肥胖男性功能性性腺功能减退症的治疗策略：系统评价与网络荟萃分析

Treatment Strategies for Functional Hypogonadism in Obese Men: A Systematic Review and Network Meta-Analysis

——《性医学杂志》，第23卷第9期，2026年9月——

<The Journal of Sexual Medicine>, Volume 23, Issue 9, September 2026

【摘要】引言：肥胖相关的功能性性腺功能减退症（FH）是一种潜在可逆的病症，与性功能障碍、代谢紊乱、身体成分改变及生活质量受损相关。尽管已有多种治疗策略，但其相对疗效和安全性尚不明确。本系统评价与网络荟萃分析旨在明确针对肥胖相关FH成年男性的各类治疗在特定结局指标上的效应，并评估比较性证据的可信度。方法：检索PubMed、Embase、Web of Science和Cochrane Library数据库（建库至2026年4月），纳入评估结构化生活方式干预（SLT）、睾酮替代疗法（TRT）、内源性睾酮恢复（ETR）疗法、基于胰高血糖素样肽-1受体激动剂（GLP-1 RA）的疗法，或TRT联合SLT的随机对照试验。采用频率学派方法进行网状荟萃分析。使用RoB 2评估偏倚风险，使用CINeMA评估证据可信度。通过敏感性分析和直接证据分析检验主要结果的稳健性。结果：共纳入23项随机对照试验，涉及1899名受试者。与常规护理/安慰剂相比，TRT联合SLT在提高总睾酮水平方面的估计增幅最大（MD 7.19，95% CI：1.18-13.21），其次是ETR疗法（MD 4.14，95% CI：0.74-7.54）和TRT（MD 2.53，95% CI：0.26-4.81）。TRT联合SLT显著改善了国际勃起功能指数（IIEF）评分（MD 1.29，95% CI：0.07-2.50）。与常规护理/安慰剂相比，没有任何干预措施能显著降低糖化血红蛋白水平。TRT降低了腰围并增加了瘦体重，但也导致红细胞比容升高；ETR疗法和TRT联合SLT也增加了瘦体重。未发现各组间不良事件存在显著差异。敏感性分析和直接证据分析的结果总体上支持主要发现的趋势。讨论：现有治疗方法在不同结局指标上显示出各异的效应，但没有单一策略在所有结局指标上均表现出持续的优越性。在多项比较中，证据的置信度为低或极低；纳入的试验在受试者特征、治疗方案及随访时长方面存在差异。这些结果应作为制定个体化治疗决策的参考，而非确立治疗方案优劣排名的依据，且尚需通过更长期的头对头试验加以证实。

【关键词】功能性性腺功能减退症；肥胖；睾酮替代疗法；GLP-1受体激动剂；网状荟萃分析

[Abstract] Introduction: Obesity-related functional hypogonadism (FH) is a potentially reversible condition associated with sexual dysfunction, metabolic disorders, altered body composition, and impaired quality of life. Although several treatment strategies are available, their comparative benefits and safety remain uncertain. This systematic review and network meta-analysis aimed to characterize their outcome-specific effects and the confidence of the comparative evidence in adult men with obesity-related FH. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to April 2026 for randomized controlled trials evaluating structured lifestyle therapy (SLT), testosterone replacement therapy (TRT), endogenous testosterone restoration (ETR) therapy, glucagon-like peptide-1 receptor agonist–based therapy, or TRT plus SLT. Frequentist network meta-analyses were performed. Risk of bias was assessed using RoB 2, and confidence in the evidence was evaluated using CINeMA. Sensitivity and direct-evidence analyses were conducted to examine the robustness of the principal findings. Results: Twenty-three randomized controlled trials involving 1899 participants were included. Compared with usual care/placebo, TRT plus SLT showed the largest estimated increase in total testosterone (MD 7.19, 95% CI, 1.18-13.21), followed by ETR therapy (MD 4.14, 95% CI, 0.74-7.54) and TRT (MD 2.53, 95% CI, 0.26-4.81). Testosterone replacement therapy plus SLT significantly improved International Index of Erectile Function scores (MD 1.29, 95% CI, 0.07-2.50). No intervention significantly reduced glycated hemoglobin compared with usual care/placebo. Testosterone replacement therapy reduced waist circumference and increased lean mass but also increased hematocrit; ETR therapy and TRT plus SLT also increased lean mass. No significant differences in adverse events were detected. Sensitivity and direct-evidence analyses generally supported the direction of the principal findings. Discussion: Available treatments showed distinct outcome-specific effects, but no single strategy was consistently superior across all outcomes. Confidence in many comparisons was low or very low, and the included trials differed in participant characteristics, treatment protocols, and follow-up duration. These findings should inform individualized treatment decisions rather than a definitive treatment ranking, and require confirmation in longer-term head-to-head trials.

[Key words] unctional hypogonadism, obesity, testosterone replacement therapy, GLP-1 receptor agonist, network meta-analysis

论文原文：Treatment strategies for functional hypogonadism in obese men: a systematic review and network meta-analysis. Liangliang Yang, Xinlei He, Shize Wang, et al. (2026). The Journal of Sexual Medicine, Volume 23, Issue 9, September 2026.

https://doi.org/10.1093/jsxmed/qdag272

（翻译兼责任编辑：MARY）

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