多囊卵巢综合征中亚临床甲状腺功能减退的患病率及其对胰岛素抵抗的影响：一项系统评价和荟萃分析。
Prevalence of subclinical hypothyroidism in polycystic ovary syndrome and its impact on insulin resistance: a systematic review and meta-analysis.
作者信息
Shekarian Arman, Mazaheri-Tehrani Sadegh, Shekarian Saba, Pourbazargan Melika, Setudeh Mahsa, Abhari Amir Parsa, Fakhrolmobasheri Mohammad, Heidarpour Maryam
机构信息
Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
出版信息
BMC Endocr Disord. 2025 Mar 19;25(1):75. doi: 10.1186/s12902-025-01896-2.
BACKGROUND
Although recent studies indicate a high prevalence of subclinical hypothyroidism (SCH) in women with polycystic ovary syndrome (PCOS), the reported prevalence rates vary widely. Therefore, we conducted this study to estimate the pooled prevalence of SCH among women with PCOS. Additionally, emerging evidence suggests that SCH may negatively impact insulin resistance in PCOS. Thus, we examined its effect on insulin resistance indices as our secondary objective.
METHODS
We searched PubMed, Web of Science, Scopus, and Embase from their inception to February 25, 2024. Observational studies reporting the prevalence of SCH among women with PCOS were included. Joanna Briggs Institute's (JBI) critical appraisal checklist for prevalence studies was adopted for the risk of bias assessment. The random-effects model was employed to estimate the pooled prevalence with its 95% confidence intervals (CI). The weighted mean difference (WMD) was used to compare the insulin resistance indices between PCOS patients with and without SCH.
RESULTS
Twenty-nine studies comprising 5765 women with PCOS were included. The meta-analysis demonstrated that 19.7% (95% CI: 16.1%; 23.5%) of women with PCOS have SCH. PCOS patients with SCH had significantly higher HOMA-IR (WMD = 0.78, 95% CI: 0.34; 1.22) and fasting insulin (WMD = 2.38, 95% CI: 0.34; 4.42) levels than those without SCH. Differences in fasting plasma glucose and 2-hour postprandial glucose did not reach statistical significance.
CONCLUSION
This systematic review and meta-analysis found that approximately 20% of women with PCOS have SCH. This underscores the need for regular thyroid function testing in these patients. The prevalence of SCH is influenced by the TSH cut-off used for diagnosis, highlighting the need for establishing a standardized TSH cut-off value. Furthermore, SCH significantly elevates the HOMA-IR index and fasting insulin levels, highlighting its potential impact on insulin resistance. Whether these metabolic changes are clinically important and put these individuals at higher risk of developing type 2 diabetes mellitus and cardiovascular disease requires further investigation.
SYSTEMATIC REVIEW REGISTRATION NUMBER IN PROSPERO
CRD42024510798.
CLINICAL TRIAL NUMBER
Not applicable.
背景
尽管最近的研究表明多囊卵巢综合征（PCOS）女性中亚临床甲状腺功能减退症（SCH）的患病率很高，但报告的患病率差异很大。因此，我们开展了这项研究，以估计PCOS女性中SCH的合并患病率。此外，新出现的证据表明，SCH可能会对PCOS患者的胰岛素抵抗产生负面影响。因此，我们将研究其对胰岛素抵抗指标的影响作为次要目标。
方法
我们检索了PubMed、Web of Science、Scopus和Embase数据库，检索时间从各数据库建库至2024年2月25日。纳入报告PCOS女性中SCH患病率的观察性研究。采用乔安娜·布里格斯研究所（JBI）的患病率研究批判性评价清单进行偏倚风险评估。采用随机效应模型估计合并患病率及其95%置信区间（CI）。采用加权平均差（WMD）比较有和无SCH的PCOS患者之间的胰岛素抵抗指标。
结果
纳入了29项研究，共5765例PCOS女性。荟萃分析表明，19.7%（95%CI：16.1%；23.5%）的PCOS女性患有SCH。患有SCH的PCOS患者的稳态模型评估胰岛素抵抗（HOMA-IR）（WMD = 0.78，95%CI：0.34；1.22）和空腹胰岛素（WMD = 2.38，95%CI：0.34；4.42）水平显著高于无SCH的患者。空腹血糖和餐后2小时血糖的差异未达到统计学意义。
结论
这项系统评价和荟萃分析发现，约20%的PCOS女性患有SCH。这突出了对这些患者进行定期甲状腺功能检测的必要性。SCH的患病率受诊断所用促甲状腺激素（TSH）临界值的影响，这凸显了建立标准化TSH临界值的必要性。此外，SCH显著提高HOMA-IR指数和空腹胰岛素水平，突出了其对胰岛素抵抗的潜在影响。这些代谢变化在临床上是否重要，以及是否会使这些个体患2型糖尿病和心血管疾病的风险更高，需要进一步研究。
系统评价在国际前瞻性系统评价注册库（PROSPERO）中的注册号：CRD42024510798。
临床试验编号
不适用。
Zotero 插件