Reply to Letter to Editor E08-5108A.
Reply to Letter to Editor E08-5108A.
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回复给编辑 E08-5108A 的信。
DOI：
10.1016/j.ajog.2008.06.023
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发表时间：
2008
影响因子：
9.8
通讯作者：
Cuenco,KarenT
中科院分区：
文献类型：
--
作者：
Stewart,ElizabethA;Zhang,Jingmai;Cuenco,KarenT
我们感谢读者对我们发现肌瘤基因研究报告的有见地的评论，并欢迎讨论和验证我们的严重性算法在不同人群中的有效性(1)。不幸的是，子宫肌瘤研究界缺乏研究所需的许多工具，而子宫肌瘤共识会议也没有解决这个问题。因此，我们在研究开始时就建立了算法，并承认算法的改进可能会随着进一步的研究而发生。算法的每个元素都可能具有除疾病严重性以外的其他影响。例如，尽管早期发病通常被认为是疾病严重程度的良好指标和疾病遗传贡献的标志，但对于肌瘤来说，获得超声等诊断服务可能会发挥作用。然而，文献支持黑人女性患子宫肌瘤的年龄更早，在子宫切除术时疾病更严重，肌瘤摘除术的比率更高。因此，我们认为子宫切除术更多地反映了疾病的严重程度，而不是获得护理的机会，而忽略这一标准将低估疾病的严重程度。尽管如此，我们重新分析了忽略子宫切除术的数据以解决这个问题(参见表5和修订表4之外的数据)。严重程度和种族之间的基本关系仍然存在，即使排除了子宫切除作为严重程度的标准。然而，从剩余的更均匀的肌瘤样本估计的优势比和可信区间似乎对混杂变量的影响更敏感。
We appreciate the reader’s insightful comments regarding the report from our Finding Genes for Fibroid Study and welcome discussion and validation of our severity algorithm in diverse populations (1). Unfortunately, the uterine leiomyoma research community lacks many tools needed for research, and leiomyoma consensus conferences have not addressed this issue. Thus, we established the algorithm at the outset of the study and acknowledge that refinements in the algorithm may occur with further research.Each of the elements of the algorithm can have influences other than disease severity. For example, although early onset of disease is typically considered a good indicator of disease severity and a marker of genetic contribution to disease, for leiomyomas, access to diagnostic services such as ultrasound could play a role. However, the literature supports that black women develop fibroids at earlier ages, have more severe disease at the time of hysterectomy and have higher rates of myomectomy. Thus, we interpret a hysterectomy to be reflective of disease severity more than access to care, and omitting this criterion would underestimate disease severity. Nonetheless, we reanalyzed our data omitting hysterectomy to address this question (see data in Addition to Table 5 and Revised Table 4). The basic relationship between severity and ethnicity remains even after excluding hysterectomy as a criterion for severity. However, the odds ratio and confidence intervals estimated from the remaining more homogeneous myoma sample seem to be more sensitive to the effects of confounding variables.