Yue Wenwen, Huang Xin, Zhang Wenjing, Li Shumin, Liu Xu, Zhao Yian, Shu Jiaxin, Liu Teng, Li Weihua, Liu Shaozhuang
School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China.
Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China.
Front Endocrinol (Lausanne). 2022 Mar 10;13:848947. doi: 10.3389/fendo.2022.848947. eCollection 2022.
Polycystic ovary syndrome (PCOS) is a complicated reproductive endocrine disease that is closely related to obesity. Metabolic surgery ameliorates a series of clinical manifestations and related comorbidities of PCOS. However, the overall efficacy of metabolic surgery on PCOS remains uncertain. This systematic review and meta-analysis aimed to evaluate the therapeutic effects of metabolic surgery on obese patients with PCOS. A systematic literature search for relevant studies was conducted on PubMed, Embase, Web of Science, and the Cochrane Library from inception to June 2021. Data extraction and quality evaluation were performed by three researchers, and RevMan 5.4 software was used to conduct the meta-analysis. A total of 14 studies involving 501 obese patients with PCOS were included. Incidence of PCOS in obese women ranged from 5.5% to 63.5% among the included studies. The results showed the incidence of abnormal menstruation decreased from 81% to 15% (OR=0.03, 95% confidence interval (CI): 0.01-0.08), while the incidence of hirsutism dropped from 71% to 38% (OR=0.21, 95% CI: 0.06-0.74). Serum total testosterone and free testosterone levels decreased by 25.92 ng/dL (MD = -25.92, 95% CI: -28.90- -22.93) and 2.28 ng/dL (SMD = -2.28, 95% CI: -3.67- -0.89), respectively. Sex hormone-binding globulin (SHBG) levels increased by 26.46 nmol/L (MD = 26.46, 95% CI: 12.97-39.95). Serum anti-Mullerian hormone (AMH) levels decreased by 1.29 ng/mL (MD = -1.29, 95% CI: -1.92- -0.66). Small sample size studies revealed that pregnancy rates ranged from 95.2% to 100% postoperatively. Metabolic surgery contributed to marked improvement of abnormal menstruation, hirsutism, and levels of free testosterone, total testosterone, SHBG, and AMH in patients with PCOS. Our findings indicate that patients with PCOS are expected to benefit from metabolic surgery, and could help potentially improve their reproductive outcomes. Metabolic surgery could thus be a new viable option for the clinical treatment of PCOS.
PROSPERO https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021251524.
多囊卵巢综合征（PCOS）是一种复杂的生殖内分泌疾病，与肥胖密切相关。代谢手术可改善PCOS的一系列临床表现及相关合并症。然而，代谢手术对PCOS的总体疗效仍不确定。本系统评价和荟萃分析旨在评估代谢手术对肥胖PCOS患者的治疗效果。从创刊至2021年6月，在PubMed、Embase、Web of Science和Cochrane图书馆对相关研究进行了系统的文献检索。由三名研究人员进行数据提取和质量评估，并使用RevMan 5.4软件进行荟萃分析。共纳入14项研究，涉及501例肥胖PCOS患者。纳入研究中肥胖女性PCOS的发病率在5.5%至63.5%之间。结果显示，月经异常的发生率从81%降至15%（OR = 0.03，95%置信区间（CI）：0.01 - 0.08），多毛症的发生率从71%降至38%（OR = 0.21，95% CI：0.06 - 0.74）。血清总睾酮和游离睾酮水平分别下降25.92 ng/dL（MD = -25.92，95% CI：-28.90 - -22.93）和2.28 ng/dL（SMD = -2.28，95% CI：-3.67 - -0.89）。性激素结合球蛋白（SHBG）水平升高26.46 nmol/L（MD = 26.46，95% CI：12.97 - 39.95）。血清抗苗勒管激素（AMH）水平下降1.29 ng/mL（MD = -1.29，95% CI：-1.92 - -0.66）。小样本量研究显示术后妊娠率在95.2%至100%之间。代谢手术有助于显著改善PCOS患者的月经异常、多毛症以及游离睾酮、总睾酮、SHBG和AMH水平。我们的研究结果表明，PCOS患者有望从代谢手术中获益，并可能有助于改善其生殖结局。因此，代谢手术可能成为PCOS临床治疗的一种新的可行选择。
PROSPERO https://www.crd.york.ac.uk/PROSPERO/，标识符CRD42021251524。
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