Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.
Clin Infect Dis. 2022 Oct 12;75(8):1397-1404. doi: 10.1093/cid/ciac134.
There are conflicting results regarding endogenous estrogen exposure and risk of incident nontuberculous mycobacterial pulmonary disease (NTM-PD). In addition, evidence on impact of hormone replacement therapy (HRT) on risk of NTM-PD is lacking. This study aimed to evaluate the impacts of endogenous estrogen exposure and HRT on risk of NTM-PD in postmenopausal women.
This population-based cohort study comprised 1 400 095 postmenopausal women without previous NTM-PD who participated in the 2009 national health screening exam in South Korea. The cohort was followed until the date of incident NTM-PD, death, or December 2018. We evaluated whether lifetime endogenous estrogen exposure and HRT were associated with incident NTM-PD. Endogenous estrogen exposure was evaluated using age at menarche and menopause and reproductive period (duration between age at menarche and age at menopause).
During a median of 8.4 (interquartile range, 8.2-8.7) years of follow-up, 0.1% of participants (1818/1 400 095) developed NTM-PD, with an incidence rate of 0.15/1000 person-years. Multivariable Cox regression analyses showed no significant relationship between endogenous estrogen exposure (age at menarche, age at menopause, and reproductive period) and risk of NTM-PD. In contrast, duration of HRT showed a significant dose-response relationship with incident NTM-PD even after adjustment for demographics and reproductive factors (adjusted hazard ratio [95% CI]: 1.30 [1.12-1.51] in HRT for <2 years; 1.28 [1.03-1.59] in 2-5 years; and 1.65 [1.33-2.05] in ≥5 years).
While there was no significant association with endogenous estrogen exposure, HRT was monotonically associated with increased risk of NTM-PD in postmenopausal women.
关于内源性雌激素暴露与非结核分枝杆菌性肺病（NTM-PD）发病风险之间存在相互矛盾的结果。此外，关于激素替代疗法（HRT）对 NTM-PD 风险影响的证据尚缺乏。本研究旨在评估内源性雌激素暴露和 HRT 对绝经后妇女 NTM-PD 发病风险的影响。
本基于人群的队列研究纳入了韩国 2009 年全国健康筛查中无 NTM-PD 既往史的 1400095 名绝经后妇女。该队列随访至 NTM-PD 发病、死亡或 2018 年 12 月。我们评估了终生内源性雌激素暴露和 HRT 是否与 NTM-PD 发病相关。内源性雌激素暴露通过初潮年龄、绝经年龄和生殖期（初潮年龄与绝经年龄之间的间隔）来评估。
在中位时间为 8.4 年（四分位间距为 8.2-8.7 年）的随访期间，0.1%（1818/1400095）的参与者发生了 NTM-PD，发病率为 0.15/1000 人年。多变量 Cox 回归分析显示，内源性雌激素暴露（初潮年龄、绝经年龄和生殖期）与 NTM-PD 风险之间无显著关系。相比之下，即使在调整了人口统计学和生殖因素后，HRT 的持续时间与 NTM-PD 的发病风险也呈显著的剂量反应关系（调整后的危险比[95%CI]：HRT<2 年为 1.30[1.12-1.51]；2-5 年为 1.28[1.03-1.59]；≥5 年为 1.65[1.33-2.05]）。
虽然内源性雌激素暴露与 NTM-PD 发病风险无显著关联，但 HRT 与绝经后妇女 NTM-PD 发病风险呈单调递增关系。
