The effects of postmenopausal hormone replacement therapy on hemostatic variables:: a meta-analysis of 46 studies
The effects of postmenopausal hormone replacement therapy on hemostatic variables:: a meta-analysis of 46 studies
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DOI：
10.1080/713603091
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发表时间：
2002-08-01
影响因子：
2
通讯作者：
Székåcs, B
中科院分区：
文献类型：
--
作者：
Acs, N;Vajo, Z;Székåcs, B
本研究的目的是总结和重新分析文献中的所有可用数据，以研究绝经后激素替代疗法（HRT）及其各种形式对止血变量的总体影响。通过Medline和Index Medicus检索文献、综述文章和个人通信确定研究。检查所有文章的参考文献列表，以查找其他研究。联系主要研究者，并要求其提供额外数据（如需要）。分别收集止血系统各因素的数据。包括以任何语言撰写的研究。使用标准的荟萃分析方法对每个研究集进行分析。共有48项研究的76个组符合分析条件。其中包括6119名使用HRT的妇女和24974名非使用者。被调查妇女的年龄为40-68岁。HRT与纤维蛋白原、凝血因子VIII、抗凝血酶III、蛋白质C和S水平显著降低相关，但与纤溶酶原水平显著升高相关。HRT与雌激素单独或联合孕激素，口服与透皮方案，不同的雌激素制剂和各种孕激素诱导显着不同的变化在许多情况下。总之，HRT与可以解释静脉血栓事件发生率增加的变化相关，也与可以解释有益血管效应的一些变化相关。令人惊讶的是，在许多情况下，孕激素的加入引起了有利的变化。此外，在某些情况下，透皮使用比口服方案具有更多的有益效果。
The aim of the study was to summarize and reanalyze all available data from the literature to study the overall effect of postmenopausal hormone replacement therapy (HRT) and its various forms on hemostatic variables. Studies were identified from literature searches by Medline and Index Medicus, review articles and personal communications. Reference lists of all articles were checked to find additional studies. Principal investigators were contacted and asked to provide additional data if required. Data were collected separately for each factor of the hemostatic system. Studies written in any language were included. Each collection of studies was analyzed using standard methods for meta-analysis. A total of 76 arms of 48 studies were eligible for analysis. This included 6119 women using HRT and 24 974 non-users. The age of investigated women was 40-68 years. HRT was associated with significantly decreased levels of fibrinogen, factor VIII, antithrombin III, and proteins C and S, but significantly increased plasminogen levels. HRT with estrogen alone or in combination with progestins, oral vs. transdermal regimens, different estrogen preparations and various progestins induced significantly different changes in many cases. In conclusion, HRT was associated with changes that could explain the increased rate of venous thrombotic events, and also with some changes that could account for beneficial vascular effects. Surprisingly, the addition of progestins induced favorable changes in many cases. Also, transdermal use was associated with more beneficial effects than oral regimens in some cases.