Meta Analysis For The Comparison Of Efficacy And Safety Between Different Insulin Sensitizers In Treatment Of Polycystic Ovary Syndrome

Objective:To evaluate clinical efficacy and safety between different insulinsensitizers， thiazolidinediones （rosiglitazone or pioglizazone） andmetformin in the treatment of polycystic ovary syndrome, evaluate theadvantages of the TZDs treatment and finally provide relevant suggestionfor clinical treatment.Methods:A thorough literature research was performed both at home andabroad about the TZDs drugs (rosiglitazone or pioglitazone) andmetformin drugs (metformin) randomized controlled trial of polycysticovary syndrome, improved Jadad score method is adopted to qualify theinclusion papers, all the data extracted was put in RevMan5.0softwareand analyzed by it.Results：According to the inclusion and exclusion criteria,12papers werefinally included,2of which in English and10in Chinese. TheMeta-analysis finds that, compared to the metformin group, TZDs moresignificantly reduced fasting insulin concentrations [P=0.03， WMD=-0.47，95%C（I-0.88,-0.06）] in patients with PCOS, and improvedinsulin resistance [P=0.01， WMD=-0.73，95%CI （-1.30,-0.16）].Meanwhile, there were significantly higher levels of serum HDL aftertreating in TZDs groups than metformin groups[P=0.04，WMD=0.26，95%CI（0.02,0.51）], and lower levels of serum LDL after treating inTZDs groups than metformin groups[P=0.02，WMD=-0.30，95%CI（-0.55,-0.06）]. In terms of T, LH, FSH, TZDs drugs were better thanmetformin groups, but there was no statistical significance[P=0.05、0.47、0.73]. There were similar functions in improving the ovulation rate,pregnancy rate, reduce the patients with PCOS fasting glucose levels,there was no statistical significance[P=0.61、0.82、0.46]. In terms ofimprovement of PCOS patients with BMI, TZDs drugs was less betterthan metformin[P＜0.00001].Conclusion:TZDs drugs are better than metformin in reducing fasting insulinlevels and improving insulin resistance in patients with polycystic ovarysyndrome. Compared to the metformin groups, TZDs drugs elevate thelevels of serum high density lipoprotein after treating more significanttly,lower the levels of serum low density lipoprotein, and improve the bloodlipids. TZDs drugs can cause the adverse reaction of a mild body massindex increase, and this may be related to the retention of water andsodium. The treatment of TZDs drugs are simple, with small side effects. Rosiglitazone have been safety warning because it may cause seriouscardiovascular events (including myocardial infarction, stroke, heartfailure, death, etc.). We prefer to use pioglitazone to the patients withobvious insulin resistance and metabolic syndrome. For the patients withpolycystic ovary syndrome who suffered severe insulin resistance,pioglitazone should be the first choice. In order to avoid the adversereactions of put on weight, it should be careful for the PCOS patientswith moderate or severe obesity to choose drugs.