更年期妇女的激素替代疗法与哮喘发作：国家队列研究
2021/01/28
摘要
背景： 激素替代疗法（HRT）在哮喘发展中的作用尚不确定。
目的： 我们调查了围绝经期妇女和绝经后妇女HRT的使用和使用时间是否与哮喘发生风险相关。
方法：我们从英国最优患者护理数据库（来自英国各地的纵向初级保健数据库）建立了一个为期17年(从2000年1月1日到2016年12月31日)的开放队列，调查对象为353173名女性(年龄46-70岁)。使用READ临床分类系统定义HRT的使用、亚型和使用持续时间；混杂变量和哮喘发作。我们拟合了多水平Cox回归模型来估计95%CI的危险比(HR)。
结果：在17年的随访(1340423人年)中，发生了7614例新发哮喘病例，每千人年的发病率为5.7(95%CI=5.5-5.8)。与不使用HRT相比，既往使用任何HRT(HR=0.83；95%CI=0.76-0.88)、单独使用雌激素(HR=0.89；95%CI=0.84-0.95)或联合使用雌激素和孕激素(HR=0.82；95%CI=0.76-0.88)与哮喘发病风险降低相关。目前使用的任何激素(HR=0.79；95%CI=0.74-0.85)、仅使用雌激素(HR=0.80；95%CI=0.73-0.87)以及雌激素和孕激素联合使用（HR=0.78; 95％CI=0.70-0.87）也是如此。使用激素替代疗法的时间较长(1-2年[HR=0.93；95%CI=0.87-0.99]；3-4年[HR=0.77；95%CI=0.70-0.84]；>5年[HR=0.71；95%CI=0.64-0.78])与哮喘发作的剂量反应风险降低相关。
结论： 我们发现，在更年期妇女中，激素替代疗法与发生迟发型哮喘的风险降低有关。尚需进一步的队列研究来证实这些发现。
Hormone Replacement Therapy and Asthma Onset in Menopausal Women: National Cohort Study
Syed A Shah, Holly Tibble, Rebecca Pillinger, Susannah McLean, Dermot Ryan, Hilary Critchley, David Price, Catherine M Hawrylowicz, Colin R Simpson, Ireneous N Soyiri, Francis Appiagyei, Aziz Sheikh, Bright I Nwaru
Abstract
BACKGROUND:There is uncertainty about the role of hormonal replacement therapy (HRT) in development of asthma.
OBJECTIVE:We investigated whether use of HRT and duration of use was associated with risk of developing asthma in peri- and post-menopausal women.
METHODS:We constructed a 17-year (1/1/2000 - 12/31/2016) open cohort of 353,173 women (46-70 years old) from the Optimum Patient Care Database, a longitudinal primary care database from across UK. HRT use, subtypes, and duration of use; confounding variables; and asthma onset were defined using the Read Clinical Classification System. We fitted multilevel Cox regression models to estimate hazard ratios (HR) with 95% confidence intervals (CIs).
RESULTS:During 17-year follow-up (1,340,423 person-years), 7,614 new asthma cases occurred, giving an incidence rate of 5.7 (95%CI 5.5-5.8) per 1,000 person-years. Compared to non-use of HRT, previous use of any (HR 0.83; 95%CI 0.76-0.88), estrogen-only (HR 0.89; 95%CI 0.84-0.95), and combined estrogen/progestogen (HR 0.82; 95%CI 0.76-0.88) HRT were associated with a reduced risk of asthma onset. This was also the case with current use of any (HR 0.79; 95%CI 0.74-0.85), estrogen-only (HR 0.80; 95%CI 0.73-0.87), and combined estrogen/progestogen (HR 0.78; 95%CI 0.70-0.87) HRT. Longer duration of HRT use (1-2 years: HR 0.93; 95%CI 0.87-0.99; 3-4 years: HR 0.77; 95%CI 0.70-0.84; 5+ years: HR 0.71; 95%CI 0.64-0.78) was associated with a dose-response reduced risk of asthma onset.
CONCLUSIONS:We found that HRT was associated with a reduced risk of developing late onset asthma in menopausal women. Further cohort studies are needed to confirm these findings.
