绝经及绝经后激素治疗与听力损失风险
Menopause and postmenopausal hormone therapy and risk of hearing loss.
作者信息
Curhan Sharon G, Eliassen A Heather, Eavey Roland D, Wang Molin, Lin Brian M, Curhan Gary C
机构信息
1Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 2Harvard Medical School, Boston, MA 3Vanderbilt Bill Wilkerson Center for Otolaryngology and Communication Sciences, Vanderbilt University School of Medicine, Nashville, TN 4Department of Biostatistics 5Department of Epidemiology, Harvard School of Public Health, Boston, MA 6The Massachusetts Eye and Ear Infirmary, Department of Otolaryngology, Boston, MA 7Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
出版信息
Menopause. 2017 Sep;24(9):1049-1056. doi: 10.1097/GME.0000000000000878.
OBJECTIVE
Menopause may be a risk factor for hearing loss, and postmenopausal hormone therapy (HT) has been proposed to slow hearing decline; however, there are no large prospective studies. We prospectively examined the independent relations between menopause and postmenopausal HT and risk of self-reported hearing loss.
METHODS
Prospective cohort study among 80,972 women in the Nurses' Health Study II, baseline age 27 to 44 years, followed from 1991 to 2013. Baseline and updated information was obtained from detailed validated biennial questionnaires. Cox proportional-hazards regression models were used to examine independent associations between menopausal status and postmenopausal HT and risk of hearing loss.
RESULTS
After 1,410,928 person-years of follow-up, 18,558 cases of hearing loss were reported. There was no significant overall association between menopausal status, natural or surgical, and risk of hearing loss. Older age at natural menopause was associated with higher risk. The multivariable-adjusted relative risk of hearing loss among women who underwent natural menopause at age 50+ years compared with those aged less than 50 years was 1.10 (95% confidence interval [CI] 1.03, 1.17). Among postmenopausal women, oral HT (estrogen therapy or estrogen plus progestogen therapy) was associated with higher risk of hearing loss, and longer duration of use was associated with higher risk (P trend < 0.001). Compared with women who never used HT, the multivariable-adjusted relative risk of hearing loss among women who used oral HT for 5 to 9.9 years was 1.15 (95% CI 1.06, 1.24) and for 10+ years was 1.21 (95% CI 1.07, 1.37).
CONCLUSIONS
Older age at menopause and longer duration of postmenopausal HT are associated with higher risk of hearing loss.
目的
绝经可能是听力损失的一个风险因素，绝经后激素治疗（HT）被认为可以减缓听力下降；然而，尚无大型前瞻性研究。我们前瞻性地研究了绝经、绝经后HT与自我报告的听力损失风险之间的独立关系。
方法
对护士健康研究II中80972名女性进行前瞻性队列研究，基线年龄为27至44岁，随访时间为1991年至2013年。基线和更新信息通过详细的经过验证的两年一次问卷调查获得。采用Cox比例风险回归模型来研究绝经状态、绝经后HT与听力损失风险之间的独立关联。
结果
经过1410928人年的随访，报告了18558例听力损失病例。自然绝经或手术绝经状态与听力损失风险之间无显著总体关联。自然绝经年龄较大与较高风险相关。与年龄小于50岁的女性相比，50岁及以上自然绝经的女性听力损失的多变量调整相对风险为1.10（95%置信区间[CI]1.03，1.17）。在绝经后女性中，口服HT（雌激素治疗或雌激素加孕激素治疗）与较高的听力损失风险相关，且使用时间越长风险越高（P趋势<0.001）。与从未使用HT的女性相比，使用口服HT 5至9.9年的女性听力损失的多变量调整相对风险为1.15（95%CI 1.06，1.24），使用10年及以上的女性为1.21（95%CI 1.07，1.37）。
结论
绝经年龄较大和绝经后HT使用时间较长与较高的听力损失风险相关。
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