螺内酯在多囊卵巢综合征女性中的多效作用是否使其不仅仅是一种抗雄激素？来自系统评价和荟萃分析的证据。

Do Pleiotropic Effects of Spironolactone in Women with PCOS Make it More than an Anti-androgen? Evidence from a Systematic Review and Meta-analysis.

机构信息

Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Jammu and Kashmir, 190011, India.

Department of Clinical Research, Sher-i-Kashmir Institute of Medical Sciences, Jammu and Kashmir, 190011, India.

出版信息

Curr Pharm Des. 2023;29(19):1486-1496. doi: 10.2174/1381612829666230331093912.

DOI:10.2174/1381612829666230331093912

PMID:36999713

Abstract

BACKGROUND

Spironolactone use as a treatment for hirsutism and other dermatological conditions among polycystic ovary syndrome (PCOS) and idiopathic hirsutism shows varied results.

OBJECTIVE

This study thus summarizes the entire evidence to better define its impact on Ferriman-Gallwey (FG) score in addition to other derangements associated with PCOS.

METHODS

PubMed, Embase, Scopus and bibliographies of relevant articles were searched. Randomized controlled trails (RCTs) investigating the efficacy of spironolactone in PCOS and idiopathic hirsutism were included. Pooled mean difference (MD) was calculated using random effects model and relevant subgroup analysis was done. Potential heterogeneity and publication bias was assessed.

RESULTS

Of 1041 retrieved studies, 24 RCTs were included. Spironolactone (100 mg/daily) exhibited a significant reduction in FG score in idiopathic hirsutism compared to finasteride (MD: -2.43; 95% C.I: -3.29, -1.57) and cyproterone acetate (MD: -1.18; 95% C.I: -2.10, -0.26), however, no significant difference was found among PCOS subjects in comparison to flutamide and finasteride. A lower dose of spironolactone (50 mg/day) exhibited no significant difference relative to metformin on FG Score (MD: -0.61; 95% C.I: -1.76, 0.54, I = 57%), serum total testosterone (MD: -0.61; 95% C.I: -1.76, 0.54), I = 57% and HOMA-IR (MD: 1.03; 95% C.I: -1.22, 3.29), I = 60% among PCOS women. The main side effects reported by the studies were menstrual irregularity, mild nausea, vomiting and diarrhea.

CONCLUSION

Spironolactone is well tolerated among idiopathic hirsute and PCOS women. The drug significantly improved hirsutism in the former group and shows a positive trend in the latter women, however, displays no effect on FSH, LH, menstrual cyclicity, BMI, and HOMA-IR in PCOS women.

摘要

背景

螺内酯治疗多囊卵巢综合征（PCOS）和特发性多毛症中的多毛症和其他皮肤疾病的效果不一。

目的

本研究旨在总结所有证据，以更好地定义其对 Ferriman-Gallwey（FG）评分的影响，以及 PCOS 相关的其他异常。

方法

检索 PubMed、Embase、Scopus 和相关文章的参考文献。纳入了研究螺内酯治疗 PCOS 和特发性多毛症疗效的随机对照试验（RCT）。使用随机效应模型计算汇总均数差（MD），并进行了相关亚组分析。评估了潜在的异质性和发表偏倚。

结果

在 1041 篇检索到的研究中，有 24 项 RCT 被纳入。与非那雄胺（MD：-2.43；95%置信区间：-3.29，-1.57）和醋酸环丙孕酮（MD：-1.18；95%置信区间：-2.10，-0.26）相比，螺内酯（100mg/d）在特发性多毛症中显著降低了 FG 评分，而与氟他胺和非那雄胺相比，PCOS 患者之间无显著差异。螺内酯的低剂量（50mg/天）与二甲双胍相比，在 FG 评分（MD：-0.61；95%置信区间：-1.76，0.54，I = 57%）、血清总睾酮（MD：-0.61；95%置信区间：-1.76，0.54）和 HOMA-IR（MD：1.03；95%置信区间：-1.22，3.29）方面无显著差异，I = 60%。研究报告的主要副作用是月经不规律、轻度恶心、呕吐和腹泻。