Division of Cardiovascular Disease, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Thromb Res. 2010 Nov;126(5):373-8. doi: 10.1016/j.thromres.2010.08.010. Epub 2010 Sep 15.
Because the risk of venous thromboembolism (VTE) associated with progestin is uncertain, we tested oral contraceptives, estrogen and progestin as independent VTE risk factors.
Using longitudinal, population-based Rochester Epidemiology Project resources, we identified all Olmsted County, MN women with objectively-diagnosed incident VTE over the 13-year period, 1988-2000 (n=726) and one to two Olmsted County women per case matched on age, event year and duration of prior medical history (n=830), and reviewed their complete medical history in the community for previously-identified VTE risk factors (i.e., hospitalization with or without surgery, nursing home confinement, trauma/fracture, leg paresis, active cancer, varicose veins and pregnancy/postpartum), and oral contraceptive, oral estrogen, and oral or injectable progestin exposure. Using conditional logistic regression we tested these hormone exposures as VTE risk factors, both unadjusted and after adjusting for previously-identified VTE risk factors.
In unadjusted models, oral contraceptives, progestin alone, and estrogen plus progestin were significantly associated with VTE. Individually adjusting for body mass index (BMI) and previously-identified VTE risk factors, these effects remained essentially unchanged except that progestin alone was not associated with VTE after adjusting for active cancer. Considering only case-control pairs without active cancer, progestin alone was positively but non-significantly associated with VTE (OR=2.49; p=0.16). Adjusting for BMI and previously-identified VTE risk factors including active cancer, oral contraceptives, estrogen alone, and progestin with or without estrogen were significantly associated with VTE.
Oral contraceptives, estrogen alone, estrogen plus progestin, and progestin with or without estrogen are independent VTE risk factors.
由于孕激素相关静脉血栓栓塞症（VTE）的风险不确定，我们测试了口服避孕药、雌激素和孕激素作为独立的 VTE 风险因素。
利用纵向、基于人群的罗切斯特流行病学项目资源，我们确定了 1988 年至 2000 年期间奥姆斯特德县（MN）所有经客观诊断的新发 VTE 女性（n=726），并按年龄、发病年份和既往病史持续时间与每位病例匹配了 1 至 2 名奥姆斯特德县女性（n=830），并在社区中查阅了她们完整的病历，以确定之前确定的 VTE 风险因素（即住院治疗，无论是否手术、养老院监禁、创伤/骨折、腿部瘫痪、活动性癌症、静脉曲张和妊娠/产后），以及口服避孕药、口服雌激素和口服或注射用孕激素的暴露情况。使用条件逻辑回归，我们在未调整和调整了先前确定的 VTE 风险因素后，测试了这些激素暴露作为 VTE 风险因素。
在未调整的模型中，口服避孕药、单独孕激素和雌激素加孕激素与 VTE 显著相关。单独调整体重指数（BMI）和先前确定的 VTE 风险因素后，除了单独使用孕激素与癌症活动无关外，这些影响基本保持不变。考虑到只有没有癌症活动的病例对照对，单独使用孕激素与 VTE 呈正相关但无统计学意义（OR=2.49；p=0.16）。仅调整 BMI 和先前确定的 VTE 风险因素，包括癌症活动、单独使用雌激素、雌激素加孕激素、单独使用孕激素或加用雌激素与 VTE 显著相关。
口服避孕药、单独使用雌激素、雌激素加孕激素和单独使用孕激素或加用雌激素是独立的 VTE 风险因素。
