优思明联合二甲双胍治疗多囊卵巢综合征的疗效Meta分析
Meta-Analysis of the Efficacy of Yasmin Combined with Metformin in the Treatment of Polycystic Ovary Syndrome
DOI: 10.12677/HJMCe.2024.121006, PDF,    科研立项经费支持
作者: 何芝挺, 刘学庆：重庆医科大学，公共卫生学院，生殖与发育教育部国际合作联合实验室，重庆；杨莉梅：重庆医科大学附属妇女儿童医院，重庆
关键词: 多囊卵巢综合征；优思明；二甲双胍；Meta分析；Polycystic Ovary Syndrome； Yasmin； Metformin； Meta-Analysis
摘要: 目的：系统评价优思明联合二甲双胍治疗多囊卵巢综合征(Polycystic ovary syndrome, PCOS)的疗效和安全性。方法：检索中国知网、万方、维普、CBM、PubMed、the Cochrane Library、EMBASE数据库，检索时间为建库至2023年12月8日。共纳入31篇研究，研究对象共2792例，其中观察组1396例，对照组1396例。结果：Meta分析结果表明，观察组与对照组相比，在提高临床总体有效率(RR = 1.25, 95%CI [1.18, 1.33], P < 0.00001)、排卵率(RR = 1.63, 95%CI [1.62, 2.02], P < 0.00001)、妊娠率(RR = 2.03, 95%CI [1.44, 2.86], P < 0.0001)方面和改善体重指数BMI (MD = −1.80, 95%CI [−2.34, −1.26], P < 0.0002)、黄体生成素LH (MD = −3.08, 95%CI [−3.82, −2.34], P < 0.00001)、睾酮T (MD = −0.44, 95%CI [−0.65, −0.24], P < 0.0001)、空腹胰岛素FINS (MD = −5.4, 95%CI [−1.26, −0.30], P < 0.05)、空腹血糖 FBG (MD = −1.54, 95%CI [−2.36, −0.38], P < 0.05)、胰岛素抵抗指数HOMA-IR (MD = −1.07, 95%CI [−1.31, −0.84], P < 0.05)、不良反应发生率(RR = 0.61, 95%CI [0.41, 0.92], P < 0.05)方面差异有统计学意义；在雌二醇E2 (MD = 0.19, 95%CI [−17.36, 1.84], P > 0.05)和促卵泡生成素FSH (MD = −0.40, 95%CI [−0.92, 0.13], P > 0.05)的没有统计学意义上的差异。结论：联合使用优思明和二甲双胍可以改善多囊卵巢综合征患者体内的激素紊乱水平、提高的妊娠能力、缓解体脂过高。
Abstract: Objective: To evaluate the efficacy and safety of Yasmin combined with metformin in the treatment of Polycystic ovary syndrome (PCOS). Methods: the databases of CNKI, Wanfang, VIP, CBM, PubMed, the Cochrane Library and EMBASE were searched from December 8, 2023. A total of 31 studies were included, with a total of 2792 subjects, including 1396 in the observation group and 1396 in the control group. Results: meta-analysis showed that compared with the control group, the clinical overall response rate (RR = 1.25, 95%CI [1.18, 1.33], P < 0.00001) and ovulation rate (RR = 1.63, 95%CI [1.62, 2.02] were improved in the observation group. P < 0.00001), Pregnancy rate (RR = 2.03, 95%CI [1.44, 2.86], P < 0.0001) and improved body mass index (MD = −1.80, 95%CI [−2.34, −1.26], P < 0.0002), luteinizing hormone LH (MD = −3.08, 95%CI [−3.82, −2.34], P < 0.00001), tes-tosterone T (MD = −0.44, 95%CI [−0.65, −0.24], P < 0.0001), fasting insulin FINS (MD = −5.4, 95%CI [−1.26, −0.30], P < 0.05), fasting blood glucose FBG (MD = −1.54, 95%CI [−2.36, −0.38], P < 0.05), insulin resistance index HOMA-IR (MD = −1.07, 95%CI [−1.31, −0.84], P < 0.05), the incidence of adverse reactions (RR = 0.61, 95%CI [0.41, 0.92], P < 0.05) were statistically significant. There were no statistically significant differences between estradiol E2 (MD = 0.19, 95%CI [−17.36, 1.84], P > 0.05) and follicle-stimulating hormone FSH (MD = −0.40, 95%CI [−0.92, 0.13], P > 0.05). Conclusion: Combined use of Yasmin and metformin can improve hormone disturbance levels, increase pregnancy capacity, and reduce high body fat in patients with PCOS.
