与使用激素治疗的绝经后妇女的血清雌二醇水平相关的因素。
Factors Associated With Serum Estradiol Levels Among Postmenopausal Women Using Hormone Therapy.
机构信息
Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Thailand; and the Department of Preventive Medicine, the Department of Medicine, the Atherosclerosis Research Unit, and the Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California.
出版信息
Obstet Gynecol. 2020 Oct;136(4):675-684. doi: 10.1097/AOG.0000000000004006.
OBJECTIVE
To identify factors associated with serum estradiol (E2) levels among healthy postmenopausal women using hormone therapy (HT).
METHODS
This is an unplanned post hoc analysis of data from ELITE (Early versus Late Intervention Trial with Estradiol), a randomized controlled trial of 1 mg oral E2 with or without vaginal progesterone in healthy early compared with late (<6 years compared with 10 or more years since menopause) postmenopausal women. We included results from visits when women reported at least 80% compliance with HT. Mixed-effects linear models identified factors associated with serum E2 levels while participants were taking HT, assessed every 6 months over a median follow-up of 4.8 years and adjusted for baseline E2 level, visit, and reduced E2 dose. Possible correlates evaluated included demographics, clinical characteristics, medication use, and biomarkers of liver and kidney metabolic function.
RESULTS
The analysis included 2,160 E2 measurements in 275 postmenopausal women. Mean±SD age was 55.4±3.9 vs 64.4±5.5 years, and mean±SD time since menopause was 3.6±1.8 vs 16.0±5.6 years for early vs late postmenopausal women. Adjusted for pretreatment E2 level, visit, and reduced dose indicator, higher serum E2 levels were associated with higher body mass index (BMI), higher weight, surgical menopause, alcohol use, and antihypertensive medication use. Current and past smoking and antifungal medication use were associated with lower serum E2 levels. In the multivariable model, higher BMI and alcohol use were associated with higher serum E2 levels, whereas current and past smoking were associated with lower serum E2 levels. These factors were similar between early and late postmenopausal women.
CONCLUSION
Factors associated with serum E2 levels among postmenopausal women taking HT include BMI, alcohol use, and smoking. As serum E2 levels relate to HT effect, achievement of desirable E2 levels may be maximized through personalized intervention.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, NCT00114517.
目的
通过激素治疗（HT），确定健康绝经后妇女血清雌二醇（E2）水平相关因素。
方法
这是一项对 ELITE（雌二醇早期与晚期干预试验）数据的未计划事后分析，这是一项随机对照试验，比较了 1 毫克口服 E2 与阴道用黄体酮联合或不联合治疗健康的绝经早期（绝经<6 年）与晚期（绝经>10 年）妇女。我们纳入了在至少 80%的 HT 依从性报告时的就诊结果。混合效应线性模型确定了参与者在接受 HT 时与血清 E2 水平相关的因素，每隔 6 个月评估一次，中位随访时间为 4.8 年，并根据基线 E2 水平、就诊和 E2 剂量减少进行调整。评估的可能相关因素包括人口统计学、临床特征、药物使用以及肝肾功能代谢生物标志物。
结果
该分析纳入了 275 名绝经后妇女的 2160 次 E2 测量。早期与晚期绝经后妇女的平均年龄分别为 55.4±3.9 岁与 64.4±5.5 岁，平均绝经时间分别为 3.6±1.8 年与 16.0±5.6 年。经预处理 E2 水平、就诊和降低剂量指标调整后，血清 E2 水平与较高的体重指数（BMI）、体重、手术绝经、饮酒和抗高血压药物使用有关。当前和过去的吸烟史和抗真菌药物使用与血清 E2 水平较低有关。在多变量模型中，较高的 BMI 和饮酒与较高的血清 E2 水平有关，而当前和过去的吸烟史与较低的血清 E2 水平有关。这些因素在绝经早期和晚期妇女中相似。
结论
接受 HT 的绝经后妇女血清 E2 水平相关因素包括 BMI、饮酒和吸烟。由于血清 E2 水平与 HT 效果相关，通过个性化干预可能最大限度地实现理想的 E2 水平。
临床试验注册
ClinicalTrials.gov，NCT00114517。
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