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更年期激素治疗和中枢神经系统瘤:丹麦嵌套病例对照研究

Nelsan Pourhadi^1,2, Amani Meaidi², Søren Friis²

¹Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.

|December 19, 2023

概括

含有孕激素的更年期激素治疗增加了脑膜瘤的风险,特别是持续的雌激素-孕激素. 仅用孕激素治疗也可能会增加质瘤的风险,因此需要进一步调查中枢神经系统 (CNS) 瘤的发展.

科学领域:

神经瘤学神经瘤学
内分泌学在内分泌学.
流行病学流行病学

背景情况:

基于雌激素的更年期激素治疗 (MHT) 影响中枢神经系统 (CNS) 瘤风险.
孕激素成分在MHT中的特定作用及其基于治疗方案 (连续或循环) 对中枢神经系统瘤风险的差异性影响仍然不清楚.

研究的目的:

调查更年期激素治疗 (MHT) 使用,特别是孕激素成分和治疗方案,与患脑膜瘤和质瘤的风险之间的联系.
为了区分与连续与循环雌激素-孕激素治疗和仅孕激素治疗相关的风险.

主要方法:

一项嵌套病例控制研究是在全国范围内对789,901名年龄在50-60岁的丹麦妇女进行的,该研究持续了19年 (2000-2018).
使用处方数据来评估对MHT的累积暴露. 统计分析考虑了诸如教育水平和使用其他药物的共变量.
在随访期间,该研究确定了1595例脑膜瘤和1167例脑瘤诊断.

主要成果:

雌激素-孕激素和仅孕激素的MHT都与脑膜瘤的风险增加有关.
与循环疗法 (HR 1.13) 相比,持续的雌激素-孕激素治疗显示脑膜瘤的风险更高 (HR 1.34).
仅用孕激素治疗与脑膜瘤风险增加和潜在的质瘤风险相关,目前/最近使用显示最高的危险比率.

结论:

持续使用雌激素-孕激素与脑膜瘤的风险增加有关,而循环使用与此无显著关联.
在使用雌激素-孕激素时,没有观察到质瘤风险的增加.
仅用孕激素治疗表明与脑膜瘤风险增加和质瘤风险的潜在增加有关,需要进一步研究长期影响.

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