文章引用：何芝挺, 杨莉梅, 刘学庆. 优思明联合二甲双胍治疗多囊卵巢综合征的疗效Meta分析[J]. 药物化学, 2024, 12(1): 33-50. https://doi.org/10.12677/HJMCe.2024.121006

参考文献

[1] March, W.A., Moore, V.M., Willson, K.J., et al. (2010) The Prevalence of Polycystic Ovary Syndrome in a Community Sample Assessed under Contrasting Diagnostic Criteria. Human Reproduction, 25, 544-551. [Google Scholar] [CrossRef] [PubMed]
[2] Shen, W., Pan, Y., Jin, B., et al. (2021) Effects of Tea Consumption on Anthropometric Parameters, Metabolic Indexes and Hormone Levels of Women with Polycystic Ovarian Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in Endocrinology, 12, 736-740. [Google Scholar] [CrossRef] [PubMed]
[3] Apter, D. (2003) Effect of an Oral Contraceptive Containing Dro-spirenone and Ethinylestradiol on General Well-Being and Fluid-Related Symptoms. The European Journal of Contra-ception & Reproductive Health Care, 8, 37-51. [Google Scholar] [CrossRef] [PubMed]
[4] Oelkers, W. (2002) Antimineralocorticoid Activity of a Novel Oral Con-traceptive Containing Drospirenone, a Unique Progestogen Resembling Natural Progesterone. The European Journal of Contraception & Reproductive Health Care, 7, 19-26.
[5] 曹清, 黄晓清, 陈阿金. 屈螺酮炔雌醇片(II)联合二甲双胍治疗多囊卵巢综合征伴糖脂代谢紊乱的疗效[J]. 临床合理用药杂志, 2023, 16(9): 139-141.
[6] 杜林, 杨丹. 屈螺酮炔雌醇片(II)配合二甲双胍方案对多囊卵巢综合征患者疗效及性激素水平的影响[J]. 妇儿健康导刊, 2022, 1(9): 122-125.
[7] 范粤缙. 屈螺酮炔雌醇片联合二甲双胍治疗多囊卵巢综合征的价值[J]. 智慧健康, 2020(15): 122-123.
[8] 冯兰凤. 屈螺酮炔雌醇联合二甲双胍治疗多囊卵巢综合征伴糖脂紊乱患者的疗效[J]. 慢性病学杂志, 2021(8): 1245-1247.
[9] 高赛赛, 厉杨杨, 厉钗微, 等. 二甲双胍联合优思明对超重型PCOS疗效及血清Betatrophin水平的影响[J]. 中国妇幼健康研究, 2021, 32(9): 1320-1325.
[10] 顾晓芳. 屈螺酮炔雌醇联合二甲双胍治疗多囊卵巢综合征的临床疗效[J]. 实用妇科内分泌电子杂志, 2021, 8(30): 4-6.
[11] 胡永. 肥胖型多囊卵巢综合征应用二甲双胍联合屈螺酮炔雌醇片(II)治疗对性激素水平的影响[J]. 实用妇科内分泌电子杂志, 2022, 9(33): 22-24.
[12] 李光莲, 陈丹苓. 优思明联合二甲双胍治疗多囊卵巢综合征的疗效观察[J]. 北方药学, 2015, 12(6): 70-71.
[13] 梁春燕. 二甲双胍联合屈螺酮炔雌醇片治疗多囊卵巢综合征的疗效及对患者糖代谢和激素水平的影响[J]. 中国社区医师, 2020, 36(25): 67-68.
[14] 屈海蓉. 二甲双胍联合口服避孕药对多囊卵巢综合征患者血清炎症因子的影响[J]. 宁夏医科大学学报, 2021, 43(11): 1146-1150.
[15] 孙境亮, 林智良, 李丽春. 屈螺酮炔雌醇与二甲双胍联合治疗多囊卵巢综合征的临床疗效[J]. 临床合理用药杂志, 2022, 15(18): 145-147.
[16] 杨建军, 何纲. 二甲双胍联合屈螺酮炔雌醇片(II)治疗多囊卵巢综合征的临床效果及对激素、糖脂代谢指标、卵巢血流情况的影响[J]. 临床医学研究与实践, 2023, 8(5): 75-78.
[17] 张俊, 周春. 二甲双胍联合优思悦治疗肥胖型多囊卵巢综合征的临床效果分析[J]. 实用妇科内分泌电子杂志, 2022, 9(3): 82-85.
[18] 赵婧. 二甲双胍联合屈螺酮炔雌醇片治疗肥胖型多囊卵巢综合征的临床效果分析[J]. 中外医药研究, 2023, 2(4): 59-61.
[19] Moro, F. (2013) Effects of Drospirenone-Ethinylestradiol and/or Metformin on CD4(+)CD28(null) T Lymphocytes Frequency in Women with Hyperinsulinemia Having Polycystic Ovary Syndrome: A Randomized Clinical Trial. Reproductive Sciences, 20, 1508-1517.
