Kelly Francinny Alves, de Oliveira Macena Lôbo Artur, Cardoso Jorge Henrique Cavalcanti Orestes, de Moraes Francisco Cezar Aquino
Department of Hypertension, Dante Pazzanese Institute of Cardiology, São Paulo, São Paulo, Brazil.
Center of Medical Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil.
Endocrine. 2025 Feb;87(2):389-399. doi: 10.1007/s12020-024-04052-3. Epub 2024 Sep 27.
Metformin was the first medication targeting insulin resistance in PCOS, and it has been extensively studied as a metabolic treatment option. In recent years, inositols have emerged as potential treatment options for PCOS, but confidence in the available evidence supporting their use is limited.
We comprehensively searched PubMed, Embase, and Cochrane databases for RCTs comparing the use of combined metformin and inositol versus metformin alone in women with PCOS. A random-effects model was used to calculate the risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). A p-value of <0.05 was deemed as statistically significant.
Six RCTs and 388 patients were included in the analysis, with follow-up ranging from 3 to 6 months. Combination therapy was significantly associated with improved menstrual cycle regularity (RR 1.56; 95% CI 1.01 to 2.41; p = 0.04), and lower values of modified Ferriman-Gallwey score (MD -0.97; 95% CI -1.53 to -0.40; p < 0.01) and LH/FSH ratios (MD -0.13; 95% CI -0.24 to -0.03; p = 0.01). Differences in acne (p = 0.58), body mass index (p = 0.13), fasting blood glucose (p = 0.07) and HOMA-IR (p = 0.25) were not statistically significant.
In this meta-analysis of RCTs, combination therapy was associated with cycle regularization and reduction in hirsutism and LH/FSH ratio compared to metformin monotherapy. Further studies are needed to clarify the true benefits of the use of inositol in PCOS treatment.
二甲双胍是首个针对多囊卵巢综合征（PCOS）胰岛素抵抗的药物，并且作为一种代谢治疗选择已得到广泛研究。近年来，肌醇已成为PCOS的潜在治疗选择，但支持其使用的现有证据的可信度有限。
我们全面检索了PubMed、Embase和Cochrane数据库，以查找比较二甲双胍与肌醇联合使用和单独使用二甲双胍治疗PCOS女性的随机对照试验（RCT）。采用随机效应模型计算风险比（RRs）和平均差（MDs）以及95%置信区间（CIs）。p值<0.05被视为具有统计学意义。
分析纳入了6项RCT和388例患者，随访时间为3至6个月。联合治疗与月经周期规律性改善显著相关（RR 1.56；95% CI 1.01至2.41；p = 0.04），改良的费里曼-盖尔韦评分较低（MD -0.97；95% CI -1.53至-0.40；p < 0.01）以及促黄体生成素/促卵泡生成素比值较低（MD -0.13；95% CI -0.24至-0.03；p = 0.01）。痤疮（p = 0.58）、体重指数（p = 0.13）、空腹血糖（p = 0.07）和稳态模型评估的胰岛素抵抗（HOMA-IR）（p = 0.25）的差异无统计学意义。
在这项RCT的荟萃分析中，与二甲双胍单药治疗相比，联合治疗与周期规律化以及多毛症和促黄体生成素/促卵泡生成素比值降低相关。需要进一步研究以阐明在PCOS治疗中使用肌醇的真正益处。
