Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom.
Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom.
J Allergy Clin Immunol Pract. 2021 Jul;9(7):2751-2760.e1. doi: 10.1016/j.jaip.2021.02.052. Epub 2021 Mar 8.
The impact of hormone replacement therapy (HRT) on clinical outcomes in menopausal women is uncertain.
To investigate the association between use of HRT and severe asthma exacerbation in perimenopausal and postmenopausal women with asthma.
We used the Optimum Patient Care Research Database, a population-based longitudinal primary care database in the United Kingdom, to construct a 17-year (January 1, 2000, to December 31, 2016) cohort of perimenopausal and postmenopausal (46-70 years, N = 31,656) women. We defined use of HRT, its subtypes, and duration of HRT use. Severe asthma exacerbation was defined as an asthma-related hospitalization, emergency department visits due to asthma, and/or prescription of oral corticosteroids. Analyses were undertaken using multilevel mixed-effects Poisson regression.
At baseline, 22% of women were using any HRT, 11% combined HRT, and 11% estrogen-only HRT. Previous, but not current, use of any (incidence rate ratio [IRR]: 1.24, 95% confidence interval [CI]: 1.22-1.26), combined (IRR: 1.28, 95% CI: 1.25-1.31), and estrogen-only HRT (IRR: 1.18, 95% CI: 1.14-1.21), and longer duration (1-2 years: IRR: 1.16, 95% CI: 1.13-1.19; 3-4 years: IRR: 1.43, 95% CI: 1.38-1.48; 5+ years: IRR: 1.32, 95% CI: 1.28-1.36) of HRT use were associated with increased risk of severe asthma exacerbation compared with nonuse. The risk estimates were greater among lean women (body mass index [BMI] <25 kg/m) than among heavier women (BMI 25-29.9 kg/m and ≥30 kg/m) and higher among smokers than nonsmokers.
Use of HRT and subtypes, particularly previous, but not current, use and use for more than 2 years, is associated with an increased risk of severe asthma exacerbation in perimenopausal/postmenopausal women with established asthma. Lean women and smokers are at greater risk than heavier women and nonsmokers, respectively.
激素替代疗法（HRT）对绝经后妇女临床结局的影响尚不确定。
研究围绝经期和绝经后哮喘女性使用 HRT 与重度哮喘恶化之间的关系。
我们使用 Optimum Patient Care Research Database，这是一个基于人群的英国纵向初级保健数据库，构建了一个 17 年（2000 年 1 月 1 日至 2016 年 12 月 31 日）的围绝经期和绝经后（46-70 岁，N=31656）女性队列。我们定义了 HRT 的使用、其亚型及其使用持续时间。重度哮喘恶化定义为哮喘相关住院、因哮喘急诊就诊和/或口服皮质类固醇处方。分析采用多水平混合效应泊松回归进行。
基线时，22%的女性正在使用任何 HRT，11%联合使用 HRT，11%单独使用雌激素 HRT。既往（而非当前）使用任何 HRT（发病率比[IRR]：1.24，95%置信区间[CI]：1.22-1.26）、联合 HRT（IRR：1.28，95% CI：1.25-1.31）和雌激素单独 HRT（IRR：1.18，95% CI：1.14-1.21），以及使用时间较长（1-2 年：IRR：1.16，95% CI：1.13-1.19；3-4 年：IRR：1.43，95% CI：1.38-1.48；5+年：IRR：1.32，95% CI：1.28-1.36）与重度哮喘恶化风险增加相关，而非不使用 HRT。在体重指数（BMI）<25 kg/m2 的瘦女性中，风险估计值大于 BMI 为 25-29.9 kg/m2 和≥30 kg/m2 的较胖女性，在吸烟者中，风险估计值大于不吸烟者。
在患有哮喘的围绝经期/绝经后女性中，HRT 的使用及其亚型，特别是既往而非当前使用以及使用超过 2 年，与重度哮喘恶化风险增加相关。瘦女性和吸烟者比较重的女性和不吸烟者的风险更大。
