Association between High Serum Homocysteine Levels and Biochemical Characteristics in Women with Polycystic Ovarian Syndrome: A Systematic Review and Meta-Analysis

BackgroundElevated homocysteine levels have been observed in previous studies of PCOS; however, the nature of the associations between high homocysteine levels and the biochemical characteristics of polycystic ovarian syndrome (PCOS)—such as obesity, insulin resistance (IR), and androgen levels—is still uncertain.MethodsA systematic search was conducted electronically up to December 28, 2015 using specific eligibility criteria. Standardized mean difference (SMD) and the corresponding 95% confidence intervals (95% CIs) were used as a measure of effect size.ResultsA total of 34 studies (with 1,718 cases and 1,399 controls) of homocysteine levels in PCOS were pooled in this meta-analysis. Significantly lower homocysteine levels were found in controls than in PCOS patients (SMD = 0.895, 95% CI = 0.643–1.146, PI2 = 90.4% and PPI2 = 0% and P = 0.50 for heterogeneity). However, metformin treatment did not appear to cause any significant change in the homocysteine levels of PCOS patients (SMD = –0.17, 95% CI = –1.10–0.75, P = 0.71; I2 = 92% and PConclusionsHigh homocysteine levels in women with PCOS are not related to degree of obesity, IR, or androgen levels. Metformin treatment cannot decrease the homocysteine levels in PCOS patients.

背景 既往针对多囊卵巢综合征（polycystic ovarian syndrome, PCOS）的研究均已观察到同型半胱氨酸水平升高的现象，但高同型半胱氨酸血症与多囊卵巢综合征的生化特征——如肥胖、胰岛素抵抗（insulin resistance, IR）及雄激素水平——之间的关联本质仍不明确。
方法 本研究通过电子数据库开展系统检索，检索时限截至2015年12月28日，检索过程遵循特定的纳入排除标准。本研究采用标准化均数差（standardized mean difference, SMD）及其对应的95%置信区间（95% confidence intervals, 95% CIs）作为效应量评价指标。
结果 本荟萃分析共纳入34项关于多囊卵巢综合征患者同型半胱氨酸水平的研究，合计纳入1718例病例组受试者与1399例对照组受试者。与多囊卵巢综合征患者相比，对照组受试者的同型半胱氨酸水平显著更低（标准化均数差=0.895，95%置信区间=0.643~1.146，异质性检验PI2=90.4%、PPI2=0%，P=0.50）。然而，二甲双胍治疗并未使多囊卵巢综合征患者的同型半胱氨酸水平出现显著变化（标准化均数差=-0.17，95%置信区间=-1.10~0.75，P=0.71；I2=92%，P
结论 多囊卵巢综合征女性患者的高同型半胱氨酸水平与肥胖程度、胰岛素抵抗及雄激素水平均无关联。二甲双胍治疗无法降低多囊卵巢综合征患者的同型半胱氨酸水平。