Wang Yun, Bao Hongchu, Cong Jianxiang, Qu Qinglan
Department of Reproductive Medicine, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, China.
Front Endocrinol (Lausanne). 2025 Jun 18;16:1553684. doi: 10.3389/fendo.2025.1553684. eCollection 2025.
To systematically evaluate the clinical efficacy of acupuncture and metformin on insulin resistance (IR) in women with Polycystic Ovary Syndrome (PCOS).
A computer search was conducted up to September 30, 2024, in databases including PubMed, EMBASE, Cochrane Library, China Biology Medicine disc (CBM), China National Knowledge Infrastructure (CNKI), Wanfang, and VIP, to collect randomized controlled trials (RCTs) on acupuncture treatment for PCOS. The effect of acupuncture and metformin on insulin sensitivity in PCOS patients was assessed. Two researchers independently screened the literature, extracted data, and evaluated the quality of included studies using the bias assessment tool recommended in the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. Meta-analysis and network analysis were conducted using Stata 17.Our primary outcome measure was the homeostasis model assessment of insulin resistance(HOMA-IR).The secondary outcomes were fasting blood glucose (FBG), fasting insulin (FINS), body mass index (BMI), and waist-to-hip ratio (WHR).
A total of 11 RCTs involving 1,248 patients were included. The meta-analysis results showed that the reduction in HOMA-IR [SMD = 0.17, 95% CI (-0.18, 0.52)] and FINS [SMD = 0.17, 95% CI (-0.38, 0.71)] values in the acupuncture group were smaller than those in the metformin group. However, reductions in BMI [SMD = -0.15, 95% CI (-0.88, 0.58)], WHR [SMD = -0.15, 95% CI (-0.88, 0.58)], and FPG [SMD = -0.19, 95% CI (-0.40, 0.02)] were greater in the acupuncture group than in the metformin group, but the differences were not statistically significant. Subgroup analysis with placebo interventions added to each group showed that metformin plus sham acupuncture was more effective than acupuncture plus placebo in reducing HOMA-IR values [SMD = 0.49, 95% CI (0.02, 0.96)] with a statistically significant difference; acupuncture plus placebo treatment had a greater advantage in reducing FPG [SMD = -0.38, 95% CI (-0.57, -0.19)] with a statistically significant difference. The network meta-analysis results indicated that only Electroacupuncture (SMD = -0.27, 95% CI [-1.37, 0.83]) and Abdominal acupuncture (SMD = -0.13, 95% CI [-1.19, 0.94]) demonstrated significant effects on reducing HOMA-IR values in women with polycystic ovary syndrome (PCOS) compared to Metformin. However, the differences between groups were not statistically significant. Furthermore, based on SUCRA values, the advantages of various acupuncture modalities for interventions targeting HOMA-IR outcomes were ranked. Electroacupuncture was identified as the most effective intervention for lowering HOMA-IR values in women with PCOS-related insulin resistance (SUCRA value: 67.4%), followed by Abdominal acupuncture (SUCRA value: 58%).
Metformin is more effective in improving HOMA-IR in patients with PCOS, while acupuncture has a greater advantage in reducing FPG. Among the different acupuncture modalities, Electroacupuncture emerged as the optimal intervention for reducing HOMA-IR values in insulin-resistant women with PCOS. Due to the limitations of existing studies, the conclusions of this study need to be confirmed by high-quality, large-sample, multicenter RCTs.
https://www.crd.york.ac.uk/prospero/, identifier CRD42023381672.
系统评价针刺与二甲双胍治疗多囊卵巢综合征（PCOS）女性胰岛素抵抗（IR）的临床疗效。
截至2024年9月30日，在PubMed、EMBASE、Cochrane图书馆、中国生物医学文献数据库（CBM）、中国知网（CNKI）、万方和维普等数据库中进行计算机检索，收集针刺治疗PCOS的随机对照试验（RCT）。评估针刺和二甲双胍对PCOS患者胰岛素敏感性的影响。两名研究人员独立筛选文献、提取数据，并使用《Cochrane系统评价干预措施手册5.1.0》推荐的偏倚评估工具评估纳入研究的质量。使用Stata 17进行荟萃分析和网络分析。我们的主要结局指标是胰岛素抵抗稳态模型评估（HOMA-IR）。次要结局指标为空腹血糖（FBG）、空腹胰岛素（FINS）、体重指数（BMI）和腰臀比（WHR）。
共纳入11项RCT，涉及1248例患者。荟萃分析结果显示，针刺组HOMA-IR[标准化均数差（SMD）=0.17，95%置信区间（CI）（-0.18，0.52）]和FINS[SMD = 0.17，95% CI（-0.38，0.71）]值的降低幅度小于二甲双胍组。然而，针刺组BMI[SMD = -0.15，95% CI（-0.88，0.58）]、WHR[SMD = -0.15，95% CI（-0.88，0.58）]和FPG[SMD = -0.19，95% CI（-0.40，0.02）]的降低幅度大于二甲双胍组，但差异无统计学意义。每组均添加安慰剂干预的亚组分析显示，二甲双胍加假针刺在降低HOMA-IR值方面比针刺加安慰剂更有效[SMD = 0.49，95% CI（0.02，0.96）]，差异有统计学意义；针刺加安慰剂治疗在降低FPG方面具有更大优势[SMD = -0.38，95% CI（-0.57，-0.19）]，差异有统计学意义。网络荟萃分析结果表明，与二甲双胍相比，仅电针（SMD = -0.27，95% CI [-1.37，0.83]）和腹针（SMD = -0.13，95% CI [-1.19，0.94]）对降低多囊卵巢综合征（PCOS）女性的HOMA-IR值有显著效果。然而，组间差异无统计学意义。此外，根据累积排序曲线下面积（SUCRA）值，对各种针刺方式针对HOMA-IR结局的干预优势进行了排序。电针被确定为降低PCOS相关胰岛素抵抗女性HOMA-IR值最有效的干预措施（SUCRA值：67.4%），其次是腹针（SUCRA值：58%）。
二甲双胍在改善PCOS患者的HOMA-IR方面更有效，而针刺在降低FPG方面具有更大优势。在不同的针刺方式中，电针是降低PCOS胰岛素抵抗女性HOMA-IR值的最佳干预措施。由于现有研究的局限性，本研究结论需要高质量、大样本、多中心RCT予以证实。
