二甲双胍联合GLP-1受体激动剂对多囊卵巢综合征患者代谢特征影响的Meta分析

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摘要目的：探讨二甲双胍联合GLP-1受体激动剂对多囊卵巢综合征（PCOS）患者代谢特征的影响。方法：通过计算机检索PubMed数据库、Cochrane图书馆、EMbase数据库、中国期刊全文数据库（CNKI）、万方数据库、维普数据库,并进一步对纳入文献的参考文献进行扩大检索。对符合纳入标准的随机对照研究（RCT）按Cochrane系统评价的方法，独立进行资料提取、质量评价并交叉核对后，采用Stata12.0软件进行Meta分析。结果：共纳入4篇临床试验文献，试验组（二甲双胍联合GLP-1受体激动剂）61例，对照组（GLP-1受体激动剂）60例。Meta分析结果显示，试验组相较于对照组在改善PCOS患者代谢方面仅在腰围改变上差异有统计学意义（SMD=0.39，95%CI=0.03～0.75，P=0.035），而在BMI（SMD=-0.13，95%CI=-0.48～0.23，P=0.492）、体质量（SMD=-0.19，95%CI=-0.54～0.17，P=0.311）、胰岛素抵抗指数（SMD=-0.68，95%CI=-2.23～0.86，P=0.386）、空腹胰岛素水平（SMD=0.19，95%CI=-0.28～0.66，P=0.426）、性激素结合球蛋白（SMD=0.72，95%CI=-0.55～2.00，P=0.266）、血清总睾酮（SMD=-0.70，95%CI=-1.98～0.57，P=0.279）方面差异无统计学意义。结论：二甲双胍联合GLP-1受体激动剂仅在改善PCOS患者腰围方面的疗效优于GLP-1受体激动剂单用，而在BMI、体质量、胰岛素抵抗指数、空腹胰岛素水平、性激素结合球蛋白、血清总睾酮方面二甲双胍并不增加GLP-1受体激动剂的治疗效果。

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	胡萍萍
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	蒋学禄

关键词 ： GLP-1激动剂, 二甲双胍, 多囊卵巢综合征, Meta分析

Abstract：Objective: Meta-analysis was performed to assess the efficacy of metformin in combination with GLP-1 agonist on the Metabolic syndrome of women with polycystic ovary syndrome (PCOS). Methods: The randomized controlled trials (RCT) were retrieved from Pubmed, Cochrane library, EMbase, CNKI, WanFang and VIP database and references listed in all studies. RCTs meeting inclusive studies were included the data extracted, the quality was evaluated and cross-checked by two reviews independently according to Cochrane Handbook for Systematic Reviews of Interventions and then Meta-analysis was conducted using Stata 12.0 software. Results: A total of 4 studies were included, of which 61 were in test group (metformin combined with GLP-1 agonist) and 60 were in control group (GLP-1 agonist). The results of Meta-analysis showed that test group had a significant difference in waist circumference change compared with control group (SMD=0.39, 95%CI: 0.03-0.75, P=0.035), the rest in BMI (SMD=-0.13, 95%CI: -0.48-0.23, P=0.492), body mass (SMD=-0.19, 95%CI: -0.54-0.17, P=0.311), insulin resistance index (SMD=-0.68, 95%CI: -2.23-0.86, P=0.386), fasting insulin level (SMD=0.19, 95%CI: -0.28-0.66, P=0.426), sex hormone binding globulin (SMD=0.72, 95%CI: -0.55-2.00, P=0.266), serum total testosterone (SMD=-0.70, 95%CI: -1.98-0.57, P=0.279), there were no significant difference. Conclusion: Metformin combined with GLP-1 agonist is superior to GLP-1 agonist alone in improving the waist circumference of patients with PCOS. In contrast, metformin does not increase the therapeutic effect of GLP-1 agonists in BMI, body mass, insulin resistance index, fasting insulin level, sex hormone binding globulin, serum total testosterone.

Key words： GLP-1 agonists metformin polycystic ovary syndrome Meta-analysis

收稿日期: 2019-01-21

基金资助:浙江省中医药科技计划项目（2018ZA038）。

通讯作者: 蒋学禄，主任医师，Email：xll1005@126.com。

作者简介: 胡萍萍（1984-），女，浙江杭州人，护师。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2019/V49/I6/447

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