題目：大型前瞻性研究中絕經(jīng)后不同類型的激素療法與靜脈血栓栓塞風(fēng)險(xiǎn)的關(guān)系

　　背景：目前使用的更年期激素療法（HT）會(huì)增加靜脈血栓（VTE）的風(fēng)險(xiǎn)，且使用的劑型也可能會(huì)影響風(fēng)險(xiǎn)。

　　方法：通過(guò)鏈接國(guó)家醫(yī)療服務(wù)住院和死亡的日常收集記錄，對(duì)英國(guó)1058259絕經(jīng)后婦女進(jìn)行隨訪。使用Cox回歸，研究激素療法和靜脈血栓栓塞的風(fēng)險(xiǎn)關(guān)系，估計(jì)相對(duì)風(fēng)險(xiǎn)（RRs）和95%可信區(qū)間（CIs）。

　　結(jié)果：在共計(jì)330萬(wàn)年的隨訪中，2200名婦女患有靜脈血栓栓塞，平均使用激素療法1.5年后被診斷出來(lái)。在上一個(gè)報(bào)告中，當(dāng)前正在使用激素療法的患者與從未使用的患者的相對(duì)風(fēng)險(xiǎn)差異因激素療法劑型的不同而不同：與單獨(dú)口服雌激素相比，口服雌激素-孕酮的風(fēng)險(xiǎn)明顯升高（相對(duì)風(fēng)險(xiǎn)2.07 [95%CI 1.86-2.31] vs 1.42 [1.21-1.66]），單獨(dú)經(jīng)皮給藥雌激素的風(fēng)險(xiǎn)沒(méi)有升高（0.82 [0.64-1.06]）。在口服雌激素-孕酮的患者中，激素療法的風(fēng)險(xiǎn)因孕酮類型的不同而不同，含有醋酸甲羥孕酮的劑型明顯高于其他孕酮的風(fēng)險(xiǎn)（2.67 [2.25-3.17] vs 1.91 [1.69-2.17]；異質(zhì)性為0.0007）。上一個(gè)報(bào)告中指出，目前使用激素療法的患者，開(kāi)始使用激素療法的頭兩年與隨后相比，患靜脈血栓栓塞的風(fēng)險(xiǎn)高出兩倍（異質(zhì)性為0.0006）。無(wú)論患肺栓塞與否，使用激素療法與深靜脈栓塞間的相關(guān)性相似。5年后，1660名從未使用激素療法的患者中有1名患者患肺栓塞而接受住院治療，相比而言，單獨(dú)口服雌激素激素療法的475名患者中有1名患肺栓塞，390名使用含炔諾酮/甲基炔諾酮的雌激素-孕酮激素療法的患者中有1名患肺栓塞，250名使用含醋酸甲羥孕酮的雌激素-孕酮療法的患者中有1名患肺栓塞。

　　結(jié)論：靜脈血栓栓塞的風(fēng)險(xiǎn)因激素療法劑型的不同而差異較大，口服雌激素-孕酮激素療法患者的風(fēng)險(xiǎn)最大，尤其是劑型中含有醋酸甲羥孕酮。

　　Venous thromboembolism risk in relation to use of different types of postmenopausal hormone therapy in a large prospective study

　　Sweetland S, Beral V, Balkwill A, Liu B, Benson VS, Canonico M, Green J, Reeves GK; The Million Women Study Collaborators.

　　J Thromb Haemost. 2012 Sep 10. doi: 10.1111/j.1538-7836.2012.04919.x. [Epub ahead of print]

　　Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, United Kingdom The Kirby Institute, University of New South Wales, Sydney NSW 2052, Australia Inserm Unit 1018, Hormone and Cardiovascular Disease Section, Villejuif Cedex, France.

　　Abstract

　　Background:Current use of menopausal hormone therapy (HT) increases venous thromboembolism (VTE) risk and the formulations used may affect risk. Methods: 1,058,259 postmenopausal UK women were followed by record linkage to routinely collected National Health Service hospital admission and death records. HT use and risk of VTE was examined using Cox regression to estimate relative risks (RRs) and 95% confidence intervals (CIs). Results: During 3.3million years of follow-up, 2200 women had an incident VTE, diagnosed 1.5 years, on average, after last reporting HT use. RRs in current versus never users at last reporting varied by HT formulation: risk was significantly greater for oral estrogen-progestin than oral estrogen-only therapy (RR=2.07 [95%CI:1.86-2.31] versus 1.42 [1.21-1.66]), with no increased risk with transdermal estrogen-only therapy (0.82 [0.64-1.06]). Among users of oral estrogen-progestin, HT risk varied by progestin type, with significantly greater risks for preparations containing medroxyprogesterone acetate than other progestins (2.67 [2.25-3.17] versus 1.91 [1.69-2.17];P(heterogeneity) =0.0007). Current users of oral HT at last reporting had twice the risk of VTE in the first two years after starting than later (P(heterogeneity) =0.0006). Associations were similar for deep vein thrombosis with and without pulmonary embolism. Over five years, 1 in 660 never users of HT were admitted to hospital for (or died from) pulmonary embolism, compared to 1 in 475 current users of oral estrogen-only HT,1 in 390 users of estrogen-progestin HT containing norethisterone/norgestrel, and 1 in 250 users of estrogen-progestin HT containing medroxyprogesterone acetate. Conclusions: VTE risk varied considerably by HT formulation, being greatest in users of oral estrogen-progestin HT, especially formulations containing medroxyprogesterone acetate. 2012 International Society on Thrombosis and Haemostasis.

　　查看原文章：http://www.ncbi.nlm.nih.gov/pubmed/22963114