性别肯定激素治疗对跨性别者亚临床动脉粥样硬化风险的影响：系统评价。
The Effect of Gender-Affirming Hormone Therapy on the Risk of Subclinical Atherosclerosis in the Transgender Population: A Systematic Review.
机构信息
Gynecological Endocrinology Unit, Division of Endocrinology, and Gender Identity Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Post-graduate Program in Endocrinology, Medicine School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Gynecological Endocrinology Unit, Division of Endocrinology, and Gender Identity Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
出版信息
Endocr Pract. 2023 Jun;29(6):498-507. doi: 10.1016/j.eprac.2022.12.017. Epub 2023 Jan 2.
OBJECTIVE
The impact of gender-affirming hormone therapy (GAHT) on cardiovascular (CV) health is still not entirely established. A systematic review was conducted to summarize the evidence on the risk of subclinical atherosclerosis in transgender people receiving GAHT.
METHODS
A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and data were searched in PubMed, LILACS, EMBASE, and Scopus databases for cohort, case-control, and cross-sectional studies or randomized clinical trials, including transgender people receiving GAHT. Transgender men and women before and during/after GAHT for at least 2 months, compared with cisgender men and women or hormonally untreated transgender persons. Studies reporting changes in variables related to endothelial function, arterial stiffness, autonomic function, and blood markers of inflammation/coagulation associated with CV risk were included.
RESULTS
From 159 potentially eligible studies initially identified, 12 were included in the systematic review (8 cross-sectional and 4 cohort studies). Studies of trans men receiving GAHT reported increased carotid thickness, brachial-ankle pulse wave velocity, and decreased vasodilation. Studies of trans women receiving GAHT reported decreased interleukin 6, plasminogen activator inhibitor-1, and tissue plasminogen activator levels and brachial-ankle pulse wave velocity, with variations in flow-mediated dilation and arterial stiffness depending on the type of treatment and route of administration.
CONCLUSIONS
The results suggest that GAHT is associated with an increased risk of subclinical atherosclerosis in transgender men but may have either neutral or beneficial effects in transgender women. The evidence produced is not entirely conclusive, suggesting that additional studies are warranted in the context of primary prevention of CV disease in the transgender population receiving GAHT.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, identifier CRD42022323757.
目的
性别肯定激素治疗（GAHT）对心血管（CV）健康的影响尚不完全明确。系统评价旨在总结接受 GAHT 的跨性别者亚临床动脉粥样硬化风险的证据。
方法
按照系统评价和荟萃分析的首选报告项目指南进行系统评价，并在 PubMed、LILACS、EMBASE 和 Scopus 数据库中检索队列、病例对照和横断面研究或随机临床试验的数据，包括接受 GAHT 的跨性别者。将接受 GAHT 的跨性别男性和女性与顺性别男性和女性或未接受激素治疗的跨性别者进行比较，至少 2 个月。报告与 CV 风险相关的内皮功能、动脉僵硬度、自主神经功能和炎症/凝血血液标志物变化的变量的研究包括在内。
结果
从最初确定的 159 项潜在合格研究中，有 12 项研究纳入系统评价（8 项横断面研究和 4 项队列研究）。接受 GAHT 的跨性别男性研究报告颈动脉厚度增加、臂踝脉搏波速度增加和血管扩张减少。接受 GAHT 的跨性别女性研究报告白细胞介素 6、纤溶酶原激活物抑制剂-1 和组织型纤溶酶原激活物水平降低以及臂踝脉搏波速度降低，血流介导的扩张和动脉僵硬度取决于治疗类型和给药途径而有所不同。
结论
结果表明，GAHT 与跨性别男性亚临床动脉粥样硬化风险增加有关，但在接受 GAHT 的跨性别女性中可能具有中性或有益的影响。所产生的证据并不完全具有结论性，表明在接受 GAHT 的跨性别人群中进行 CV 疾病一级预防的背景下，需要进行更多的研究。
系统评价注册
PROSPERO，标识符 CRD42022323757。
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