Wahedna I, Cooper S, Williams J, Paterson I C, Britton J R, Tattersfield A E
Division of Respiratory Medicine, City Hospital, Nottingham, UK.
Thorax. 1994 Sep;49(9):910-4. doi: 10.1136/thx.49.9.910.
Pulmonary lymphangioleiomyomatosis is a rare progressive disease of unknown aetiology affecting premenopausal women. Since the oral contraceptive pill has been implicated in its pathogenesis, a case control study was carried out to determine whether women with the disease were more likely to have taken the oral contraceptive pill, and whether the disease was associated with other conditions related to sex hormones including pregnancy, parity, and fibroids.
All chest physicians in the UK were asked for details of all live patients with pulmonary lymphangioleiomyomatosis; the patient's family doctor was then asked for four age and sex matched control subjects from their patient register. Details of lifetime use of the oral contraceptive pill, pregnancy, parity, history of fibroids, and smoking were obtained from cases and controls. Relative odds of exposure to potential risk factors were estimated by conditional logistic regression.
Medical details were obtained from all 23 cases of lymphangioleiomyomatosis identified; questionnaires were completed by 21 cases (one by proxy) and by 46 matched controls of mean (SD) age 43 (10) and 44 (11) years, respectively. The patients had a mean age of 34 (9) years at onset of symptoms and a median (range) time of 2 (0-29) years from onset of symptoms to diagnosis. Compared with control subjects, cases did not differ in the use of the oral contraceptive pill (odds ratio (OR) 0.39, 95% CI 0.09 to 1.68), diagnosis of fibroids (OR 3.12; 95% CI 0.52 to 18.7), age of menarche, menstrual history, or lifetime smoking. They were, however, less likely to have been pregnant (OR 0.14, 95% CI 0.03 to 0.71) or to have had children (OR 0.13, 95% CI 0.03 to 0.67). More pregnancies had ended in spontaneous abortion (28% v 8%) but the proportion of women undergoing spontaneous abortion was similar in cases and controls (OR 2.13, 95% CI 0.47 to 9.3).
This study does not support the hypothesis that use of the oral contraceptive pill is causally associated with the development of pulmonary lymphangioleiomyomatosis. Sex hormones may be involved, however, since patients were less likely to have been pregnant or to have had children, and tended to have had more spontaneous abortions and an increased incidence of fibroids.
肺淋巴管平滑肌瘤病是一种病因不明的罕见进行性疾病，影响绝经前女性。由于口服避孕药被认为与其发病机制有关，因此进行了一项病例对照研究，以确定患有该疾病的女性是否更有可能服用过口服避孕药，以及该疾病是否与其他与性激素相关的情况有关，包括怀孕、生育次数和子宫肌瘤。
向英国所有胸科医生询问所有存活的肺淋巴管平滑肌瘤病患者的详细信息；然后要求患者的家庭医生从其患者登记册中选取四名年龄和性别匹配的对照对象。从病例组和对照组获取口服避孕药的终生使用情况、怀孕情况、生育次数、子宫肌瘤病史和吸烟情况的详细信息。通过条件逻辑回归估计暴露于潜在危险因素的相对比值比。
获取了所确定的所有23例淋巴管平滑肌瘤病患者的医疗详细信息；21例患者（1例由代理人填写）和46例匹配对照完成了问卷调查，对照组的平均（标准差）年龄分别为43（10）岁和44（11）岁。患者出现症状时的平均年龄为34（9）岁，从症状出现到诊断的中位（范围）时间为2（0 - 29）年。与对照对象相比，病例组在口服避孕药的使用（比值比（OR）0.39，95%置信区间0.09至1.68）、子宫肌瘤诊断（OR 3.12；95%置信区间0.52至18.7）、初潮年龄、月经史或终生吸烟方面没有差异。然而，她们怀孕（OR 0.14，95%置信区间0.03至0.71）或生育子女（OR 0.13，95%置信区间0.03至0.67）的可能性较小。更多的怀孕以自然流产告终（28%对8%），但病例组和对照组中自然流产女性的比例相似（OR 2.13，95%置信区间0.47至9.3）。
本研究不支持口服避孕药的使用与肺淋巴管平滑肌瘤病的发生存在因果关系这一假设。然而，性激素可能参与其中，因为患者怀孕或生育子女的可能性较小，并且自然流产的倾向更大，子宫肌瘤的发病率也有所增加。
