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目的系统评价二甲双胍和噻唑烷二酮类药物联合治疗多囊卵巢综合征(PCOS)的疗效与安全性。方法计算机检索Cochrane图书馆、Medline、EMbase、EBSCO、ScienceDirect、OVID、SpringerLINK、Wiley、中国生物医学文献数据库(CBM)、中国期刊网(CNKI)、维普数据库(VIP),同时注意未发表文献、会议论文和学位论文的检索,对部分文献使用手工检索。检索年限从建库至2009年11月。查找以噻唑烷二酮类药物和二甲双胍联合治疗为干预措施治疗PCOS的随机对照试验(RCT)/临床对照试验(CCT)进行质量评价,运用Revman5.0统计软件对提取的相关数据进行Meta分析。结果共有5个试验符合纳入标准。Meta分析结果显示:二甲双胍治疗PCOS同时加用噻唑烷二酮类较二甲双胍单药明显改善胰岛素抵抗[P<0.00001,WMD=-0.21,95%CI(-0.27,-0.15)]、促进排卵[P=0.003,OR=2.76,95%CI(1.14,5.42)],但其降低腰臀比(waist-hipratio,WHR)[P=0.51,WMD=0.02,95%CI(-0.04,0.08)]和雄激素[P=0.20,WMD=-31.14,95%CI(-79.21,16.92)]的作用较单药无差异,联合治疗反而削弱了二甲双胍单药改善体质量指数(BMI)[P=0.02,WMD=0.54,95%CI(0.08,1.00)]的作用。没有研究报道不良反应。结论噻唑烷二酮类药物和二甲双胍联合治疗PCOS较二甲双胍单药治疗能显著改善胰岛素抵抗、促进排卵且用药相对安全。
Objective To evaluate the efficacy and safety of metformin and thiazolidinedione in the treatment of polycystic ovary syndrome (PCOS). METHODS: The Cochrane Library, Medline, EMbase, EBSCO, ScienceDirect, OVID, SpringerLINK, Wiley, CBM, CNKI and VIP databases were searched by computer. At the same time, Theses and dissertations were retrieved and some of the literature was searched manually. Retrieved from the construction period to November 2009. To investigate the quality evaluation of randomized controlled trials (RCTs) and clinical controlled trials (CCTs) with thiazolidinedione and metformin as the interventions to treat PCOS. Meta-analysis was performed on the extracted data using Revman 5.0 statistical software. Results A total of five trials met the inclusion criteria. Meta-analysis showed that metformin treatment of PCOS combined with thiazolidinediones compared with metformin significantly improved insulin resistance [P <0.00001, WMD = -0.21, 95% CI (-0.27, -0.15)], promote ovulation [P = 0.003, OR = 2.76, 95% CI (1.14,5.42)], but it decreased WHR (P 0.51, WMD 0.02, 95% CI -0.04, 0.08) The effects of hormones (P = 0.20, WMD = -31.14, 95% CI (-79.21, 16.92)] were not different from those of monotherapy. Combination therapy attenuated the improvement of body mass index (BMI) = 0.54, 95% CI (0.08, 1.00)]. No studies reported adverse reactions. Conclusion The combination of thiazolidinedione and metformin in PCOS can significantly improve insulin resistance, promote ovulation and the relative safety of medication compared with metformin monotherapy.