二甲双胍联合螺内酯与单纯二甲双胍治疗多囊卵巢综合征的疗效比较：一项荟萃分析。
Metformin combined with spironolactone vs. metformin alone in polycystic ovary syndrome: a meta-analysis.
机构信息
Department of Endocrinology and Metabolism, The Third Affiliate Hospital of Guangzhou Medical University, Guangzhou, China.
Key Laboratory for Major Obstetric Diseases of Guangdong Higher Education Institutes, Guangzhou Medical University, Guangzhou, China.
出版信息
Front Endocrinol (Lausanne). 2023 Aug 10;14:1223768. doi: 10.3389/fendo.2023.1223768. eCollection 2023.
AIMS
Due to its high heterogenicity and unclear etiology, there is currently no specific treatment for polycystic ovary syndrome (PCOS). Metformin, as an insulin sensitizer, combined with spironolactone, an antiandrogen medication, may exert complementary effects on PCOS. We therefore performed a meta-analysis of trials in which metformin combined with spironolactone was applied to treat PCOS to evaluate the efficacy and safety of the combination therapy.
METHODS
We retrieved the PubMed, Embase, Scopus, Cochrane Library, CNKI, CBM, Wangfang, and VIP databases for literatures published from their inception to December 16, 2022 on the effects of metformin combined with spironolactone in the treatment of PCOS. Inclusion criteria according to P.I.C.O.S criteria were: PCOS patients, metformin combined with spironolactone interventions, metformin alone control group, and randomized controlled trials with the following outcome data: body mass index (BMI), hirsutism score, luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone (TT), fasting blood glucose (FBG), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), and side effects including nausea, vomiting, diarrhea and drug withdrawal.
RESULTS
Our results revealed that metformin combined with spironolactone significantly reduced BMI and TT, but that it exerted no significant effects on hirsutism score, or on FSH or LH concentrations. Combined treatment also resulted in a significant diminution in FBG and insulin resistance using the HOMA-IR when the interventional time was greater than 6 months. In addition, the combination did not have a higher occurrence of adverse reactions than metformin alone.
CONCLUSION
Compared with metformin alone, metformin combined with spironolactone therapy may be more effective in reducing BMI and serum androgen levels, but the combination showed no significant effect on the hirsutism score or gonadotropin hormone levels, and was not associated with an elevation in side-effects. Moreover, when the treatment course was greater than 6 months, combination therapy reduced FBG and improved insulin resistance more effectively than metformin alone. However, more research is needed to determine the most effective course of treatment.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022355515.
目的
由于多囊卵巢综合征（PCOS）具有高度异质性和不明确的病因，目前尚无特异性治疗方法。二甲双胍作为胰岛素增敏剂，与抗雄激素药物螺内酯联合应用，可能对 PCOS 发挥互补作用。因此，我们对二甲双胍联合螺内酯治疗 PCOS 的临床试验进行了荟萃分析，以评估联合治疗的疗效和安全性。
方法
我们检索了从建库至 2022 年 12 月 16 日发表的关于二甲双胍联合螺内酯治疗 PCOS 效果的 PubMed、Embase、Scopus、Cochrane Library、CNKI、CBM、万方和 VIP 数据库文献。根据 P.I.C.O.S 标准的纳入标准为：PCOS 患者、二甲双胍联合螺内酯干预、二甲双胍单药对照、随机对照试验，且具有以下结局数据：体重指数（BMI）、多毛症评分、促黄体生成素（LH）、卵泡刺激素（FSH）、总睾酮（TT）、空腹血糖（FBG）、稳态模型评估的胰岛素抵抗（HOMA-IR）和不良反应，包括恶心、呕吐、腹泻和停药。
结果
我们的结果表明，二甲双胍联合螺内酯治疗可显著降低 BMI 和 TT，但对多毛症评分或 FSH 或 LH 浓度无显著影响。当干预时间大于 6 个月时，联合治疗还可显著降低 FBG 和 HOMA-IR 评估的胰岛素抵抗。此外，与单独使用二甲双胍相比，联合治疗的不良反应发生率并没有更高。
结论
与单独使用二甲双胍相比，二甲双胍联合螺内酯治疗可能在降低 BMI 和血清雄激素水平方面更有效，但对多毛症评分或促性腺激素水平无显著影响，且与不良反应发生率升高无关。此外，当治疗疗程大于 6 个月时，联合治疗比单独使用二甲双胍更能有效降低 FBG 并改善胰岛素抵抗。然而，需要更多的研究来确定最有效的治疗疗程。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/，标识符 CRD42022355515。
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