羅格列酮對比二甲雙胍治療多囊卵巢綜合征的系統評價_《中國循證醫學雜志》

作者：

杜強 , 楊生 , 吳波 , 韓萍

中國醫科大學附屬盛京醫院內分泌科（沈陽?110004）;

關鍵詞：

羅格列酮二甲雙胍多囊卵巢綜合征系統評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20110171

視頻：

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目的　系統評價羅格列酮對比二甲雙胍治療多囊卵巢綜合征（PCOS）的有效性和安全性。
方法　計算機檢索MEDLINE、Cochrane 圖書館、EMbase、EBSCO、CBM、CNKI、中華醫學會期刊自建數據庫、VIP，檢索年限從建庫至2010年12月。查找羅格列酮與二甲雙胍對比治療PCOS的隨機對照試驗。由兩位研究者按照納入與排除標準篩選試驗、提取資料和評價方法學質量后，采用Stata 11.0軟件進行Meta分析。
結果　共納入6個RCT，合計286例PCOS患者。Meta分析結果顯示：二者在改善胰島素敏感性［SMD= –0.14，95%CI（–0.46，0.19），P=0.412］和降低雄激素水平［SMD=0.05，95%CI（–0.26，0.36），P=0.747］方面差異無統計學意義；羅格列酮降低體重的作用不如二甲雙胍［SMD=0.34，95%CI（0.11，0.58），P=0.004］，但不良反應發生率較二甲雙胍低。
結論　羅格列酮和二甲雙胍一樣，可以改善PCOS患者胰島素敏感性及降低雄激素水平，在降低體重方面的作用不如二甲雙胍，但羅格列酮不良反應發生率較二甲雙胍低。故羅格列酮更適用于體重偏輕及不能耐受二甲雙胍胃腸道副作用的PCOS患者。鑒于本系統評價納入研究較少且樣本量較小，因此使用上述結論時必須謹慎。未來尚需開展更多大樣本、高質量、多中心的隨機對照試驗。

引用本文： 杜強,楊生,吳波,韓萍. 羅格列酮對比二甲雙胍治療多囊卵巢綜合征的系統評價. 中國循證醫學雜志, 2011, 11(9): 1021-1026. doi: 10.7507/1672-2531.20110171 復制

1.	1 Radosh L. Drug treatments for polycystic ovary syndrome. Am Fam Physician , 2009, 79(8): 671-676.
2.	Leeman L, Acharya U. The use of metformin in the management of polycystic ovary syndrome and associated anovulatory infertility: the current evidence. J Obstet Gynaecol , 2009, 29(6): 467-72.
3.	Moll E, van der Veen F, van Wely M. The role of metformin in polycystic ovary syndrome: a systematic review. Hum Reprod Update , 2007, 13(6): 527-37.
4.	Costello MF, Eden JA. A systemic review of the reproductive system effects of metformin in patients with polycystic ovary syndrome. Fertil Steril , 2003, 79: 1-13.
5.	Jadad AR, Moore RA, Carroll D, et al . Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials , 1996, 17: 1-12.
6.	Jensterle M, Janez A, Mlinar B, et al . Impact of metformin and rosiglitazone treatment on glucose transporter 4 mRNA expression in women with polycystic ovary syndrome. Eur J Endocrinol , 2008, 158(6): 793-801.
7.	馬良坤, 金利娜, 郁琦, 等. 生活方式調整及藥物治療多囊卵巢綜合征的臨床研究. 中華婦產科學雜志, 2007, 42: 294-297.
8.	Baillargeon JP, Jakubowicz DJ, Iuorno MJ, et al . Effects of metformin and rosiglitazone, alone and in combination, in nonobese women with polycystic ovary syndrome and normal indices of insulin sensitivity. Fertil Steril , 2004, 82(4): 893-902.
9.	Kilicdag EB, Bagis T, Zeyneloglu HB, et al . Homocysteine levels in women with polycystic ovary syndrome treated with metformin versus rosiglitazone: a randomized study. Hum Reprod , 2005, 20(4): 894-899.
10.	孫玉菡, 吳紅. 二甲雙胍和羅格列酮治療多囊卵巢綜合征的臨床療效觀察. 重慶醫科大學學報, 2010, 35: 267-270.
11.	Yilmaz M, Karakoç A, Törüner FB, et al . The effects of rosiglitazone and metformin on menstrual cyclicity and hirsutism in polycystic ovary syndrome. Gynecol Endocrinol , 2005, 21(3): 154-160.
12.	Hojlund K, Glintborg D, Andersen NR, et al . Impaired insulin-stimulated phosphorylation of Akt and AS160 in skeletal muscle of women with polycystic ovary syndrome is reversed by pioglitazone treatment. Diabetes , 2008, 2: 357-366.
13.	Haller K, Laisk T, Peters M, et al . VNTR I/I genotype of insulin gene is associated with the increase of follicle number independent from polycystic ovary syndrome. Acta Obstet Gynecol Scand , 2007, 86(6): 726-732.
14.	Waterworth DM, Bennett ST, Gharani N, et al . Linkage and association of insulin gene VNTR regulatory polymorphism with polycystic ovary syndrome. Lancet , 1997, 349(9057): 986-990.
15.	張俊英, 馬彬, 楊克虎, 等. 二甲雙胍和羅格列酮聯用治療2型糖尿病的系統評價. 中國循證醫學雜志, 2009, 4: 437-445.
16.	Schoppee PD, Garmey JC, Veldhuis JD. Putative activation of the peroxisome proliferator-activated receptor γ impairs androgen and enhances progesterone biosynthesis in primary cultures of porcine theca cells. Biology of Reproduction , 2002, 66(1): 190-198.
17.	Balfour JA, Plosker GL. Rosiglitazone. Drugs , 1999, 57: 921-930.

