Endocr Pract. 2017 Apr 2;23(4):408-421. doi: 10.4158/EP161622.OR. Epub 2017 Jan 17.
To conduct a systematic review and meta-analysis comparing transdermal estrogens (TDEs) versus oral estrogens (OEs) in Turner syndrome (TS).
Randomized trials and observational comparative studies with a minimal follow-up of 6 months for skeletal and metabolic outcomes and serum hormone changes were included. Outcomes were pooled with a random effects model and are reported as mean differences between OE and TDE groups and 95% confidence intervals (CIs).
Of 845 candidate references, 4 studies were included. Both OEs and TDEs were associated with an increase in whole-body bone mineral density (BMD) z-score, with TDE therapy displaying a greater increase. OEs were associated with higher fasting glucose and total cholesterol. Both OEs and TDEs reduced low-density lipo-protein cholesterol (LDL-C) and increased high-density lipoprotein cholesterol (HDL-C), with OEs providing a more favorable effect. The use of 17-β estradiol was associated with a higher total cholesterol and lower LDL-C than TDE. No statistically significant difference was found between OEs and TDEs in body mass index, fat mass, fat free mass, insulin-like growth factor 1, insulin-like growth factor binding protein 3, fasting insulin, triglycerides, estradiol, or estrone levels.
In girls with TS, TDEs may be associated with a more beneficial effect on fasting glucose, cholesterol, and whole-body BMD. However, OEs have a more favorable impact on LDL-C and HDL-C. 17-β estradiol has a more favorable effect on LDL-C.
BMI = body mass index BMD = bone mineral density CI = confidence interval HDL-C = high density lipo-protein-cholesterol IGF-1 = insulin-like growth factor 1 IGF-BP3 = insulin-like growth factor binding protein 3 LDL-C = low density lipoprotein-cholesterol MD = mean difference OE = oral estrogen RCT = randomized controlled trial TDE = transdermal estrogen TS = Turner syndrome.
系统评价和荟萃分析比较经皮雌激素（TDE）与口服雌激素（OE）在特纳综合征（TS）中的疗效。
纳入了骨骼和代谢结局以及血清激素变化的最小随访时间为 6 个月的随机试验和观察性对照研究。使用随机效应模型汇总结果，并报告 OE 组与 TDE 组之间的平均差异和 95%置信区间（CI）。
在 845 篇候选参考文献中，有 4 项研究被纳入。OE 和 TDE 均与全身骨密度（BMD）Z 评分增加相关，TDE 治疗显示出更大的增加。OE 与空腹血糖和总胆固醇升高相关。OE 和 TDE 均降低了低密度脂蛋白胆固醇（LDL-C）并增加了高密度脂蛋白胆固醇（HDL-C），OE 具有更有利的作用。17-β 雌二醇的使用与总胆固醇升高和 LDL-C 降低有关，而 TDE 则与总胆固醇降低和 LDL-C 降低有关。OE 和 TDE 之间在体重指数、脂肪量、无脂肪量、胰岛素样生长因子 1、胰岛素样生长因子结合蛋白 3、空腹胰岛素、甘油三酯、雌二醇或雌酮水平方面无统计学显著差异。
在 TS 女孩中，TDE 可能与空腹血糖、胆固醇和全身 BMD 的更有益作用相关。然而，OE 对 LDL-C 和 HDL-C 的影响更有利。17-β 雌二醇对 LDL-C 的作用更有利。
BMI = 体重指数 BMD = 骨密度 CI = 置信区间 HDL-C = 高密度脂蛋白胆固醇 IGF-1 = 胰岛素样生长因子 1 IGF-BP3 = 胰岛素样生长因子结合蛋白 3 LDL-C = 低密度脂蛋白胆固醇 MD = 平均差异 OE = 口服雌激素 RCT = 随机对照试验 TDE = 经皮雌激素 TS = 特纳综合征。
