閉経後のホルモン置換療法:科学的レビュー
Heidi D Nelson1, Linda L Humphrey, Peggy Nygren
1Oregon Health and Science University, Mail Code BICC 504, 3181 SW Sam Jackson Park Rd, Portland, OR 97201, USA. nelsonh@ohsu.edu
JAMA
|August 21, 2002
まとめ
ホルモン置換療法 (HRT) は,骨粗鬆症の骨折や結腸直腸がんの予防などの利点を提供しています. しかし,心血管疾患,脳卒中,血栓,長期使用の乳がん,胆炎などのリスクも伴います.
科学分野:
- 生殖医学は,生殖器医学である.
- 心血管医学は,心臓血管医学である.
- 腫瘍学 腫瘍学
- ゲリアトリクス ゲリアトリクス
背景:
- 閉経後のホルモン置換療法 (HRT) は,米国では一般的です.
- 新しい証拠により,慢性疾患の予防におけるHRTの役割を再評価する必要がある.
研究 の 目的:
- プライマリ予防のためのHRTの利益と害を評価する.
- 主なアウトカムには,心血管疾患,血栓栓塞栓症,骨粗鬆症,がん,認知症,胆囊炎が含まれています.
主な方法:
- MEDLINE,HealthSTAR,およびコクランデータベースを含む包括的な文献レビュー.
- 最近の女性の健康イニシアチブ (WHI) と心臓およびエストロゲン/プロゲステン置換研究 (HERS) のデータを含む.
- メタアナリシスと結果率の計算は,比較グループと合格した英語研究で実施されました.
主要な成果:
- HRTは,現在の使用者における冠動脈疾患 (CHD) の発生率と死亡率の低下を示しましたが,これはすべての社会経済的な地位制御された研究において一貫しませんでした.
- 脳卒中と静脈性血栓栓塞栓症のリスクの増加が観察されました,特に使用の最初の1年間.
- 骨粗鬆症の骨折に対する有意な保護と結腸直腸癌の発生率の減少が認められた.
- より長い使用期間で乳がんのリスクが増加し,エストロゲン無抵抗で子宮内膜がんのリスクが増加しました.
- HRTの使用は,胆囊炎のリスクの増加と関連していました.
- 認知機能の改善は閉経期の女性で見られたが,認知症の予防に関するデータはまだ決定的ではない.
結論:
- HRTは,骨粗鬆症の骨折と結腸直腸癌の予防に有益です.
- 潜在的な害には,心血管疾患,脳卒中,血栓塞栓症,乳がん (長期使用),胆炎のリスクの増加が含まれます.
- 認知症の予防におけるHRTの役割については,さらなる調査が必要です.
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