Benkhadra Khalid, Mohammed Khaled, Al Nofal Alaa, Carranza Leon Barbara G, Alahdab Fares, Faubion Stephanie, Montori Victor M, Abu Dabrh Abd Moain, Zúñiga Hernández Jorge Alberto, Prokop Larry J, Murad Mohammad Hassan
Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905.
J Clin Endocrinol Metab. 2015 Nov;100(11):4021-8. doi: 10.1210/jc.2015-2238.
The objective was to assess the effect of menopausal hormonal therapy (MHT) on all-cause and cause-specific mortality.
We conducted a comprehensive search of several databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, and Scopus) from inception until August 2013. We included randomized controlled trials (RCTs) of more than 6 months of duration comparing MHT with no treatment. Pairs of independent reviewers selected trials, assessed risk of bias and extracted data. We estimated risk ratios (RRs) and 95% confidence intervals (CIs) using the random-effects model.
We included 43 RCTs at moderate risk of bias. Meta-analysis showed no effect on mortality (RR 0.99 [95% CI, 0.94-1.05]), regardless of MHT type or history of preexisting heart disease. No association was found between MHT and cardiac death (RR 1.04 [95% CI 0.87-1.23]) or stroke (RR 1.49 [95% CI 0.95-2.31]). Estrogen plus progesterone use was associated with a likely increase in breast cancer mortality (RR 1.96 [95% CI 0.98-3.94]), whereas estrogen use was not. MHT use was not associated with mortality of other types of cancer. In 5 trials, MHT was likely started at a younger age: 2 RCTs with mean age less than 60 and 3 RCTs with MHT started less than 10 years after menopause. Meta-analysis of these 5 RCTs showed a reduction of mortality with MHT (RR 0.70 [95% CI 0.52-0.95]).
The current evidence suggests that MHT does not affect the risk of death from all causes, cardiac death and death from stroke or cancer. These data may be used to support clinical and policy deliberations about the role of MHT in the care of symptomatic postmenopausal women.
评估绝经激素治疗（MHT）对全因死亡率和特定病因死亡率的影响。
我们对多个数据库（MEDLINE、EMBASE、Cochrane对照试验中央注册库和系统评价数据库以及Scopus）进行了全面检索，检索时间从建库至2013年8月。我们纳入了持续时间超过6个月的比较MHT与未治疗的随机对照试验（RCT）。由两名独立评审员筛选试验、评估偏倚风险并提取数据。我们使用随机效应模型估计风险比（RR）和95%置信区间（CI）。
我们纳入了43项偏倚风险为中度的RCT。荟萃分析显示，无论MHT类型或既往心脏病史如何，MHT对死亡率均无影响（RR 0.99 [95%CI，0.94 - 1.05]）。未发现MHT与心源性死亡（RR 1.04 [95%CI 0.87 - 1.23]）或中风（RR 1.49 [95%CI 0.95 - 2.31]）之间存在关联。使用雌激素加孕激素可能会增加乳腺癌死亡率（RR 1.96 [95%CI 0.98 - 3.94]），而单独使用雌激素则不会。使用MHT与其他类型癌症的死亡率无关。在5项试验中，MHT可能开始于较年轻的年龄：2项RCT的平均年龄小于60岁，3项RCT在绝经后不到10年开始使用MHT。对这5项RCT进行的荟萃分析显示，使用MHT可降低死亡率（RR 0.70 [95%CI 0.52 - 0.95]）。
目前的证据表明，MHT不会影响全因死亡、心源性死亡以及中风或癌症死亡的风险。这些数据可用于支持关于MHT在有症状绝经后女性护理中作用的临床和政策讨论。
