Jick H, Derby L E, Myers M W, Vasilakis C, Newton K M
Boston Collaborative Drug Survelliance Program, Boston University Medical Center, Lexington, MA 02173, USA.
Lancet. 1996 Oct 12;348(9033):981-3. doi: 10.1016/S0140-6736(96)07114-0.
At the request of researchers in the UK, we conducted a case-control study to explore the relation between use of postmenopausal oestrogen hormone replacement therapy (HRT) and idiopathic venous thromboembolism (VTE).
The study was based on information derived from Group Health Cooperative of Puget Sound for the period 1980 to 1994. Women aged 50-74 years admitted to hospital for idiopathic VTE were identified from hospital records. The diagnosis of idiopathic VTE was validated from the clinical record. Women who had medical conditions predisposing to VTE (a history of VTE or cancer, recent trauma, or surgery) were excluded as cases. Four control subjects matched to each case by age, duration of Cooperative membership, and calendar time were identified from the base population. Various potential risk factors were recorded based on record review.
An initial analysis of 42 cases and 168 matched controls yielded a matched relative risk estimate of 3.6 (95% CI 1.6-7.8) for current users of oestrogens compared with non-users. There was a substantial effect of daily oestrogen dose. The matched relative risk estimates for oestrogen users of 0.325 mg, 0.625 mg, and 1.25 mg or more daily were 2.1, 3.3, and 6.9, respectively. Body-mass index was independently associated with the risk of VTE but did not materially confound the relation of oestrogen and VTE. The absolute risk of idiopathic VTE is estimated to be low (0.9 x 10(-4) woman-years) in non-users of oestrogen; the risk in current users is estimated at 3.2 x 10(-4) woman-years.
The risk of idiopathic VTE is about three times higher among current users of replacement oestrogens than among non-users. However, the absolute risk is low for both groups and accounts for only a modest increase in morbidity.
应英国研究人员的要求，我们开展了一项病例对照研究，以探讨绝经后雌激素激素替代疗法（HRT）的使用与特发性静脉血栓栓塞症（VTE）之间的关系。
该研究基于普吉特海湾健康合作组织1980年至1994年期间的信息。从医院记录中确定50 - 74岁因特发性VTE入院的女性。特发性VTE的诊断通过临床记录进行验证。有易患VTE疾病（VTE或癌症病史、近期外伤或手术）的女性被排除在病例组之外。从基础人群中确定与每个病例在年龄、合作成员资格持续时间和日历时间上相匹配的四名对照对象。基于记录审查记录各种潜在风险因素。
对42例病例和168名匹配对照的初步分析得出，与非使用者相比，当前雌激素使用者的匹配相对风险估计值为3.6（95%置信区间1.6 - 7.8）。每日雌激素剂量有显著影响。每日使用0.325毫克、0.625毫克和1.25毫克及以上雌激素使用者的匹配相对风险估计值分别为2.1、3.3和6.9。体重指数与VTE风险独立相关，但并未实质性混淆雌激素与VTE之间的关系。估计非雌激素使用者中特发性VTE的绝对风险较低（0.9×10⁻⁴人年）；当前使用者的风险估计为3.2×10⁻⁴人年。
当前使用替代雌激素的人群中特发性VTE的风险比非使用者高约三倍。然而，两组的绝对风险都较低，仅导致发病率有适度增加。
