绝经后的激素替代疗法:科学综述
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
概括
激素替代疗法 (HRT) 提供了诸如预防骨质疏松性骨折和结直肠癌等好处. 然而,它也带有风险,包括心血管事件,中风,血栓,长期使用的乳腺癌和胆囊炎.
科学领域:
- 生殖医学 生殖医学
- 心血管医学 心血管医学
- 在瘤学瘤学.
- 老年病的医生 老年病的医生
背景情况:
- 绝经后的激素替代疗法 (HRT) 在美国很常见.
- 新的证据需要重新评估HRT在预防慢性疾病中的作用.
研究的目的:
- 评估HRT对初级预防的益处和危害.
- 关键的结果包括心血管疾病,血栓栓塞,骨质疏松症,癌症,痴呆症和胆囊炎.
主要方法:
- 包括MEDLINE,HealthSTAR和Cochrane数据库在内的综合文献审查.
- 包括最近的妇女健康倡议 (WHI) 和心脏和雌激素/孕激素替代研究 (HERS) 数据.
- 对符合条件的英语研究和对照组进行了元分析和结果率计算.
主要成果:
- 在目前的使用者中,HRT显示降低了冠心病 (CHD) 发病率和死亡率,但这在所有社会经济地位受控研究中都不一致.
- 观察到中风和静脉血栓栓塞的风险增加,特别是在使用的第一年.
- 观察到对骨质疏松性骨折的显著保护以及结直肠癌发病率的减少.
- 鉴定出使用时间较长的乳腺癌风险增加和使用无异性雌激素的子宫内膜癌风险增加.
- 使用HRT与胆囊炎的风险增加有关.
- 更年期妇女的认知能力有所改善,但痴呆症预防数据仍不确定.
结论:
- 在预防骨质疏松性骨折和结直肠癌方面,HRT提供了好处.
- 潜在的危害包括心血管疾病,中风,血栓栓塞,乳腺癌 (长期使用) 和胆囊炎的风险增加.
- HRT在痴呆症预防中的作用需要进一步研究.
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