Hormonal replacement therapy after menopause is protective of disease activity in women with inflammatory bowel disease
Hormonal replacement therapy after menopause is protective of disease activity in women with inflammatory bowel disease
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DOI：
10.1111/j.1572-0241.2007.01700.x
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发表时间：
2008-05-01
影响因子：
9.8
通讯作者：
Reddy, Deepa
中科院分区：
文献类型：
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作者：
Kane, Sunanda V.;Reddy, Deepa
背景和目的：绝经后炎症性肠病（IBD）的性质以前没有研究过。本研究的目的是表征更年期对疾病活动性的影响，并确定疾病活动性的可能修饰因子。方法：这是一项在芝加哥大学IBD诊所随访的女性回顾性研究。使用临床评分系统评估受试者月经前后的疾病活动度。感兴趣的变量包括：吸烟史，绝经前口服避孕药（OCP）的使用，激素替代疗法（HRT）的使用。结果：纳入65名女性，其中20名患有溃疡性结肠炎，45名患有克罗恩病。绝经的中位年龄与历史对照相似。23例（35%）患者在绝经前出现活动性症状，25例（38%）患者在绝经后2年内出现与发作相符的疾病指标（P < 0.05）。作为一个组，月经前和月经后发作的患者之间没有关系（P < 0.05）。然而，绝经后使用HRT对疾病活动性有显著的保护作用（风险比[HR] 0.18, 95%可信区间[CI] 0.04-0.72）。随着使用时间的延长，HR也存在剂量反应效应（0.20,0.07-0.65）。结论：绝经后发作的可能性与绝经前发作的可能性并无不同。然而，激素替代疗法可能对绝经后的疾病活动有保护作用。雌激素的抗炎作用可能是这种观察的机制。
BACKGROUND AND AIMS: The nature of inflammatory bowel disease (IBD) following menopause has not been previously studied. The aim of this study was to characterize the effect of menopause on disease activity and identify possible modifiers of disease activity.METHODS: This was a retrospective study of women followed at the University of Chicago IBD Clinic. Disease activity was assessed using clinical scoring systems during the pre- and postmenstrual periods of subjects. Variables of interest included: history of smoking, use of oral contraceptives (OCP) prior to onset of menopause, and use of hormone replacement therapy (HRT).RESULTS: Sixty-five women were included, 20 with ulcerative colitis and 45 with Crohn's disease. The median age of menopause was similar to historical controls. Twenty-three patients (35%) experienced active symptoms in the premenopausal time period and 25 patients (38%) had disease indices consistent with a flare within the first 2 yr after menopause (P > 0.05). There was no relation between those who had a pre- versus postmenstrual flare as a group (P > 0.05). However, there was a significant protective effect on disease activity with postmenopausal HRT use (hazard ratio [HR] 0.18, 95% confidence interval [CI] 0.04-0.72). There was also a dose-response effect noted with an HR with longer duration of use (0.20, 0.07-0.65).CONCLUSIONS: The likelihood of having a flare postmenopause is not different from having it premenopause. HRT, however, may provide a protective effect for disease activity in the postmenopausal period. The anti-inflammatory effects of estrogen may be the mechanism for this observation.