绝经后女性中激素疗法与静脉血栓栓塞的相关性

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Title：Hormone therapy and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration and progestogens: the ESTHER study.
绝经后女性中激素疗法与静脉血栓栓塞的相关性——雌激素给药途径与孕激素对其影响（ESTHER研究）
Author：Canonico M, Oger E, Plu-Bureau G, Conard J, Meyer G, Levesque H, Trillot N, Barrellier MT, Wahl D, Emmerich J, Scarabin PY; Estrogen and Thromboembolism Risk (ESTHER) Study Group.

Resource: Circulation. 2007 Feb 20;115(7):840-5.

Abstract：
摘要：

BACKGROUND: Oral estrogen therapy increases the risk of venous thromboembolism (VTE) in postmenopausal women. Transdermal estrogen may be safer. However, currently available data have limited the ability to investigate the wide variety of types of progestogen. 背景：口服雌激素治疗可增加在绝经后妇女静脉血栓栓塞的风险性。经皮注射雌激素可能是安全的。但目前的所获资料限定了孕激素运用类型的研究。
METHODS AND RESULTS: We performed a multicenter case-control study of VTE among postmenopausal women 45 to 70 years of age between 1999 and 2005 in France. We recruited 271 consecutive cases with a first documented episode of idiopathic VTE (208 hospital cases, 63 outpatient cases) and 610 controls (426 hospital controls, 184 community controls) matched for center, age, and admission date. After adjustment for potential confounding factors, odds ratios (ORs) for VTE in current users of oral and transdermal estrogen compared with nonusers were 4.2 (95% CI, 1.5 to 11.6) and 0.9 (95% CI, 0.4 to 2.1), respectively. There was no significant association of VTE with micronized progesterone and pregnane derivatives (OR, 0.7; 95% CI, 0.3 to 1.9 and OR, 0.9; 95% CI, 0.4 to 2.3, respectively). In contrast, norpregnane derivatives were associated with a 4-fold-increased VTE risk (OR, 3.9; 95% CI, 1.5 to 10.0). 方法和结果：我们进行了一项有关静脉血栓栓塞的多中心病例对照研究，研究对象选取法国1999至2005年间年龄从45到70岁的绝经后妇女，共271例首诊为特发性静脉血栓栓塞（208例住院，63例门诊）及620例对照（426例住院，184例门诊），并记录住院中心，年龄和入院日期。校正潜在的致混淆因素后，口服和皮下运用雌激素的患者静脉血栓栓塞OR值相对于对照组分别为4.2（95%可信区间，1.5至11.6）和0.9（95%可信区间，0.4至2.1）。服用微粒化的黄体酮和孕烷衍生物后静脉血栓栓塞无显著相关性（其OR值分别为0.7，0.9；95%可信区间分别为0.3至1.9，0.4至2.3）。相反，非孕烷衍生物与静脉血栓栓塞增加4倍风险性相关（OR值为3.9，95%可信区间为1.5至10.0）。

CONCLUSIONS: Oral but not transdermal estrogen is associated with an increased VTE risk. In addition, our data suggest that norpregnane derivatives may be thrombogenic, whereas micronized progesterone and pregnane derivatives appear safe with respect to thrombotic risk. If confirmed, these findings could benefit women in the management of their menopausal symptoms with respect to the VTE risk associated with oral estrogen and use of progestogens. 结论：口服而不经皮运用雌激素与静脉血栓栓塞风险增加相关。另外，我们研究表明非孕烷衍生物可能具有血栓形成性，而微粒化的黄体酮和孕烷衍生物相对于血栓形成似乎是安全的。如上述被证实，此研究发现有助于降低口服雌激素和运用孕激素治疗绝经后症状产生静脉血栓栓塞的风险。