Salpeter Shelley R, Cheng Ji, Thabane Lehana, Buckley Nicholas S, Salpeter Edwin E
Santa Clara Valley Medical Center, 751 S. Bascom Ave, San Jose, CA 95128, USA.
Am J Med. 2009 Nov;122(11):1016-1022.e1. doi: 10.1016/j.amjmed.2009.05.021.
There is uncertainty over the risks and benefits of hormone therapy. We performed a Bayesian meta-analysis to evaluate the effect of hormone therapy on total mortality in younger postmenopausal women. This analysis synthesizes evidence from different sources, taking into account varying views on the issue.
A comprehensive search from 1966 through January 2008 identified randomized controlled trials of at least 6 month's duration that evaluated hormone therapy in women with mean age <60 years and reported at least one death, and prospective observational cohort studies that evaluated the relative risk of mortality associated with hormone therapy after adjustment for confounding variables.
The results were synthesized using a hierarchical random-effects Bayesian meta-analysis. The pooled results from 19 randomized trials, with 16,000 women (mean age 55 years) followed for 83,000 patient-years, showed a mortality relative risk of 0.73 (95% credible interval 0.52-0.96). When data from 8 observational studies were added to the analysis, the resultant relative risk was 0.72 (credible interval 0.62-0.82). The posterior probability that hormone therapy reduces total mortality in younger women is almost 1.
The synthesis of data using Bayesian meta-analysis indicates a reduction in mortality in younger postmenopausal women taking hormone therapy compared with no treatment. This finding should be interpreted taking into account the potential benefits and harms of hormone therapy.
激素疗法的风险和益处尚不确定。我们进行了一项贝叶斯荟萃分析，以评估激素疗法对绝经后年轻女性全因死亡率的影响。该分析综合了来自不同来源的证据，同时考虑了对此问题的不同观点。
全面检索1966年至2008年1月期间的文献，确定了至少为期6个月的随机对照试验，这些试验评估了平均年龄<60岁女性的激素疗法，并报告了至少一例死亡病例；以及前瞻性观察队列研究，这些研究评估了在调整混杂变量后与激素疗法相关的死亡相对风险。
采用分层随机效应贝叶斯荟萃分析对结果进行综合。19项随机试验的汇总结果显示，16000名女性（平均年龄55岁）随访了83000患者年，死亡相对风险为0.7（95%可信区间0.52 - 0.96）。当将8项观察性研究的数据加入分析时，最终相对风险为0.72（可信区间0.62 - 0.82）。激素疗法降低年轻女性全因死亡率的后验概率几乎为1。
使用贝叶斯荟萃分析对数据进行综合表明，与未接受治疗相比，接受激素疗法的绝经后年轻女性死亡率降低。应结合激素疗法的潜在益处和危害来解读这一发现。
