Barr R Graham, Wentowski Catherine C, Grodstein Francine, Somers Samuel C, Stampfer Meir J, Schwartz Joel, Speizer Frank E, Camargo Carlos A
Department of Medicine, Brigham & Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachesetts, USA.
Arch Intern Med. 2004 Feb 23;164(4):379-86. doi: 10.1001/archinte.164.4.379.
Female reproductive hormones appear to influence asthma, although data are conflicting, and may modulate development of chronic obstructive pulmonary disease (COPD). Therefore, in a prospective cohort study, we evaluated whether postmenopausal hormone use was associated with an increased rate of newly diagnosed asthma and, separately, newly diagnosed COPD.
Postmenopausal hormone use was assessed by questionnaire biennially from 1976 onward. New physician diagnoses of asthma or COPD were reported on questionnaires from 1988 to 1996 and confirmed in 1998 using supplementary questionnaires. Grades of diagnostic certainty were established from reports of medication use and pulmonary function using validated definitions.
During 546259 person-years of follow-up, current use of estrogen alone was associated with an increased rate of asthma (multivariate rate ratio, 2.29; 95% confidence interval [CI], 1.59-3.29) compared with those who never used hormones. Current users of estrogen plus progestin had a similarly increased rate of newly diagnosed asthma. Rate ratios increased with certainty of diagnosis of asthma. In contrast, rates of newly diagnosed COPD were the same among hormone users and nonusers (multivariate rate ratio, 1.05; 95% CI, 0.80-1.37).
Postmenopausal hormone use was associated with an increased rate of newly diagnosed asthma but not newly diagnosed COPD. Female reproductive hormones may contribute to the onset of asthma among adult women, but do not appear to hasten the development of COPD.
尽管数据存在矛盾，但女性生殖激素似乎会影响哮喘，并且可能调节慢性阻塞性肺疾病（COPD）的发展。因此，在一项前瞻性队列研究中，我们评估了绝经后激素使用是否与新诊断哮喘的发生率增加相关，以及单独评估是否与新诊断的COPD相关。
从1976年起，每两年通过问卷调查评估绝经后激素的使用情况。1988年至1996年通过问卷报告哮喘或COPD的新医生诊断情况，并在1998年使用补充问卷进行确认。根据药物使用报告和肺功能，使用经过验证的定义确定诊断确定性等级。
在546259人年的随访期间，与从未使用过激素的人相比，单纯使用雌激素与哮喘发生率增加相关（多变量发生率比，2.29；95%置信区间[CI]，1.59 - 3.29）。目前使用雌激素加孕激素的人新诊断哮喘的发生率同样增加。哮喘诊断的确定性越高，发生率比越高。相比之下，激素使用者和非使用者中新诊断COPD的发生率相同（多变量发生率比，1.05；95%CI，0.80 - 1.37）。
绝经后激素使用与新诊断哮喘的发生率增加相关，但与新诊断的COPD无关。女性生殖激素可能导致成年女性哮喘的发病，但似乎不会加速COPD的发展。
