题目：大型前瞻性研究中绝经后不同类型的激素疗法与静脉血栓栓塞风险的关系

　　背景：目前使用的更年期激素疗法（HT）会增加静脉血栓（VTE）的风险，且使用的剂型也可能会影响风险。

　　方法：通过链接国家医疗服务住院和死亡的日常收集记录，对英国1058259绝经后妇女进行随访。使用Cox回归，研究激素疗法和静脉血栓栓塞的风险关系，估计相对风险（RRs）和95%可信区间（CIs）。

　　结果：在共计330万年的随访中，2200名妇女患有静脉血栓栓塞，平均使用激素疗法1.5年后被诊断出来。在上一个报告中，当前正在使用激素疗法的患者与从未使用的患者的相对风险差异因激素疗法剂型的不同而不同：与单独口服雌激素相比，口服雌激素-孕酮的风险明显升高（相对风险2.07 [95%CI 1.86-2.31] vs 1.42 [1.21-1.66]），单独经皮给药雌激素的风险没有升高（0.82 [0.64-1.06]）。在口服雌激素-孕酮的患者中，激素疗法的风险因孕酮类型的不同而不同，含有醋酸甲羟孕酮的剂型明显高于其他孕酮的风险（2.67 [2.25-3.17] vs 1.91 [1.69-2.17]；异质性为0.0007）。上一个报告中指出，目前使用激素疗法的患者，开始使用激素疗法的头两年与随后相比，患静脉血栓栓塞的风险高出两倍（异质性为0.0006）。无论患肺栓塞与否，使用激素疗法与深静脉栓塞间的相关性相似。5年后，1660名从未使用激素疗法的患者中有1名患者患肺栓塞而接受住院治疗，相比而言，单独口服雌激素激素疗法的475名患者中有1名患肺栓塞，390名使用含炔诺酮/甲基炔诺酮的雌激素-孕酮激素疗法的患者中有1名患肺栓塞，250名使用含醋酸甲羟孕酮的雌激素-孕酮疗法的患者中有1名患肺栓塞。

　　结论：静脉血栓栓塞的风险因激素疗法剂型的不同而差异较大，口服雌激素-孕酮激素疗法患者的风险最大，尤其是剂型中含有醋酸甲羟孕酮。

　　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