Acs N, Vajo Z, Miklos Z, Siklosi G, Paulin F, Felicetta J V, Székåcs B
Department of Obstetrics and Gynecology, Semmelweis Medical School, Budapest, Hungary.
Gynecol Endocrinol. 2002 Aug;16(4):335-46.
The aim of the study was to summarize and reanalyze all available data from the literature to study the overall effect of postmenopausal hormone replacement therapy (HRT) and its various forms on hemostatic variables. Studies were identified from literature searches by Medline and Index Medicus, review articles and personal communications. Reference lists of all articles were checked to find additional studies. Principal investigators were contacted and asked to provide additional data if required. Data were collected separately for each factor of the hemostatic system. Studies written in any language were included. Each collection of studies was analyzed using standard methods for meta-analysis. A total of 76 arms of 48 studies were eligible for analysis. This included 6,119 women using HRT and 24,974 non-users. The age of investigated women was 40-68 years. HRT was associated with significantly decreased levels of fibrinogen, factor VIII, antithrombin III, and proteins C and S, but significantly increased plasminogen levels. HRT with estrogen alone or in combination with progestins, oral vs. transdermal regimens, different estrogen preparations and various progestins induced significantly different changes in many cases. In conclusion, HRT was associated with changes that could explain the increased rate of venous thrombotic events, and also with some changes that could account for beneficial vascular effects. Surprisingly, the addition of progestins induced favorable changes in many cases. Also, transdermal use was associated with more beneficial effects than oral regimens in some cases.
本研究的目的是总结并重新分析文献中所有可得数据，以研究绝经后激素替代疗法（HRT）及其各种形式对止血变量的总体影响。通过检索Medline和《医学索引》、综述文章以及个人交流来确定研究。检查所有文章的参考文献列表以查找其他研究。如有需要，联系主要研究者并要求提供额外数据。针对止血系统的每个因素分别收集数据。纳入任何语言撰写的研究。使用标准的荟萃分析方法对每组研究进行分析。共有48项研究的76个组符合分析条件。这包括6119名使用HRT的女性和24974名未使用者。被调查女性的年龄为40 - 68岁。HRT与纤维蛋白原、凝血因子VIII、抗凝血酶III以及蛋白C和S水平显著降低相关，但纤溶酶原水平显著升高。单独使用雌激素或与孕激素联合使用的HRT、口服与经皮给药方案、不同的雌激素制剂以及各种孕激素在许多情况下会引起显著不同的变化。总之，HRT与一些可解释静脉血栓形成事件发生率增加的变化相关，也与一些可解释有益血管效应的变化相关。令人惊讶的是，在许多情况下添加孕激素会产生有利变化。此外，在某些情况下，经皮使用比口服给药方案具有更有益的效果。