背景： 激素替代疗法（HRT）在哮喘发展中的作用尚不确定。
目的： 我们调查了围绝经期妇女和绝经后妇女HRT的使用和使用时间是否与哮喘发生风险相关。
方法：我们从英国最优患者护理数据库（来自英国各地的纵向初级保健数据库）建立了一个为期17年(从2000年1月1日到2016年12月31日)的开放队列，调查对象为353173名女性(年龄46-70岁)。使用READ临床分类系统定义HRT的使用、亚型和使用持续时间；混杂变量和哮喘发作。我们拟合了多水平Cox回归模型来估计95%CI的危险比(HR)。
结果：在17年的随访(1340423人年)中，发生了7614例新发哮喘病例，每千人年的发病率为5.7(95%CI=5.5-5.8)。与不使用HRT相比，既往使用任何HRT(HR=0.83；95%CI=0.76-0.88)、单独使用雌激素(HR=0.89；95%CI=0.84-0.95)或联合使用雌激素和孕激素(HR=0.82；95%CI=0.76-0.88)与哮喘发病风险降低相关。目前使用的任何激素(HR=0.79；95%CI=0.74-0.85)、仅使用雌激素(HR=0.80；95%CI=0.73-0.87)以及雌激素和孕激素联合使用（HR=0.78; 95％CI=0.70-0.87）也是如此。使用激素替代疗法的时间较长(1-2年[HR=0.93；95%CI=0.87-0.99]；3-4年[HR=0.77；95%CI=0.70-0.84]；>5年[HR=0.71；95%CI=0.64-0.78])与哮喘发作的剂量反应风险降低相关。
结论： 我们发现，在更年期妇女中，激素替代疗法与发生迟发型哮喘的风险降低有关。尚需进一步的队列研究来证实这些发现。
(中日友好医院呼吸与危重症医学科 王静茹 摘译 林江涛 审校)
(J Allergy Clin Immunol. 2020 Dec 3;S0091-6749(20)31697-3.doi:10.1016/j.jaci.2020.11.024. Online ahead of print.)
(J Allergy Clin Immunol. 2020 Dec 3;S0091-6749(20)31697-3.doi:10.1016/j.jaci.2020.11.024. Online ahead of print.)
Hormone Replacement Therapy and Asthma Onset in Menopausal Women: National Cohort Study
Syed A Shah, Holly Tibble, Rebecca Pillinger, Susannah McLean, Dermot Ryan, Hilary Critchley, David Price, Catherine M Hawrylowicz, Colin R Simpson, Ireneous N Soyiri, Francis Appiagyei, Aziz Sheikh, Bright I Nwaru
Abstract
BACKGROUND:There is uncertainty about the role of hormonal replacement therapy (HRT) in development of asthma.
OBJECTIVE:We investigated whether use of HRT and duration of use was associated with risk of developing asthma in peri- and post-menopausal women.
METHODS:We constructed a 17-year (1/1/2000 - 12/31/2016) open cohort of 353,173 women (46-70 years old) from the Optimum Patient Care Database, a longitudinal primary care database from across UK. HRT use, subtypes, and duration of use; confounding variables; and asthma onset were defined using the Read Clinical Classification System. We fitted multilevel Cox regression models to estimate hazard ratios (HR) with 95% confidence intervals (CIs).
RESULTS:During 17-year follow-up (1,340,423 person-years), 7,614 new asthma cases occurred, giving an incidence rate of 5.7 (95%CI 5.5-5.8) per 1,000 person-years. Compared to non-use of HRT, previous use of any (HR 0.83; 95%CI 0.76-0.88), estrogen-only (HR 0.89; 95%CI 0.84-0.95), and combined estrogen/progestogen (HR 0.82; 95%CI 0.76-0.88) HRT were associated with a reduced risk of asthma onset. This was also the case with current use of any (HR 0.79; 95%CI 0.74-0.85), estrogen-only (HR 0.80; 95%CI 0.73-0.87), and combined estrogen/progestogen (HR 0.78; 95%CI 0.70-0.87) HRT. Longer duration of HRT use (1-2 years: HR 0.93; 95%CI 0.87-0.99; 3-4 years: HR 0.77; 95%CI 0.70-0.84; 5+ years: HR 0.71; 95%CI 0.64-0.78) was associated with a dose-response reduced risk of asthma onset.
CONCLUSIONS:We found that HRT was associated with a reduced risk of developing late onset asthma in menopausal women. Further cohort studies are needed to confirm these findings.
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Caspase-11促进过敏性气道炎症
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隐藏在英国初级保健系统中的潜在重症哮喘患者