[20] 朱晓明, 覃晓欣. 屈螺酮炔雌醇片联合二甲双胍治疗多囊卵巢综合征的临床观察[J]. 实用妇科内分泌电子杂志, 2023, 10(6): 52-54.
[21] 谢亚莉, 韦丽花, 王平. 二甲双胍联合屈螺酮炔雌醇片对青春期多囊卵巢综合征患者症状改善及血清性激素水平的影响[J]. 中国处方药, 2020, 18(8): 127-128.
[22] 徐珊珊, 刘建国, 余建. 优思明联合二甲双胍治疗青春期多囊卵巢综合征疗效观察[J]. 中国现代医学, 2013, 23(8): 96-99.
[23] 陈莉莉, 明小琼. 屈螺酮炔雌醇叠加二甲双胍对多囊卵巢综合征的效果[J]. 中外医学研究, 2023, 21(7): 54-57.
[24] 李萍, 曾晓琴, 何耀娟. 屈螺酮炔雌醇片(II)联合二甲双胍治疗多囊卵巢综合征临床研究[J]. 深圳中西医结合杂志, 2018, 28(13): 7-10.
[25] 李秋红. 分析多囊卵巢综合征患者经阴道彩色多普勒超声诊断及应用二甲双胍联合屈螺酮炔雌醇的疗效[J]. 中国科技期刊数据库医药, 2021(9): 61-62.
[26] 李姝. 屈螺酮炔雌醇片+二甲双胍联合用药方案治疗多囊卵巢综合征的临床效果[J]. 中外女性健康研究, 2022(6): 12-13.
[27] 刘倩岚. 二甲双胍对多囊卵巢综合征患者的临床疗效观察[J]. 现代医学与健康研究电子杂志, 2023, 7(5): 1-3.
[28] 任萌. 屈螺酮炔雌醇片+二甲双胍治疗多囊卵巢综合征的临床效果研究[J]. 中国实用医药, 2023, 18(2): 120-122.
[29] 覃钰纯, 朱少萍, 黄琳. 二甲双胍联合屈螺酮炔雌醇片(II)对多囊卵巢综合征的疗效[J]. 深圳中西医结合杂志, 2020, 30(18): 146-148.
[30] 唐华玲. 二甲双胍联合优思悦对多囊卵巢综合征患者胰岛素水平及性激素的影响[J]. 实用妇科内分泌电子杂志, 2022, 9(5): 69-71.
[31] 吴琼. 优思明联合二甲双胍治疗多囊卵巢综合征临床效果及对血清性激素的影响[J]. 基层医学论坛, 2022, 26(8): 30-32.
[32] 贠舒雯. 屈螺酮炔雌醇片联合二甲双胍治疗多囊卵巢综合征疗效及对性激素水平的影响分析[J]. 实用妇科内分泌电子杂志, 2022, 9(2): 63-66.
[33] 黄辉. 屈螺酮炔雌醇片联合二甲双胍治疗多囊卵巢综合征的疗效及预后分析[J]. 北方药学, 2015, 12(9): 165.
[34] 周京晶, 董玉琼, 余婧, 等. 屈螺酮炔雌醇片(II)联合二甲双胍治疗青春期多囊卵巢综合征疗效观察[J]. 海南医学, 2022, 33(13): 1698-1701.
[35] Genazzani, A.D., Lanzoni, C., Ricchieri, F., et al. (2007) Metformin Administration Is More Effective When Non-Obese Patients with Polycystic Ovary Syndrome Show both Hyperandrogenism and Hyperinsulinemia. Gy-necological Endocrinology, 23, 146-152. [Google Scholar] [CrossRef] [PubMed]
[36] Infante, M., Armani, A., Marzolla, V., Infante, M., et al. (2019) Adipocyte Mineralocorticoid Receptor. Vitamins and Hormones, 109, 189-209. [Google Scholar] [CrossRef] [PubMed]
[37] Giordano, A., Frontini, A. and Cinti, S. (2016) Converti-ble Visceral Fat as a Therapeutic Target to Curb Obesity. Nature Reviews Drug Discovery, 15, 405-424. [Google Scholar] [CrossRef] [PubMed]
[38] Klipping, C., Duijkers, I., Mawet, M., et al. (2021) Endocrine and Meta-bolic Effects of an Oral Contraceptive Containing Estetrol and Drospirenone. Contraception, 103, 213-221. [Google Scholar] [CrossRef] [PubMed]
[39] Palomba, S., Falbo, A., Russo, T., et al. (2010) Systemic and Local Effects of Metformin Administration in Patients with Polycystic Ovary Syndrome (PCOS): Relationship to the Ovulatory Response. Human Reproduction, 25, 1005-1013. [Google Scholar] [CrossRef] [PubMed]