代谢手术治疗肥胖型多囊卵巢综合征的meta分析
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摘要
目的:系统评价代谢手术对肥胖型多囊卵巢综合征的影响。方法:检索PubMed、EMBASE、Cochrane Library、CNKI和万方数据库。检索时间为2000-01～2017-05。结局指标包括PCOS、月经周期异常、多毛症、不孕症。结果:纳入的19篇报道中,共纳入接受代谢手术病人共2716例,其中女性病人2274例。经代谢手术后,PCOS发生率术前12.27%术后降低为4.76%(95%CI:2.14～9.86,Z=3.92,P<0.0001)。月经周期异常发生率术前34.43%术后降低为10.79%(95%CI:5.62～26.15,Z=6.36,P<0.0001)。多毛症发生率70.59%降低为21.01%(95%CI:3.57～31.06,Z=4.27,P<0.0001)。不孕症发生率7.69%术后降低为2.56%(95%CI:1.77～5.81,Z=3.85,P=0.0001)。结论:代谢手术可显著改善肥胖型多囊卵巢综合征的临床症状。
Objective:To review the effect of metabolic surgery for the treatment polycystic ovarian syndrome(PCOS).Methods:A comprehensive search of electronic databases about metabolic surgery and PCOS was completed.Electronic literature search was performed on PubMed,EMBASE,Cochrance Library,CNKI and Wanfang from January 1,2000 to May 1,2017.Meta-analysis was performed on PCOS,menstrual irregularity,hirsutism,and inferility outcomes.Results:Among all the 19 included studies,a total of 2716 cases were reported,including 2274 female patients.The incidence of PCOS preoperatively was12.27%,which significantly decreased postoperatively to4.76%(95%CI:2.14～9.86,Z=3.92,P<0.0001).The incidence of menstrual irregularity preoperatively was34.43%,which significantly decreased postoperatively to10.79%(95%CI:5.62～26.15,Z=6.36,P<0.0001).The incidence of hirsutism preoperatively was70.59%,which decreased significantly postoperatively to21.01%(95%CI:3.57～31.06,Z=4.27,P<0.0001).The incidence of inferility preoperatively was7.69%,which decreased significantly postoperatively to2.56%(95%CI:1.77～5.81,Z=3.85,P=0.0001).Conclusion:Bariatric surgery effctively attenuates PCOS and its clinical sympomatology in abnomal obese women.
Objective:To review the effect of metabolic surgery for the treatment polycystic ovarian syndrome(PCOS).Methods:A comprehensive search of electronic databases about metabolic surgery and PCOS was completed.Electronic literature search was performed on PubMed,EMBASE,Cochrance Library,CNKI and Wanfang from January 1,2000 to May 1,2017.Meta-analysis was performed on PCOS,menstrual irregularity,hirsutism,and inferility outcomes.Results:Among all the 19 included studies,a total of 2716 cases were reported,including 2274 female patients.The incidence of PCOS preoperatively was12.27%,which significantly decreased postoperatively to4.76%(95%CI:2.14～9.86,Z=3.92,P<0.0001).The incidence of menstrual irregularity preoperatively was34.43%,which significantly decreased postoperatively to10.79%(95%CI:5.62～26.15,Z=6.36,P<0.0001).The incidence of hirsutism preoperatively was70.59%,which decreased significantly postoperatively to21.01%(95%CI:3.57～31.06,Z=4.27,P<0.0001).The incidence of inferility preoperatively was7.69%,which decreased significantly postoperatively to2.56%(95%CI:1.77～5.81,Z=3.85,P=0.0001).Conclusion:Bariatric surgery effctively attenuates PCOS and its clinical sympomatology in abnomal obese women.
