The association between the environmental endocrine disruptor bisphenol A and polycystic ovary syndrome: a systematic review and meta-analysis

Objective: To investigate the association between bisphenol A (BPA) and polycystic ovary syndrome (PCOS).
Methods: A systematic review and meta-analysis using STATA software for observational studies.
Results: Nine studies involving 493 PCOS patients and 440 controls were included in this review. The meta-analysis demonstrated that PCOS patients had significantly higher BPA levels compared with control groups (standardized mean difference (SMD): 2.437, 95% confidence interval (CI): (1.265, 3.609), p < .001). For studies of serum samples detected by enzyme-linked immunosorbent assay (ELISA), subgroup analyses according to ethnicity, body mass index (BMI), sample size, detection method (high-performance liquid chromatography (HPLC) and ELISA), PCOS-to-control ratio and study quality displayed that high BPA levels were significantly associated with Caucasian PCOS patients (SMD: 0.615, 95% CI: (0.308, 0.922), p < .001), high BMI (SMD: 0.512, 95% CI: (0.180, 0.843), p = .002), high quality (SMD: 0.624, 95% CI: (0.391, 0.856), p < .001), and high HOMA-IR (SMD: 0.467, 95% CI: (0.121, 0.813), p = .008).
Conclusions: Serum BPA may be positively associated with women with PCOS and BPA might be involved in the insulin-resistance and hyperandrogenism of PCOS. More evidence from high quality studies, advanced detection methods, and larger cohorts for observational trials are needed to further confirm the association between BPA and PCOS.

研究目的：探讨双酚A（bisphenol A, BPA）与多囊卵巢综合征（polycystic ovary syndrome, PCOS）之间的关联。
研究方法：本研究采用系统综述与荟萃分析方法，使用STATA软件对观察性研究进行整合分析。
研究结果：本综述共纳入9项研究，涉及493名多囊卵巢综合征患者与440名对照人群。荟萃分析结果显示，多囊卵巢综合征患者的双酚A水平显著高于对照组（标准化均数差（standardized mean difference, SMD）=2.437，95%置信区间（confidence interval, CI）为(1.265, 3.609)，p<0.001）。针对采用酶联免疫吸附试验（enzyme-linked immunosorbent assay, ELISA）检测血清样本的亚组，按种族、体质量指数（body mass index, BMI）、样本量、检测方法（高效液相色谱法（high-performance liquid chromatography, HPLC）与ELISA）、多囊卵巢综合征与对照人群比例及研究质量进行亚组分析，结果显示高双酚A水平与高加索人群多囊卵巢综合征患者（标准化均数差=0.615，95%置信区间=(0.308, 0.922)，p<0.001）、高体质量指数人群（标准化均数差=0.512，95%置信区间=(0.180, 0.843)，p=0.002）、高质量研究队列（标准化均数差=0.624，95%置信区间=(0.391, 0.856)，p<0.001）及高稳态模型胰岛素抵抗指数（Homeostatic Model Assessment for Insulin Resistance, HOMA-IR）人群（标准化均数差=0.467，95%置信区间=(0.121, 0.813)，p=0.008）显著相关。
研究结论：血清双酚A水平可能与女性多囊卵巢综合征呈正相关，双酚A或参与多囊卵巢综合征的胰岛素抵抗与高雄激素血症过程。未来仍需开展高质量研究、采用先进检测方法及更大样本量的观察性队列研究，以进一步验证双酚A与多囊卵巢综合征之间的关联。