Harmon Q E, Baird D D
Women's Health Group, Epidemiology Branch, National Institute of Environmental Health Sciences, PO Box 12233, MD A3-05, Research Triangle Park, NC 27709, USA
Women's Health Group, Epidemiology Branch, National Institute of Environmental Health Sciences, PO Box 12233, MD A3-05, Research Triangle Park, NC 27709, USA.
Hum Reprod. 2015 Jun;30(6):1499-504. doi: 10.1093/humrep/dev069. Epub 2015 Mar 27.
Is use of depot medroxyprogesterone acetate (DMPA) a risk factor for or a protective factor against prevalent uterine leiomyoma?
Ever use of DMPA was associated with a decreased risk (adjusted risk ratio (RR): 0.8, 95% confidence interval (CI): 0.6, 0.9) of prevalent leiomyoma in young African American women.
Although progesterone is associated with growth of leiomyoma, previous epidemiological studies have shown a protective association for DMPA use. These previous studies may have been biased by studying clinically diagnosed leiomyoma (DMPA may mask symptoms thus delaying diagnoses).
STUDY DESIGN, SIZE, DURATION: Cross sectional analysis of baseline data from a cohort study of 1696 African American women.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Community-based recruitment (e.g. letters, flyers, radio and TV announcements) were used to enroll African American women between 23 and 34 years old without a previous diagnosis of leiomyoma in the Metropolitan Detroit area. Extensive questionnaire data were used to determine DMPA use and screening ultrasound detected the presence of leiomyoma ≥0.5 cm in diameter. Relative risks with adjustment for covariates were calculated for the presence of leiomyoma based on ever use of DMPA as well as duration and recency of use.
Among the 1696 volunteers who enrolled, 43% had used DMPA. Leiomyoma were detected in 17% of those who had ever used DMPA compared with 26% of those who had never used DMPA. The reduction in prevalence remained after adjustment for potential confounders and was highest among women who had used DMPA for more than 4 years (adjusted RR: 0.5, 95% CI: 0.3, 0.8). The reduction in risk was seen for women whose most recent use was up to 8 years prior to study enrollment.
LIMITATIONS, REASONS FOR CAUTION: The use of cross-sectional data means that the timing of initial fibroid development is not known, so the temporality of the association is uncertain. However in this sample of young women, most fibroids were small, suggesting that DMPA exposure may have occurred before leiomyoma development.
Our findings are in agreement with previous epidemiological studies, but protected from the bias inherent in the use of clinically diagnosed leiomyoma. Although further studies will be needed to elucidate the mechanism, use of DMPA as a contraceptive appears to provide long lasting protection against uterine leiomyoma.
STUDY FUNDING/COMPETING INTERESTS: No competing interests. This research was supported in part by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences, and in part by funds allocated for health research by the American Recovery and Reinvestment Act.
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使用醋酸甲羟孕酮长效避孕针（DMPA）是患子宫平滑肌瘤的风险因素还是保护因素？
曾经使用过DMPA与年轻非裔美国女性患平滑肌瘤风险降低相关（调整风险比（RR）：0.8，95%置信区间（CI）：0.6，0.9）。
尽管孕酮与平滑肌瘤生长相关，但既往流行病学研究显示使用DMPA具有保护作用。既往这些研究可能因研究临床诊断的平滑肌瘤而存在偏倚（DMPA可能掩盖症状从而延迟诊断）。
研究设计、规模、持续时间：对一项针对1696名非裔美国女性的队列研究的基线数据进行横断面分析。
参与者/材料、研究环境、方法：通过社区招募（如信件、传单、广播和电视公告），在底特律都会区纳入年龄在23至34岁且既往未诊断出平滑肌瘤的非裔美国女性。使用广泛的问卷数据来确定DMPA的使用情况，并通过筛查超声检测直径≥0.5厘米的平滑肌瘤的存在。根据DMPA的使用情况以及使用持续时间和最近使用时间，对协变量进行调整后计算平滑肌瘤存在的相对风险。
在纳入的1696名志愿者中，43%使用过DMPA。曾经使用过DMPA的女性中17%检测出平滑肌瘤，而从未使用过DMPA的女性中这一比例为26%。在对潜在混杂因素进行调整后，患病率仍有所降低，在使用DMPA超过4年的女性中降低幅度最大（调整RR：0.5，95%CI：0.3，0.8）。在研究入组前最近一次使用时间长达8年的女性中观察到风险降低。
局限性、谨慎理由：使用横断面数据意味着肌瘤初始发生时间未知，因此关联的时间顺序不确定。然而在这个年轻女性样本中，大多数肌瘤较小，表明DMPA暴露可能发生在平滑肌瘤发展之前。
我们的研究结果与既往流行病学研究一致，但避免了使用临床诊断的平滑肌瘤所固有的偏倚。尽管需要进一步研究来阐明其机制，但使用DMPA作为避孕药似乎能提供长期预防子宫平滑肌瘤的作用。
研究资金/利益冲突：无利益冲突。本研究部分由美国国立卫生研究院国家环境健康科学研究所的内部研究项目资助，部分由《美国复苏与再投资法案》分配用于健康研究的资金资助。
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