引文
[1]Jiao J,Fang Y,Wang T,et al.Epidemiologic investigation of polycystic ovarian syndrome(pcos)in han ethnic women of reproductive age in liaoning province,China[J].Clinical & Experimental Obstetrics & Gynecology,2014;41(3):304-309
[2]武红琴,阮祥燕,卢永军,等.多囊卵巢综合征病人合并代谢综合征的患病率和预测指标[J].首都医科大学学报,2015;36(4):553-558
[3]Legro RS,Castracane VD,Kauffman RP.Detecting insulin resistance in polycystic ovary syndrome:purposes and pitfalls[J].Obstetrical & Gynecological Survey,2004;59(2):141-154
[4]Kalra P,Bansal B,Nag P,et al.Abdominal fat distribution and insulin resistance in indian women with polycystic ovarian syndrome[J].Fertility & Sterility,2009;91(4):1437-1440
[5]Glueck CJ,Dharashivkar S,Wang P,et al.Obesity and extreme obesity,Manifest by ages20-24years,Continuing through32-41years in women,Should alert physicians to the diagnostic likelihood of polycystic ovary syndrome as a reversible underlying endocrinopathy[J].Eur J Obstet Gynecol Reprod Biol,2005;122(2):206-212
[6]Rubino F,Nathan DM,Eckel RH,et al.Metabolic surgery in the treatment algorithm for type 2 diabetes:A joint statement by international diabetes organizations[J].Diabetes care,2016;39(6):861-877
[7]刘欢妹,张忠涛,孟化,等.代谢手术治疗多囊卵巢综合征的研究进展[J].国际外科学杂志,2016;43(8):568-571
[8]Bhandari S,Ganguly I,Bhandari M,et al.Effect of SLEeve gastrectomy bariatric surgery-induced weight loss on serum amh levels in reproductive aged women[J].Gynecological Endocrinology the Official Journal of the International Society of Gynecological Endocrinology,2016;32(10):799-802
[9]Brancatisano A,Wahlroos S,Brancatisano R.Improvement in comorbid illness after placement of the swedish adjustable gastric band[J].Surgery for Obesity & Related Diseases Official Journal of the American Society for Bariatric Surgery,2008;4(3):S39-46
[10]Chiofalo F,Ciuoli C,Formichi C,et al.Bariatric surgery reduces serum anti-mullerian hormone levels in obese women with and without polycystic ovarian syndrome[J].Obesity Surgery,2017;27(7):1750-1754
[11]Collins J,Mattar S,Qureshi F,et al.Initial outcomes of laparoscopic roux-en-Y gastric bypass in morbidly obese adolescents[J].Surgery for Obesity & Related Diseases,2007;3(2):147-152
[12]Dixon JB,O′brien PE.Neck circumference a good predictor of raised insulin and free androgen index in obese premenopausal women:changes with weight loss[J].Clinical Endocrinology,2002;57(6):769-778
[13]Eid GM,Cottam DR,Velcu LM,et al.Effective treatment of polycystic ovarian syndrome with roux-en-Y gastric bypass[J].Surgery for Obesity & Related Diseases,2005;1(2):77-80
[14]Eid GM,Mccloskey C,Titchner R,et al.Changes in hormones and biomarkers in polycystic ovarian syndrome treated with gastric bypass[J].Surgery for Obesity & Related Diseases Official Journal of the American Society for Bariatric Surgery,2014;10(5):787-791
[15]Escobar-morreale HF,Botella-carretero JI,Alvarez-blasco F,et al.The polycystic ovary syndrome associated with morbid obesity may resolve after weight loss induced by bariatric surgery.J clin endocrinol metab[J].Journal of Clinical Endocrinology & Metabolism,2005;90(12):6364-6369
[16]George K,Azeez H.Resolution of gynaecological issues after bariatric surgery-A retrospective analysis[J].Obes Surg,2013;23(8):1043
[17]Jamal M,Gunay Y,Capper A,et al.Roux-en-Y gastric bypassameliorates polycystic ovary syndrome and dramatically improvesconception rates:a9-year analysis.Surg Obes Relat Dis,2012;8(4):440-444
[18]Kj?r MM,Madsbad S,Hougaard DM,et al.The impact of gastric bypass surgery on sex hormones and menstrual cycles in premenopausal women[J].Gynecological Endocrinology,2017;33(2):160-163
