绝经后女性盆腔器官脱垂的局部雌激素治疗：一项系统评价和荟萃分析
Local Estrogen Therapy for Pelvic Organ Prolapse in Postmenopausal Women: A Systematic Review and Meta-Analysis.
作者信息
Yu Xia, He Li, Wang Yanjun, Wang Li, Yang Zhenglin, Lin Yonghong
机构信息
Chengdu Women's and Children's Central Hospital, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
出版信息
Iran J Public Health. 2022 Aug;51(8):1728-1740. doi: 10.18502/ijph.v51i8.10255.
BACKGROUND
The prevalence of pelvic organ prolapse (POP) is expected to increase in the next few decades, imposing a substantial medical burden. The effect of local estrogen therapy (LET) on POP in postmenopausal women is still controversial; therefore, we aimed to provide reliable evidence to address this issue from the perspective of vaginal health and quality of life (QoL).
METHODS
We searched in the PubMed, the Web of Science, Embase and the Cochrane Library databases for eligible RCTs from beginning to Apr 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in our study.
RESULTS
Seven RCTs(n=570) were included. No significant improvement of the epithelial thickness (SMD=1.38, 95%CI -0.54 to 3.31, =0.16) or vaginal pH (SMD=-0.98, 95%CI -2.65 to 0.69, =0.25) after LET compared with the control. A slight increase was observed in the VMI (MD=16.58, 95%CI 1.14 to 32.02, =0.04). Regarding QoL, no significant differences between the estrogen group and the control group in PFIQ-7 (6m: MD=3.60, 95%CI -3.13 to 10.33, =0.29; 12m: MD=3.53, 95%CI -3.35 to 10.41, =0.31), PISQ-12(6m: MD=0.62, 95%CI -0.73 to 1.98, =0.37; 12m: MD=0.36, 95%CI -1.06 to 1.77, =0.62), or PGI-I (6m: RR=0.99, 95%CI 0.92 to 1.07, =0.88; 12m: RR=1.01, 95%CI 0.95 to 1.07, =0.72) score. Moreover, no more specific adverse events (AEs) (RR=1.11, 95%CI 0.84 to 1.48, =0.46) were observed in the interventional group.
CONCLUSION
Not find LET caused either a significant improvement in vaginal health and QoL or more AEs.
背景
预计在未来几十年中，盆腔器官脱垂（POP）的患病率将会上升，这将带来沉重的医疗负担。局部雌激素治疗（LET）对绝经后女性POP的影响仍存在争议；因此，我们旨在从阴道健康和生活质量（QoL）的角度提供可靠证据以解决这一问题。
方法
我们在PubMed、科学网、Embase和Cochrane图书馆数据库中检索了从开始到2021年4月的符合条件的随机对照试验（RCT）。我们的研究遵循系统评价和Meta分析的首选报告项目指南。
结果
纳入了7项RCT（n = 570）。与对照组相比，LET治疗后上皮厚度（标准化均数差[SMD]=1.38，95%置信区间[CI] -0.54至3.31，P = 0.16）或阴道pH值（SMD=-0.98，95%CI -2.65至0.69，P = 0.25）无显著改善。阴道成熟指数（VMI）略有增加（平均差[MD]=16.58，95%CI 1.14至32.02，P = 0.04）。关于生活质量，雌激素组和对照组在盆腔功能影响问卷-7（PFIQ-7）（6个月：MD = 3.60，95%CI -3.13至10.33，P = 0.29；12个月：MD = 3.53，95%CI -3.35至10.41，P = 0.31）、盆腔性兴趣问卷-12（PISQ-12）（6个月：MD = 0.62，95%CI -0.73至1.98，P = 0.37；12个月：MD = 0.36，95%CI -1.06至1.77，P = 0.62）或患者总体印象-改善（PGI-I）（6个月：相对危险度[RR]=0.99，95%CI 0.92至1.07，P = 0.88；12个月：RR = 1.01，95%CI 0.95至1.07，P = 0.72）评分方面无显著差异。此外，干预组未观察到更多特定的不良事件（AE）（RR = 1.11，95%CI 0.84至1.48，P = 0.46）。
结论
未发现LET能显著改善阴道健康和生活质量或导致更多不良事件。
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