Gallbladder disease and use of transdermal versus oral hormone replacement therapy in postmenopausal women: prospective cohort study
Gallbladder disease and use of transdermal versus oral hormone replacement therapy in postmenopausal women: prospective cohort study
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DOI：
10.1136/bmj.a386
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发表时间：
2008-08-02
影响因子：
105.7
通讯作者：
Reeves, Gillian
中科院分区：
文献类型：
--
作者：
Liu, Bette;Beral, Valerie;Reeves, Gillian
目的确定经皮与口服激素替代疗法相比是否能降低绝经后妇女胆囊疾病的风险。设计在英格兰和苏格兰的国家卫生服务系统（NHS）登记的妇女。参与者1001391名绝经后妇女（平均年龄56岁）从1996年至2001年从NHS乳腺筛查中心招募，随后与常规收集的NHS胆囊疾病住院数据记录关联。主要结果测量胆囊疾病住院的校正相对风险和标准化发病率。结果在随访期间，19889名妇女因胆囊疾病入院，17190名（86%）接受了胆囊切除术。与从未使用过激素替代疗法的患者相比，目前使用激素替代疗法的患者更有可能因胆囊疾病而入院（相对风险1.64，95%置信区间1.58 - 1.69），但经皮治疗的风险显著低于口服治疗（相对危险度1.17，1.10 ~ 1.24 v1.74，1.68 ~ 1.80;异质性P < 0.001）。在使用口服治疗的女性中，马雌激素与胆囊疾病的风险比雌二醇略高（相对风险1.79，1.72 - 1.87 v1.62，1.54 - 1.70;异质性P 0.625 mg，1.91（1.78 - 2.04）v1 mg，1.68（1.59 - 1.77）v1 mg）。
Objective To determine whether transdermal compared with oral use of hormone replacement therapy reduces the risk of gallbladder disease in postmenopausal women.Design Prospective cohort study (Million Women Study).Setting Women registered with the National Health Service (NHS) in England and Scotland.Participants 1001391 postmenopausal women (mean age 56) recruited between 1996 and 2001 from NHS breast screening centres and followed by record linkage to routinely collected NHS hospital admission data for gallbladder disease.Main outcome measures Adjusted relative risk and standardised incidence rates of hospital admission for gallbladder disease or cholecystectomy according to use of hormone replacement therapy.Results During follow-up 19 889 women were admitted for gallbladder disease; 17 190 (86%) had a cholecystectomy. Compared with never users of hormone replacement therapy, current users were more likely to be admitted for gallbladder disease (relative risk 1.64, 95% confidence interval 1.58 to 1.69) but risks were substantially lower with transdermal therapy than with oral therapy (relative risk 1.17, 1.10 to 1.24 v 1.74, 1.68 to 1.80; heterogeneity P < 0.001). Among women using oral therapy, equine oestrogens were associated with a slightly greater risk of gallbladder disease than estradiol (relative risk 1.79, 1.72 to 1.87 v 1.62, 1.54 to 1.70; heterogeneity P 0.625 mg, 1.91 (1.78 to 2.04) v 1 mg, 1.68 (1.59 to 1.77) v