长期激素疗法用于绝经前和绝经后妇女
Magdalena Bofill Rodriguez1, Li Ning Yong2, Sanja Mirkov3,4
1Department of Obstetrics, Gynaecology and Reproductive Sciences, University of Auckland, Auckland, New Zealand.
绝经后妇女使用激素治疗存在各种风险. 联合治疗可能会增加乳腺癌和血栓栓塞,而仅用雌激素治疗会增加中风和胆囊疾病的风险,但会减少骨折.
科学领域:
- 内分泌学 在内分泌学.
- 妇科 妇科 妇科 妇科
- 心血管医学 心血管医学
- 在瘤学瘤学.
背景情况:
- 激素治疗 (HT) 用于治疗更年期症状,心血管疾病,骨质疏松症和女性痴呆症.
- 这是一个更新的Cochrane评论,评估了长期HT影响.
研究的目的:
- 评估长期使用 (≥1年) 激素治疗的长期影响.
- 评估结果包括死亡率,心血管事件,癌症,胆囊疾病,骨折和认知.
- 专注于绝经前和绝经后的女性.
主要方法:
- 包括HT (雌激素+/-孕激素) 与安慰剂的随机双盲试验,持续时间≥1年.
- 搜索了多个数据库和试验注册到2024年9月.
- 两位作者独立选择了研究,评估了偏差,并提取了数据;确定性使用GRADE进行评估.
主要成果:
- 24项研究 (45,660名参与者),主要是绝经后的美国女性>60岁.
- 结合HT:可能增加乳腺癌 (RR 1.27),可能中风 (RR 1.39),可能静脉血栓栓塞 (RR 2.03),可能减少骨折 (RR 0.78).
- 仅含雌激素的HT:可能增加中风 (RR 1.33) 和胆囊疾病 (RR 1.78),可能减少骨折 (RR 0.73),冠状动脉事件和乳腺癌的差异很小或没有.
结论:
- 组合和仅雌激素HT之间的风险概况不同.
- 仅含雌激素的HT:增加中风/胆囊疾病,减少骨折,对冠状动脉事件/乳腺癌中性.
- 联合HT:增加乳腺癌/血栓塞栓症风险. 由于依赖口服HT研究,建议谨慎使用.
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