[19]Kyriacou A,Hunter AL,Tolofari S,et al.Gastric bypass surgery in women with or without polycystic ovary syndrome-a comparative observational cohort analysis[J].European Journal of Internal Medicine,2014;25(2):e23-24
[20]Luk S,Wong S,Ng E.Bariatric surgery in chinese patients with polycystic ovarian syndrome(pcos)[J].Obes Surg,2014;24(8):1168
[21]Messiah SE,Lopezmitnik G,Winegar D,et al.Changes in weight and comorbidities among adolescents undergoing bariatric surgery:1-year results from the bariatric outcomes longitudinal database[J].Surgery for Obesity & Related Diseases,2013;9(4):503-513
[22]Sugerman HJ,Sugerman EL,De maria EJ,et al.Bariatric surgery for severely obese adolescents[J].J Gastrointest Surg,2003;7(1):102-107
[23]Talebpour M.Role of excessive weight loss in treatment of infertility and irregular periodic cycle in morbid obese female secondary to bariatric surgery[C]//// Congress of the International Federation for the Surgery of Obesity,2011:1119
[24]Turkmen S,Ahangari A,B?ckstrom T.Roux-en-Y gastric bypass surgery in patients with polycystic ovary syndrome and metabolic syndrome[J].Obesity Surgery,2016;26(1):1-8
[25]Turkmen S,Andreen L,Cengiz Y.Effects of roux-en-Y gastric bypass surgery on eating behaviour and allopregnanolone levels in obese women with polycystic ovary syndrome[J].Gynecological Endocrinology the Official Journal of the International Society of Gynecological Endocrinology,2015;31(4):301-305
[26]Wang K,Jiang Q,Zhi Y,et al.Contrasting SLEeve gastrectomy with lifestyle modification therapy in the treatment of polycystic ovary syndrome[J].Journal of Laparoendoscopic & Advanced Surgical Techniques Part A,2015;25(6):493-498
[27]Fauser BC,Tarlatzis BC,Rebar RW,et al.Consensus on women’s health aspects of polycystic ovary syndrome(pcos):the amsterdam eshre/asrm-sponsored 3 rd pcos consensus workshop group[J].Hum Reprod,2012;27(1):14-24
[2]武红琴,阮祥燕,卢永军,等.多囊卵巢综合征病人合并代谢综合征的患病率和预测指标[J].首都医科大学学报,2015;36(4):553-558
[3]Legro RS,Castracane VD,Kauffman RP.Detecting insulin resistance in polycystic ovary syndrome:purposes and pitfalls[J].Obstetrical & Gynecological Survey,2004;59(2):141-154
[4]Kalra P,Bansal B,Nag P,et al.Abdominal fat distribution and insulin resistance in indian women with polycystic ovarian syndrome[J].Fertility & Sterility,2009;91(4):1437-1440
[5]Glueck CJ,Dharashivkar S,Wang P,et al.Obesity and extreme obesity,Manifest by ages20-24years,Continuing through32-41years in women,Should alert physicians to the diagnostic likelihood of polycystic ovary syndrome as a reversible underlying endocrinopathy[J].Eur J Obstet Gynecol Reprod Biol,2005;122(2):206-212
[6]Rubino F,Nathan DM,Eckel RH,et al.Metabolic surgery in the treatment algorithm for type 2 diabetes:A joint statement by international diabetes organizations[J].Diabetes care,2016;39(6):861-877
[7]刘欢妹,张忠涛,孟化,等.代谢手术治疗多囊卵巢综合征的研究进展[J].国际外科学杂志,2016;43(8):568-571
[8]Bhandari S,Ganguly I,Bhandari M,et al.Effect of SLEeve gastrectomy bariatric surgery-induced weight loss on serum amh levels in reproductive aged women[J].Gynecological Endocrinology the Official Journal of the International Society of Gynecological Endocrinology,2016;32(10):799-802
[9]Brancatisano A,Wahlroos S,Brancatisano R.Improvement in comorbid illness after placement of the swedish adjustable gastric band[J].Surgery for Obesity & Related Diseases Official Journal of the American Society for Bariatric Surgery,2008;4(3):S39-46
[10]Chiofalo F,Ciuoli C,Formichi C,et al.Bariatric surgery reduces serum anti-mullerian hormone levels in obese women with and without polycystic ovarian syndrome[J].Obesity Surgery,2017;27(7):1750-1754
