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JAMA:激素治疗用于绝经后女性慢性病一级预防:USPSTF推荐声明

2018-01-04 易湛苗 环球医学

2017年12月,美国预防服务工作组(USPSTF)在《JAMA》发布了激素治疗用于绝经后女性慢性病一级预防的推荐声明。

2017年12月,美国预防服务工作组(USPSTF)在《JAMA》发布了激素治疗用于绝经后女性慢性病一级预防的推荐声明。

重要性:绝经发生在中位年龄51.3岁,到达绝经期的美国女性一般预期再存活30年。大部分慢性疾病的流行情况和发病率随年龄增加,如冠心病、痴呆、卒中、骨折和乳腺癌;然而,这些疾病能被仅仅归因于绝经的风险增加情况并不确定。自从妇女健康倡议(WHI)发表关于“绝经后女性使用激素治疗与严重不良健康影响相关”的结果以来,绝经后激素治疗的使用率已经下降。

目的:更新2012年USPSTF对于绝经期激素治疗用于慢性疾病一级预防的推荐情况。

证据审查:USPSTF审查了绝经后女性中,全身(即口服或经皮)激素治疗用于慢性病预防的获益和危害的证据,以及在不同亚组或绝经后不同干预时机的女性中,结局是否存在差异。

结果:尽管绝经后女性中旨在预防慢性病的激素治疗的使用与一些获益相关,也有证据显示充分的危害。USPSTF确定,绝经后女性中激素治疗的获益和危害的程度均为小~中等。因此,USPSTF以中等确定性得出结论:雌激素联合孕激素对大部分有完整子宫的绝经后女性慢性病的一级预防无净获益,雌激素单药对大部分进行过子宫切除术的绝经后女性慢性病的一级预防无净获益。

结论和推荐:USPSTF推荐反对雌激素联合孕激素用于绝经后女性的慢性病一级预防。(D推荐)USPSTF推荐反对雌激素单药用于进行过子宫切除术的绝经后女性的慢性病一级预防。

原始出处:
US Preventive Services Task Force, Grossman DC, Curry SJ, et al.Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women: US Preventive Services Task Force Recommendation Statement.JAMA. 2017 Dec 12;318(22):2224-2233. doi: 10.1001/jama.2017.18261.

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    2018-01-06 lingqf
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    2018-01-06 zxxiang
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    2018-01-04 1e0f8808m18(暂无匿称)

    女性慢病一级预防.激素发挥作用.

    0

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绝经后激素治疗的历史已经有60多年了,有meta分析表明,这一方案与几种癌症的罹患风险升高有关,但此前的相关分析有一定局限性。本文在人群基础上评估绝经后采用现代方案系统性激素治疗者的癌症总体罹患风险。

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