Mohammed Khaled, Abu Dabrh Abd Moain, Benkhadra Khalid, Al Nofal Alaa, Carranza Leon Barbara G, Prokop Larry J, Montori Victor M, Faubion Stephanie S, Murad Mohammad Hassan
Evidence-Based Practice Research Program (K.M., K.B., A.A.N., V.M.M., M.H.M.), Knowledge and Evaluation Research, Center for the Science of Health Care Delivery (K.M., A.M.A.D., K.B., A.A.N., V.M.M., M.H.M.), Division of Preventive, Occupational, and Aerospace Medicine (K.M., K.B., M.H.M.), Division of Pediatric Endocrinology (A.A.N.), Division of Endocrinology, Diabetes, Metabolism and Nutrition (B.G.C.L., V.M.M.), Library Public Services (L.J.P.), and Division of General Internal Medicine, Women's Health Clinic (S.S.F.), Mayo Clinic, Rochester, Minnesota 55905.
J Clin Endocrinol Metab. 2015 Nov;100(11):4012-20. doi: 10.1210/jc.2015-2237.
Menopausal hormone therapy is widely used to alleviate climacteric symptoms but may increase the risk of venous and arterial vascular events.
The objective was to synthesize the evidence about the risk of vascular events in postmenopausal women who use oral estrogen therapy (ET) and transdermal ET.
We searched bibliographical databases through August 2013 for longitudinal comparative studies that enrolled postmenopausal women using either oral or transdermal ET and reported the outcomes of interest: venous thromboembolism (VTE), pulmonary embolism, deep venous thrombosis (DVT), myocardial infarction (MI), and stroke. Two reviewers independently selected and appraised studies. Outcomes were pooled using random effects meta-analysis and were reported as risk ratio (RR) and 95% confidence interval (CI).
We included 15 observational studies at moderate risk of bias with follow-up of 3 to 20.25 years. When compared to transdermal ET, oral ET was associated with increased risk of a first episode of VTE (RR, 1.63; 95% CI, 1.40-1.90; I(2) = 53%), DVT (RR, 2.09; 95% CI, 1.35-3.23; I(2) = 0 %), and possibly stroke (RR, 1.24; 95% CI, 1.03-1.48; a single case-controlled study), but not MI (RR, 1.17; 95% CI, 0.80-1.71; I(2) = 74%).
Observational evidence warranting low confidence suggests that compared to transdermal ET, oral ET may be associated with increased risk of VTE and DVT, but not MI.
绝经激素治疗被广泛用于缓解更年期症状，但可能会增加静脉和动脉血管事件的风险。
本研究旨在综合分析使用口服雌激素治疗（ET）和经皮ET的绝经后女性发生血管事件风险的相关证据。
我们检索了截至2013年8月的文献数据库，查找纳入使用口服或经皮ET的绝经后女性的纵向比较研究，并报告感兴趣的结局：静脉血栓栓塞（VTE）、肺栓塞、深静脉血栓形成（DVT）、心肌梗死（MI）和中风。两名研究者独立筛选并评估研究。使用随机效应荟萃分析汇总结局，并报告为风险比（RR）和95%置信区间（CI）。
我们纳入了15项偏倚风险为中度的观察性研究，随访时间为3至20.25年。与经皮ET相比，口服ET与首次发生VTE（RR，1.63；95%CI，1.40 - 1.90；I² = 53%）、DVT（RR，2.09；95%CI，1.35 - 3.23；I² = 0%）以及可能的中风（RR，1.24；95%CI，1.03 - 1.48；一项病例对照研究）风险增加相关，但与MI无关（RR，1.17；95%CI，0.80 - 1.71；I² = 74%）。
低可信度的观察性证据表明，与经皮ET相比，口服ET可能与VTE和DVT风险增加相关，但与MI无关。