[11]Collins J,Mattar S,Qureshi F,et al.Initial outcomes of laparoscopic roux-en-Y gastric bypass in morbidly obese adolescents[J].Surgery for Obesity & Related Diseases,2007;3(2):147-152
[12]Dixon JB,O′brien PE.Neck circumference a good predictor of raised insulin and free androgen index in obese premenopausal women:changes with weight loss[J].Clinical Endocrinology,2002;57(6):769-778
[13]Eid GM,Cottam DR,Velcu LM,et al.Effective treatment of polycystic ovarian syndrome with roux-en-Y gastric bypass[J].Surgery for Obesity & Related Diseases,2005;1(2):77-80
[14]Eid GM,Mccloskey C,Titchner R,et al.Changes in hormones and biomarkers in polycystic ovarian syndrome treated with gastric bypass[J].Surgery for Obesity & Related Diseases Official Journal of the American Society for Bariatric Surgery,2014;10(5):787-791
[15]Escobar-morreale HF,Botella-carretero JI,Alvarez-blasco F,et al.The polycystic ovary syndrome associated with morbid obesity may resolve after weight loss induced by bariatric surgery.J clin endocrinol metab[J].Journal of Clinical Endocrinology & Metabolism,2005;90(12):6364-6369
[16]George K,Azeez H.Resolution of gynaecological issues after bariatric surgery-A retrospective analysis[J].Obes Surg,2013;23(8):1043
[17]Jamal M,Gunay Y,Capper A,et al.Roux-en-Y gastric bypassameliorates polycystic ovary syndrome and dramatically improvesconception rates:a9-year analysis.Surg Obes Relat Dis,2012;8(4):440-444
[18]Kj?r MM,Madsbad S,Hougaard DM,et al.The impact of gastric bypass surgery on sex hormones and menstrual cycles in premenopausal women[J].Gynecological Endocrinology,2017;33(2):160-163
[19]Kyriacou A,Hunter AL,Tolofari S,et al.Gastric bypass surgery in women with or without polycystic ovary syndrome-a comparative observational cohort analysis[J].European Journal of Internal Medicine,2014;25(2):e23-24
[20]Luk S,Wong S,Ng E.Bariatric surgery in chinese patients with polycystic ovarian syndrome(pcos)[J].Obes Surg,2014;24(8):1168
[21]Messiah SE,Lopezmitnik G,Winegar D,et al.Changes in weight and comorbidities among adolescents undergoing bariatric surgery:1-year results from the bariatric outcomes longitudinal database[J].Surgery for Obesity & Related Diseases,2013;9(4):503-513
[22]Sugerman HJ,Sugerman EL,De maria EJ,et al.Bariatric surgery for severely obese adolescents[J].J Gastrointest Surg,2003;7(1):102-107
[23]Talebpour M.Role of excessive weight loss in treatment of infertility and irregular periodic cycle in morbid obese female secondary to bariatric surgery[C]//// Congress of the International Federation for the Surgery of Obesity,2011:1119
[24]Turkmen S,Ahangari A,B?ckstrom T.Roux-en-Y gastric bypass surgery in patients with polycystic ovary syndrome and metabolic syndrome[J].Obesity Surgery,2016;26(1):1-8
[25]Turkmen S,Andreen L,Cengiz Y.Effects of roux-en-Y gastric bypass surgery on eating behaviour and allopregnanolone levels in obese women with polycystic ovary syndrome[J].Gynecological Endocrinology the Official Journal of the International Society of Gynecological Endocrinology,2015;31(4):301-305
[26]Wang K,Jiang Q,Zhi Y,et al.Contrasting SLEeve gastrectomy with lifestyle modification therapy in the treatment of polycystic ovary syndrome[J].Journal of Laparoendoscopic & Advanced Surgical Techniques Part A,2015;25(6):493-498
[27]Fauser BC,Tarlatzis BC,Rebar RW,et al.Consensus on women’s health aspects of polycystic ovary syndrome(pcos):the amsterdam eshre/asrm-sponsored 3 rd pcos consensus workshop group[J].Hum Reprod,2012;27(1):14-24