Abstract
The objective of the study is to assess the TNF-α levels in PCOS patients and healthy controls. A comprehensive electronic search in Medline, Embase, and the Cochrane Library database was conducted up to July 2016. Random-effects model was used to estimate the standardized mean differences (SMDs) with 95% confidence intervals (CIs). Twenty-nine studies with a total of 1960 participants (1046 PCOS patients and 914 controls) were included in this meta-analysis. The TNF-α levels in PCOS patients were significantly higher than those in controls (random-effects, SMD = 0.60, 95% CI = 0.28–0.92, P<0.001). With regard to the subgroup analyses stratified by ethnicity, study quality, methods, and BMI, significantly high TNF-α levels were found in patients with PCOS in almost all of these subgroups. In the subgroup stratified by HOMA-IR ratio and T ratio, significant differences were only observed in the subgroups with HOMA-IR ratio of >1.72(SMD = 0.967, 95% CI = 0.103–1.831, P = 0.028, I2 = 93.5%) and T ratio>2.10 (SMD = 1.420, 95% CI = 0.429–2.411, P = 0.005, I2 = 96.1%). By meta-regression it was suggested that ethnicity might contribute little to the heterogeneity between the included studies. Through cumulative meta-analysis and sensitivity analysis it was supposed that the higher TNF-α levels of PCOS patients compared to healthy controls was stable and reliable. This meta-analysis suggests that the circulating TNF-α levels in women with PCOS are significantly higher than those in healthy controls. It may be involved in promoting insulin resistance and androgen excess of PCOS.
Highlights
Polycystic ovary syndrome (PCOS) is one of the most common heterogeneous endocrine disorders, which affects 5%–10% of women in reproductive age and is considered as one of the leading causes of female infertility[1]
S1 Fig. The quantitative synthesis for TNF-α levels in PCOS patients compared with controls stratified by Ethnicity. (TIF)
S2 Fig. The quantitative synthesis for TNF-α levels in PCOS patients compared with controls stratified by Study quality. (TIF)
Summary
Polycystic ovary syndrome (PCOS) is one of the most common heterogeneous endocrine disorders, which affects 5%–10% of women in reproductive age and is considered as one of the leading causes of female infertility[1]. It is characterized by biochemical or clinical hyperandrogenism, polycystic ovaries on ultrasonography and oligo-ovulation or anovulation. Tumor Necrosis Factor-Alpha and Polycystic Ovary Syndrome obesity which predisposes women with PCOS to type 2 diabetes mellitus(T2DM)[2] and cardiovascular disease[3]. TNF-α played a role in the pathogenesis of insulin resistance [5] It inhibited tyrosine phosphorylation of insulin receptor and insulin receptor substrate-1 in muscle and fat cells [5]. TNF-α may be a useful biomarker for the diagnosis of PCOS and the treatment of T2DM and cardiovascular diseases in women with PCOS
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