1. 1 Radosh L. Drug treatments for polycystic ovary syndrome. Am Fam Physician , 2009, 79(8): 671-676.
2. Leeman L, Acharya U. The use of metformin in the management of polycystic ovary syndrome and associated anovulatory infertility: the current evidence. J Obstet Gynaecol , 2009, 29(6): 467-72.
3. Moll E, van der Veen F, van Wely M. The role of metformin in polycystic ovary syndrome: a systematic review. Hum Reprod Update , 2007, 13(6): 527-37.
4. Costello MF, Eden JA. A systemic review of the reproductive system effects of metformin in patients with polycystic ovary syndrome. Fertil Steril , 2003, 79: 1-13.
5. Jadad AR, Moore RA, Carroll D, et al . Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials , 1996, 17: 1-12.
6. Jensterle M, Janez A, Mlinar B, et al . Impact of metformin and rosiglitazone treatment on glucose transporter 4 mRNA expression in women with polycystic ovary syndrome. Eur J Endocrinol , 2008, 158(6): 793-801.
7. 馬良坤, 金利娜, 郁琦, 等. 生活方式調整及藥物治療多囊卵巢綜合征的臨床研究. 中華婦產科學雜志, 2007, 42: 294-297.
8. Baillargeon JP, Jakubowicz DJ, Iuorno MJ, et al . Effects of metformin and rosiglitazone, alone and in combination, in nonobese women with polycystic ovary syndrome and normal indices of insulin sensitivity. Fertil Steril , 2004, 82(4): 893-902.
9. Kilicdag EB, Bagis T, Zeyneloglu HB, et al . Homocysteine levels in women with polycystic ovary syndrome treated with metformin versus rosiglitazone: a randomized study. Hum Reprod , 2005, 20(4): 894-899.
10. 孫玉菡, 吳紅. 二甲雙胍和羅格列酮治療多囊卵巢綜合征的臨床療效觀察. 重慶醫科大學學報, 2010, 35: 267-270.
11. Yilmaz M, Karakoç A, Törüner FB, et al . The effects of rosiglitazone and metformin on menstrual cyclicity and hirsutism in polycystic ovary syndrome. Gynecol Endocrinol , 2005, 21(3): 154-160.
12. Hojlund K, Glintborg D, Andersen NR, et al . Impaired insulin-stimulated phosphorylation of Akt and AS160 in skeletal muscle of women with polycystic ovary syndrome is reversed by pioglitazone treatment. Diabetes , 2008, 2: 357-366.
13. Haller K, Laisk T, Peters M, et al . VNTR I/I genotype of insulin gene is associated with the increase of follicle number independent from polycystic ovary syndrome. Acta Obstet Gynecol Scand , 2007, 86(6): 726-732.
14. Waterworth DM, Bennett ST, Gharani N, et al . Linkage and association of insulin gene VNTR regulatory polymorphism with polycystic ovary syndrome. Lancet , 1997, 349(9057): 986-990.
15. 張俊英, 馬彬, 楊克虎, 等. 二甲雙胍和羅格列酮聯用治療2型糖尿病的系統評價. 中國循證醫學雜志, 2009, 4: 437-445.
16. Schoppee PD, Garmey JC, Veldhuis JD. Putative activation of the peroxisome proliferator-activated receptor γ impairs androgen and enhances progesterone biosynthesis in primary cultures of porcine theca cells. Biology of Reproduction , 2002, 66(1): 190-198.
17. Balfour JA, Plosker GL. Rosiglitazone. Drugs , 1999, 57: 921-930.

《中國循證醫學雜志》

羅格列酮對比二甲雙胍治療多囊卵巢綜合征的系統評價

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《中國循證醫學雜志》

羅格列酮對比二甲雙胍治療多囊卵巢綜合征的系統評價

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