Xu Youhua, Lin Jing, Wang Shanshan, Xiong Jianfeng, Zhu Quan
State Key Laboratory of Quality Research in Chinese Medicine, Faculty of Chinese Medicine, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau, China.
Research Center of Natural Medicine, Clinical School of Kunming General Hospital of Chengdu Military Command, Kunming Medical University, Kunming, China.
Kaohsiung J Med Sci. 2014 Jul;30(7):350-61. doi: 10.1016/j.kjms.2014.03.002. Epub 2014 Apr 18.
Previous studies have shown that the incidence of diabetes is higher when women come to menopause. This study was carried out to examine the effects of combined estrogen replacement therapy (ERT) on diabetes in postmenopausal women. PubMed/MEDLINE was searched for English-language articles published between January 1997 and June 2011. Studies that examined ERT on the incidence of diabetes and randomized clinical trials that evaluated combined ERT (estrogen plus progesterone) on diabetic indices in postmenopausal women were included. Pooled relative risks were calculated using a random- or a fixed-effects model. Sixteen studies comprising 17,971 cases were included. Based on the pooled data, ERT significantly reduced the incidence of diabetes [odds ratio (OR), 0.61; 95% confidence interval (CI), 0.55-0.68, ERT past/current/continuous use vs. never use; OR, 0.57; 95% CI, 0.51-0.65, ERT current/continuous use vs. past/never use]. Women with combined ERT have significantly lower levels of fasting plasma glucose (mean difference, -1.41 mM/L; 95% CI, -2.49 to -0.33 mM/L) and HbA1c (mean difference, -0.73%; 95% CI, from -1.28 to -0.18%) compared with placebo. Furthermore, combined ERT dramatically reduced plasma total cholesterol (mean difference, -0.34 mM/L; 95% CI, from -0.53 to -0.15 mM/L) and low-density lipoprotein (mean difference, -0.43 mM/L; 95% CI, from -0.71 to -0.14 mM/L) but slightly increased high-density lipoprotein (mean difference, 0.02 mM/L; 95% CI, from -0.07 to 0.12 mM/L) levels as compared with placebo control. This systemic review and meta-analysis provides evidence that postmenopausal women taking low-dose combined ERT have a decreased risk of developing diabetes and have better diabetic control.
以往研究表明，女性进入更年期后糖尿病发病率更高。本研究旨在探讨联合雌激素替代疗法（ERT）对绝经后女性糖尿病的影响。通过检索PubMed/MEDLINE数据库，查找1997年1月至2011年6月期间发表的英文文章。纳入研究ERT对糖尿病发病率影响的研究，以及评估联合ERT（雌激素加孕激素）对绝经后女性糖尿病指标影响的随机临床试验。使用随机效应模型或固定效应模型计算合并相对风险。共纳入16项研究，涉及17971例病例。根据汇总数据，ERT显著降低糖尿病发病率[优势比（OR），0.61；95%置信区间（CI），0.55 - 0.68，ERT过去/当前/持续使用与从未使用相比；OR，0.57；95% CI，0.51 - 0.65，ERT当前/持续使用与过去/从未使用相比]。与安慰剂相比，接受联合ERT的女性空腹血糖水平显著降低（平均差值，-1.41 mM/L；95% CI，-2.49至-0.33 mM/L），糖化血红蛋白（HbA1c）水平也显著降低（平均差值，-0.73%；95% CI，-1.28至-0.18%）。此外，与安慰剂对照组相比，联合ERT显著降低血浆总胆固醇水平（平均差值，-0.34 mM/L；95% CI，-0.53至-0.15 mM/L）和低密度脂蛋白水平（平均差值，-0.43 mM/L；95% CI，-0.71至-0.14 mM/L），但高密度脂蛋白水平略有升高（平均差值，0.02 mM/L；95% CI，-0.07至0.12 mM/L）。该系统评价和荟萃分析提供了证据，表明服用低剂量联合ERT的绝经后女性患糖尿病的风险降低，且糖尿病控制情况更好。
