Absence of protective effect of oral contraceptive use on the development of rheumatoid arthritis: a meta-analysis of observational studies
Absence of protective effect of oral contraceptive use on the development of rheumatoid arthritis: a meta-analysis of observational studies
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DOI：
10.1111/1756-185x.12413
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发表时间：
2014-09-01
影响因子：
2.5
通讯作者：
He, Jia
中科院分区：
文献类型：
--
作者：
Chen, Qi;Jin, Zhichao;He, Jia
目的：调查口服避孕药（OC）的使用与类风湿性关节炎（RA）发展之间的关联。方法：我们基于观察性研究进行了系统回顾和荟萃分析。酌情使用固定或随机效应模型获得汇总估计。进行了剂量反应荟萃分析、亚组分析、累积荟萃分析、敏感性分析和发表偏倚测试。结果：我们对 28 项研究进行荟萃分析，包括 18 项病例对照研究、3 项巢式病例对照研究和 7 项队列研究。在病例对照研究中，与从未使用过 OC 的人相比，曾经、当前和过去的 OC 用户患 RA 的风险分别为 0.69（95% 置信区间 [CI]，0.53-0.89）、0.71（95% CI，0.48-1.06）和 0.67（95% CI，0.44-1.01）。在前瞻性研究中，曾经、当前和过去使用 OC 的相应比值比 (OR) 分别为 1.00 (95% CI, 0.87-1.15)、0.93 (95% CI, 0.70-1.23) 和 0.93 (95% CI, 0.78-1.12)。累积荟萃分析显示，随着时间的推移，随着样本量的增加，合并的 OR 移至中线。 OC 使用与 RA 严重程度呈负相关（OR，0.41；95% CI，0.22-0.78）。研究数据的剂量反应荟萃分析显示，OC 使用与 RA 风险之间的关联与 OC 使用持续时间无关。结论：OC 使用对 RA 发病没有保护作用，但似乎可以预防进展为严重 RA。此外，随着OC成分的变化，OC的使用对RA风险的保护作用较低。最后，未发现 OC 使用与 RA 风险之间存在累积效应。
Aim: To investigate the association between oral contraceptive (OC) use and development of rheumatoid arthritis (RA).Method: We conducted a systematic review and meta-analysis based on observational studies. Summary estimates were obtained using fixed- or random-effects models as appropriate. Dose-response meta-analysis, subgroup analysis, cumulative meta-analysis, sensitivity analysis and publication bias tests were performed.Results: Our meta-analysis of 28 studies included 18 case-control, three nested case-control, and seven cohort studies. In case-control studies, the risk of RA of ever, current and past OC users was 0.69 (95% confidence interval [CI], 0.53-0.89), 0.71 (95% CI, 0.48-1.06) and 0.67 (95% CI, 0.44-1.01), respectively, compared to that of never OC users. In prospective studies, the corresponding odds ratios (ORs) of ever, current and past OC use were 1.00 (95% CI, 0.87-1.15), 0.93 (95% CI, 0.70-1.23) and 0.93 (95% CI, 0.78-1.12), respectively. A cumulative meta-analysis showed that the pooled ORs moved to the midline with an increase in sample size as years passed. There was an inverse association between OC use and severity of RA (OR, 0.41; 95% CI, 0.22-0.78). Dose-response meta-analysis of the study data revealed that the association between OC use and risk of RA was independent of duration of OC use.Conclusion: OC use has no protective effect on RA onset, but appears to prevent progression to severe RA. In addition, OC use has a lower protective effect on the risk of RA with change in OC composition. Finally, no cumulative effect was found between OC use and risk of RA.