（0.07-1.44）]、ET-1 [1.06（0.52-1.59）]和纤维蛋白原[0.20（0.01-0.39）]的检测结果接近显著（敏感性分析结果不稳定），而 IL-6 [0.71（-0.16-1.59）]的检测结果无差异。
与对照组相比，PCOS 患者的血清 CVD 风险标志物浓度升高。这种明显的风险是否会转化为以后生活中 CVD 发病率的增加，仍有待阐明。
