醋酸甲羟孕酮对女性血脂谱的影响：随机对照试验的时间和剂量反应荟萃分析。

The impact of medroxyprogesterone acetate on lipid profiles in Women: A time and dose-response meta-analysis of randomized controlled trials.

作者信息

Feng Li, Wang Le, Hernández-Wolters Benjamin, Prabahar Kousalya, Velu Periyannan, Kord-Varkaneh Hamed

机构信息

Department of Rehabilitation Medicine, The People's Hospital of Huaiyin. Jinan, Jinan-250001, China.

Department of Emergency Medicine, The People's Hospital of Huaiyin. Jinan, Jinan-250001, China.

出版信息

Diabetes Res Clin Pract. 2024 Mar;209:111073. doi: 10.1016/j.diabres.2023.111073. Epub 2023 Dec 22.

DOI:10.1016/j.diabres.2023.111073

PMID:38142749

Abstract

BACKGROUND

The effect of MPA on the lipid profile and CVD risk is still controversial; hence, this comprehensive dose-response meta-analysis of randomized controlled trials was conducted to assess the effect of MPA on lipid profiles in women.

METHODS

A comprehensive search was conducted in the following databases: Web of Science, Scopus, PubMed/Medline, and Embase, up to October 20, 2023. A random-effects meta-analysis approach based on the DerSimonian and Laird method was used to compute the combined estimates of the intervention's impact on the lipid profile.

RESULTS

35 eligible studies with 58 arms were included in our meta-analyses analysis. Combined effect sizes suggested a significant effect of MPA on total cholesterol (TC) levels (WMD: -3.43 mg/dL, 95 % CI: -5.38 to -1.48, p < 0.001), HDL-C levels (WMD: -3.34 mg/dL, 95 % CI: -3.77 to -2.91, p < 0.001), and triglyceride (TG) levels (WMD: -9.13 mg/dL, 95 % CI: -10.92 to -7.33, p < 0.001). The subgroup meta-analysis revealed a more substantial reduction in TC in studies with dosages > 2.5 mg/day (WMD: -4.10 mg/dL), mean participant age lower than 60 years (WMD: -3.80 mg/dL), mean BMI lower than 25 kg/m (WMD: -5.61 mg/dL), duration of intervention of 12 months or more (WMD: -3.98 mg/dL), and when the baseline TC value was equal to or greater than 200 mg/dL (WMD: -4.13 mg/dL).

CONCLUSIONS

The current meta-analysis showed a statistically significant decrease in TC, TG, and HDL-C levels and a non-significant increase in LDL-C levels after MPA administration in women.

摘要

背景

醋酸甲羟孕酮（MPA）对血脂谱和心血管疾病风险的影响仍存在争议；因此，进行了这项随机对照试验的综合剂量反应荟萃分析，以评估MPA对女性血脂谱的影响。

方法

截至2023年10月20日，在以下数据库中进行了全面检索：科学网、Scopus、PubMed/Medline和Embase。采用基于DerSimonian和Laird方法的随机效应荟萃分析方法，计算干预对血脂谱影响的合并估计值。

结果

我们的荟萃分析纳入了35项符合条件的研究，共58个研究组。合并效应量表明，MPA对总胆固醇（TC）水平有显著影响（加权均数差：-3.43mg/dL，95%可信区间：-5.38至-1.48，p<0.001）、高密度脂蛋白胆固醇（HDL-C）水平（加权均数差：-3.34mg/dL，95%可信区间：-3.77至-2.91，p<0.001）和甘油三酯（TG）水平（加权均数差：-9.13mg/dL，95%可信区间：-10.92至-7.33，p<0.001）。亚组荟萃分析显示，在剂量>2.5mg/天的研究中，TC降低更为显著（加权均数差：-4.10mg/dL）；平均参与者年龄低于60岁（加权均数差：-3.80mg/dL）；平均体重指数低于25kg/m²（加权均数差：-5.61mg/dL）；干预持续时间为12个月或更长（加权均数差：-3.98mg/dL）；以及基线TC值等于或大于200mg/dL时（加权均数差：-4.13mg/dL）。